1. Jones SC. Let’s Talk About Autistic Autism Researchers. Autism in Adulthood;2021 (2021/09/01);3(3):206-208.

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2. Dwyer P, Acevedo SM, Brown HM, Grapel J, Jones SC, Nachman BR, Raymaker DM, Williams ZJ. An Expert Roundtable Discussion on Experiences of Autistic Autism Researchers. Autism in Adulthood;2021 (2021/09/01);3(3):209-220.

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3. Hume R, Burgess H. “I’m Human After All”: Autism, Trauma, and Affective Empathy. Autism in Adulthood;2020 (2021/09/01);3(3):221-229.

Academic literature has long associated autism with empathy deficits. Although this view has been attenuated over time to include only cognitive empathy, earlier perceptions continue to influence popular representations of autism and screening/diagnostic tools. As a result, empathetic autistics may be prevented from accessing diagnosis, and those with a diagnosis may experience internalized stigma or violence under the guise of therapy. There are, however, some autistics who do self-identify as having empathy difficulties. The purpose of this perspective piece was to first trouble the view of empathy ?deficit? as intrinsic within autism and consider alternative explanations and, second, to more deeply consider post-traumatic stress disorder (PTSD) as a factor for autistic people who self-identify as having empathy difficulties. Using both literature and author narrative, we argue that autistics are more likely to experience trauma and more vulnerable to developing PTSD, but less likely to receive a diagnosis of PTSD than nonautistics, as their PTSD-related symptoms, such as a lack of affective empathy, may be conflated with autism traits. Our main recommendations are: (1) future studies should investigate the possible interactions between autism, trauma, PTSD, and affective empathy, determining whether autistic adults with PTSD may recover affective empathy following therapy; (2) clinicians should look beyond autism if their client identifies a lack of affective empathy as part of their challenges; (3) and clinicians should adapt diagnostic procedures for PTSD in autistic adults to accommodate those with alexithymia, and exercise caution when using screening tools for autism, allowing empathic autistic adults to access diagnosis. Lay summary What is the topic of this article and why is it important? Many people believe that autism causes a lack of empathy. This belief is a problem because it denies the lived experience of autistic adults and makes them appear as less than human. It can also lead to violence against autistics, and it can mean that empathic autistic adults miss out on an autism diagnosis. As a result, they may not be able to access necessary supports. This situation may cause suffering for autistic adults. What is the perspective of the authors? R.H. is an autistic woman diagnosed in adulthood, who is often overwhelmed by too much empathy. She worked as an employment mentor for autistics and is now a PhD candidate researching relationship-building between autistic service users and their support professionals. H.B. is an autistic man diagnosed in childhood. As a teenager, he was also diagnosed with post-traumatic stress disorder (PTSD), a mental disorder caused by trauma. He did not feel any empathy for most of his life and felt very distressed by this, as he thought that it was a permanent trait of his autism. However, he started feeling empathy after trauma therapy and falling in love. Both authors believe that autistic adults can experience all forms of empathy. What arguments do the authors make? The authors cite research that shows other reasons which may explain the autism?empathy myth: (1) nonautistics may not recognize empathy in autistics because of mutual differences, (2) nonautistics may not believe autistics who say they have empathy because old research suggested that this is impossible, and (3) empathy research on autistics may not be correct because it uses inappropriate methods. The authors then suggest that unrecognized PTSD may be the reason why some autistics have difficulties in this area. They think so because PTSD can shut down emotional empathy. Autistics are more likely to experience trauma, more vulnerable to developing PTSD, and less likely to receive a diagnosis of PTSD than nonautistics. What do the authors recommend? 1.Researchers should work with autistic adults who report difficulty in feeling empathy to determine whether they may have PTSD and/or recover empathy after trauma therapy. 2.Professionals who support autistic adults should look beyond autism if their client dentifies a lack of empathy as part of their challenges. 3.Clinicians should treat questions relating to empathy with caution when using autism screening/diagnostic tools, allowing empathic autistic adults to access diagnosis and appropriate supports. How will these recommendations help autistic adults now or in the future? We hope that this will lead to better support for autistics who have PTSD, and less biased referral and diagnostic procedures for those who do not. We also hope that autistic adults might feel less stigma by suggesting PTSD, not autism, as the underlying cause if they have difficulties feeling empathy.

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4. Cai RY, Brown L. Cultivating Self-Compassion to Improve Mental Health in Autistic Adults. Autism in Adulthood;2020 (2021/09/01);3(3):230-237.

Many autistic adults experience poor mental health. Research has consistently shown that cultivating self-compassion is a promising approach to strengthening resilience in nonautistic adults. Self-compassion is a trainable skill that is associated with several mental health benefits, such as higher levels of happiness and well-being as well as lower symptoms of depression and anxiety. However, no studies to date have explored self-compassion in autistic individuals. We suggest that self-compassion may be a relevant target in mental health interventions for autistic adults without severe or profound intellectual disability. Self-compassion may improve mental health in autistic adults through directly modifying emotions (as an emotion regulation strategy) or its interactions with emotion regulation processes. Existing approaches to cultivating self-compassion include identifying and practicing self-compassionate behaviors, using self-compassionate thought records, and practicing self-compassion meditations. Before self-compassion approaches are implemented by autistic adults, it will be necessary to evaluate their role and effectiveness in mental health through carefully designed studies. We suggest that researchers should first study the relationship between self-compassion and mental health outcomes in autistic adults. Once researchers have established the connection, we can then begin to study self-compassion-based interventions for autistic adults. Relevant clinical considerations include identifying the autistic groups that self-compassion practices are suitable for, determining how autistic adults with and without mental health conditions can effectively practice self-compassion (on their own and with the support of clinicians), and evaluating existing self-compassion tools or designing new tools. It is also relevant for future research to identify the enablers and barriers to using self-compassion in autistic adults. Lay summary What is self-compassion? Self-compassion is when we: are friendly toward ourselves (kindness) are aware of our feelings and thoughts (mindful awareness) realize that everyone feels pain and makes mistakes (common humanity) What is the purpose of this article? We think that practicing self-compassion is important for autistic adults. No research has studied self-compassion in autistic individuals. We provide examples of how to improve self-compassion. We make recommendations for future research on self-compassion for autistic adults. What perspectives do the authors bring to this subject? We bring together different and unique perspectives in this article. One author is a researcher whose research has focused on emotion regulation and mental health in autistic youth and adults. The other author is a self-compassion researcher who is also a private practice clinical psychologist. We have practiced self-compassion and personally experienced the benefits of developing our self-compassion skills. We think that cultivating self-compassion has helped to improve our mental health and enriched our lives. Why is self-compassion important? Self-compassion is associated with a lot of positive aspects of life in nonautistic individuals. These positive aspects include greater happiness and well-being, and lower levels of depression and anxiety symptoms. How is self-compassion relevant to autistic adults? We know that as a group, autistic adults have poorer mental health when compared with nonautistic adults. That is, autistic adults experience higher rates of anxiety and depression. Research shows that practicing self-compassion in nonautistic people can improve their mental health. We think that cultivating self-compassion can also be helpful to autistic adults. What do the authors recommend? We suggest that cultivating self-compassion may improve the mental health of autistic adults. There are several ways to improve self-compassion. Self-compassion can be improved by identifying and practicing self-compassionate behaviors. For example, we can take a walk outside. Another way to improve self-compa sion is to record our thoughts. This can be performed by keeping a log of self-critical thoughts. We can also practice self-compassion by meditating. It is too early to tell how self-compassion should be practiced by autistic adults. Research is needed to observe if self-compassion is helpful to autistic adults. We made a series of recommendations for researchers and clinicians. Researchers should first check if there is a relationship between self-compassion and mental health in autistic adults. If more self-compassion is associated with better mental health, then researchers and clinicians can try and find out how we can improve autistic people’s self-compassion. How will these recommendations help autistic adults now or in the future? We hope that our recommendations will start a conversation on the relevance of self-compassion for autistic adults and lead to the development of self-compassion-related research programs that involve autistic adults. The ultimate goal is to improve the mental health and psychological well-being of autistic adults in the future.

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5. Gray S, Kirby AV, Graham Holmes L. Autistic Narratives of Sensory Features, Sexuality, and Relationships. Autism in Adulthood;2021 (2021/09/01);3(3):238-246.

Background: Research about the experience of sexuality and intimacy for autistic people has largely excluded the potential influences of autistic sensory features, which are highly common. The aim of this study was to explore how autistic sensory features influence autistic people’s experiences of sexuality and relationships, including the impact of low and high neurological threshold sensory patterns and regarding specific sensory modalities. Methods: Utilizing a qualitative approach, we explored autistic people’s perspectives about the influences of sensory features on their experiences of sexuality and relationships through existing publicly available narratives (5 books and 13 online forums containing messages from 72 unique usernames) and responses to an open-ended survey question (N?=?49). We used deductive coding based on Dunn’s model of sensory processing, as well as inductive coding to identify additional themes about autistic sensory features and sexuality. Results: Our findings indicated that sexual and relationship experiences were related to both sensory sensitivity and sensation seeking (i.e., low and high threshold sensory patterns) across several sensory modalities, including touch, sight, sound, and smell. Sensory features influenced autistic people’s sexual and relationship experiences in both positive and negative ways. Examined narratives revealed adaptations and strategies used by autistic people to enhance or enable engagement in sexual activity as well as implications for their sexual identity. Conclusions: Sensory features and their impact on the sexuality and relationship experiences of autistic people should be considered in clinical practice and educational programming. More research is needed to further understand the impact of autistic sensory features on experiences of sexuality and relationships, and to develop effective strategies to promote safe and satisfying engagement, when desired.

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6. Reuben KE, Stanzione CM, Singleton JL. Interpersonal Trauma and Posttraumatic Stress in Autistic Adults. Autism in Adulthood;2021 (2021/09/01);3(3):247-256.

Background: Many autistic adults report interpersonal traumas (IPTs) such as physical or sexual assault, which are often associated with posttraumatic stress and dissociation. Factors such as gender might make autistic individuals particularly vulnerable to experiencing IPT and negative posttraumatic symptoms. Methods: In this study, 687 self-identified autistic adults completed an online survey on their traumatic experiences and mental health symptoms. Results: Seventy-two percent of participants reported experiencing sexual assault, other unwanted or uncomfortable sexual experiences, or physical assault. Forty-four percent of participants met the criteria for posttraumatic stress disorder (PTSD), including 50% of those who had experienced IPT and 28% of those who had not (odds ratio?=?2.50; 95% confidence interval 1.74?3.60). IPT was also significantly associated with higher levels of psychoform (p?

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7. Park-Cardoso J, da Silva APS. Preference to Eat Alone: Autistic Adults’ Desire for Freedom of Choice for a Peaceful Space. Autism in Adulthood;2021 (2021/09/01);3(3):257-265.

Backgrounds: Autistic adults tend to prefer eating alone, which may result in further social isolation. This study aims to understand contexts of challenges autistic adults face when eating with other people outside home. Methods: We explored autistic subjectivities actively situated in eating environments. We conducted follow-up individual email interviews with autistic adults diagnosed with an autism spectrum disorder in adulthood (n?=?10) and autistic adults without a formal diagnosis (n?=?6), both of whom had participated in our prior online survey with Brazilian autistic adults. We used a thematic analysis to gain an in-depth understanding of challenging characteristics of social situations in the eating space. Results: To eat out comfortably, many participants did not talk while eating, chose places without sensory overload, chose places with eatable foods, ate at off-peak hours, used sensory tools, and/or left places when stressed. Participants developed these coping strategies to negotiate incongruences between their autistic personal characteristics and their physical environments. However, there were incongruences between the coping strategies and social contexts with codiners. Participants often could not freely use the strategies?both in work and in casual social situations. This lack of freedom of choice often resulted in feeling uncomfortable, sick, or having meltdowns during or after social dining. Because of these experiences, many participants decided to avoid social dining. Conclusions: The preference to eat alone in autistic adults may reflect their desire for freedom of choice to use coping strategies to eat in a peaceful food space. Creating a peaceful eating environment may be a feasible and humanistic approach to reduce unwanted aloneness and social isolation in autistic adults. Lay summary Why was this study done? Eating together with other people is a common activity to socialize and feel a sense of belonging. But autistic adults often prefer to eat alone, though they have a desire to socialize. What was the purpose of this study? To study challenging aspects of eating out with other people, to understand why some autistic adults prefer to eat alone. What did the researchers do? We interviewed adults who considered themselves to be on the autism spectrum. Of the 16 interview participants, 10 were formally diagnosed with an autism condition and 6 were not. They once participated in our online survey with Brazilian autistic adults. The interviews were done by email. We asked about eating places and experiences in eating out. We looked for the common themes over all the interview responses. What were the results of the study? When eating out alone, participants had strategies to eat comfortably. They could eat without talking, choose places without sensory overload, choose places with eatable foods, eat at off-peak hours, use tools such as earphones, or leave the place when stressed. However, they often could not freely do so in both work and casual social situations. They knew that their coping strategies would be considered inappropriate by others. For example, many participants felt pressured to talk while eating. Also, other people had different preferences for the times and places to eat from participants. It was difficult for participants to deal with the stressful environment without using their coping strategies. So, participants often felt uncomfortable, sick, or had meltdowns during or after eating out with others. For these reasons, many of them avoided eating out with others. What do these findings add to what was already known? Autistic adults’ preference to eat alone and difficulty in social situations involving eating have been understood as eating problems in autism. Our findings suggest that some dining companions reduce autistic persons’ freedom to eat in comfortable social and physical environments, and that the preference expresses a desire to have such freedom. What are potential weaknesses in the study? Because we used email interviews, the study did not include any parti ipant without access to email, and participants were all college educated, unlike most Brazilian adults with an autism diagnosis. How will these findings help autistic adults now or in the future? The findings will help autistic adults by letting others know ways that dining companions potentially reduce autistic persons’ freedom to eat comfortably and by inspiring them not to do so. The findings also suggest that society should focus on creating a peaceful eating environment instead of focusing on finding ways to treat autistic aloneness as if aloneness in autism is caused by problems inside of the autistic individual.

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8. Jose C, George-Zwicker P, Bouma A, Tardif L, Pugsley D, Bélanger M, Robichaud M, Gaudet J. The Associations Between Clinical, Social, Financial Factors and Unmet Needs of Autistic Adults: Results from an Observational Study. Autism in Adulthood;2021 (2021/09/01);3(3):266-274.

Background: Autism is a developmental disability that affects how individuals experience the world. Each Autistic individual experiences Autism in their own way, meaning that the level and type of assistance in their everyday lives vary widely. A shortage of programs and services tailored to Autistic adults exists worldwide, and the current gap between needs and services is likely to worsen as the growing number of Autistic children being diagnosed reach adulthood. This research sought to determine priorities in terms of health and social service needs of Autistic adults and to examine factors influencing whether or not these services were being received. Methods: Through a multistakeholder approach, researchers and Autistic adults codeveloped the Maritime Provinces Needs Assessment Survey and collected data from August 2017 to February 2018. The research team engaged Autistic adult partners, including one that was project colead, as full partners. We recruited survey respondents from three Maritime Provinces using mainly social media and local Autism networks. We used Poisson regression analyses to identify factors most strongly associated with the number of unmet needs reported by Autistic adults. Results: In total, 260 respondents completed the needs assessment survey: 77 self-reporting Autistic adults (aged 19?55 years), 87 Autistic adults (aged 18?63 years) whose information was provided by a proxy respondent, and 96 professionals working in the field of Autism. Autistic adults reported a mean of 2.1?±?1.5 (self-reported) and 2.8?±?2.1 (proxy-reported) services wanted but not received. The number of mental health and neurodevelopmental conditions, unemployment, and perception that government support is insufficient were positively related to unmet needs. Conclusions: Overall, the results of this study highlight considerable gaps among the support needs of Autistic adults. The identification of factors associated with a higher number of unmet needs helps identify potential subgroups requiring more attention. Lay summary Why was this study done? There is currently a shortage of programs and services for Autistic adults. Little is known about which services are most important to Autistic adults and which factors are associated with not receiving them. What was the purpose of this study? Our goals were (1) to determine the service need priorities of Autistic adults and (2) to examine factors associated with unmet needs. What did the researchers do? The researchers invited health professionals, service providers, policy makers, Autism advocates, as well as Autistic adults and caregivers of Autistic adults to participate as part of the project team. In the early phases of the project, we named an Autistic adult colead of the project. In doing so, we acknowledged that conducting relevant research on the Autistic adult community implies not only hearing their voices and concerns, but also providing an opportunity for equal say on the research itself. We adapted previously used surveys to align them with our objectives of focusing only on Autistic adults. We launched the survey online and promoted it using various media and community channels, many of them direct suggestions from Autistic adult team members. We made paper copies available and provided a phone number for those who needed support filling out the survey. What were the results of the study? More than 25% of Autistic adults identified 12 different services as priority needs. Autistic adults who (1) reported more mental health and neurodevelopmental conditions, (2) perceived their mental health as poor, or (3) felt that government support was insufficient were at greater risk of having unmet needs. What do these findings add to what was already known? Similar to previous studies, we found that the service needs of Autistic adults are varied, and that many are not receiving the services they consider a priority. Our study also went one step further by identifying factors that are associated with a higher number of unmet needs. What are potential weaknesses n the study? Our sample does not necessarily reflect the Autistic adult community as a whole, since we were unable to guarantee that hard-to-reach segments had access to our survey. In addition, we are unable to know how our results may change over time, as our survey was filled out on one occasion only. Finally, we did not measure Autistic traits and therefore are unable to estimate how different types of traits are associated with certain needs. How will these findings help autistic adults now or in the future? Our results may help bring attention to subgroups of Autistic adults who need more help receiving the services they require.

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9. Alkhaldi RS, Sheppard E, Burdett E, Mitchell P. Do Neurotypical People Like or Dislike Autistic People?. Autism in Adulthood;2021 (2021/09/01);3(3):275-279.

Background: This study investigated whether neurotypical individuals’ judgments that they dislike a person are more common when viewing autistic individuals than when viewing neurotypical individuals. Methods: Videos of autistic and neurotypical targets were presented to a group of perceivers (neurotypical adults) who were asked whether or not they liked each target and why. Results: It was more common for perceivers to ?like? neurotypical than autistic targets. The number of ?likes? each target received correlated highly with perceiver ratings of target social favorability. Perceivers cited perceived awkwardness and lack of empathy as being reasons for deciding they disliked targets. Conclusions: The findings shed light on how neurotypical people (mis)perceive autistic people. Such perceptions may act as a barrier to social integration for autistic people. Lay summary Why was this study done? Previous research has found that nonautistic people tend to form less positive first impressions of autistic people than they do of other nonautistic people. These studies have tended to present questions such as ?How trustworthy is this person?? or ?How attractive is this person?? along with ratings scales. However, although it is known that nonautistic people tend to give lower ratings on these scales, we do not know whether this amounts to a dislike for autistic people or just lower levels of liking. What was the purpose of this study? This study aimed to find out whether nonautistic people are less likely to say they like (and more likely to say they dislike) autistic people than other nonautistic people. What did the researchers do? The researchers presented videos of autistic and nonautistic people to other nonautistic adults. The people watching the videos were not told that some of the people in the videos were autistic. They were asked to decide whether they liked or disliked the person in each video and to say why they had made their decision by choosing from a range of options. What were the results of the study? Nonautistic people were more likely to say they disliked the person in the video if they were autistic, even though they did not know the diagnosis. The most common reasons for disliking a person was that they appeared awkward, and that they appeared to lack empathy. What do these findings add to what was already known? It was already known that nonautistic people tend to rate autistic people less positively on ratings scales. This study suggests that when making judgments?of either liking or disliking?they will sometimes go so far as to say they dislike autistic people. What are potential weaknesses in the study? All of the people in the video clips were male, while those watching the videos were mainly female. Therefore, we do not know whether the same observations would be made for perceptions of autistic females. The number of participants watching the videos was relatively small: a larger sample would give more reliable findings. How will these findings help autistic adults now or in the future? The findings add to previous research showing nonautistic people’s misperceptions of autistic people could be a barrier to social integration for autistic people. They highlight the need for interventions at the societal level aimed at reducing misunderstanding and promoting tolerance.

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10. Ashworth M, Crane L, Steward R, Bovis M, Pellicano E. Toward Empathetic Autism Research: Developing an Autism-Specific Research Passport. Autism in Adulthood;2021 (2021/09/01);3(3):280-288.

Autistic adults sometimes report negative experiences of research participation. People have developed passports or toolkits in other areas where community members report dissatisfaction (e.g., health care, criminal justice). We created a Research Passport that autism researchers and autistic adults could use to support the inclusion of autistic adults as research participants. We designed and developed the Research Passport via an iterative design process. First, we gathered ideas for a Research Passport via focus groups with autistic adults without an intellectual disability (ID) (n?=?9) and autism researchers (n?=?6; one of whom was autistic). We found that the Research Passport (1) was a useful idea, but not a panacea for all issues in autism research, (2) needed to be universal and flexible, and (3) could have a broad remit (e.g., to record scores on commonly used standardized tasks that could, with permission, be shared with different researchers). Next, we conducted a preliminary evaluation of a prototype Research Passport via usability testing in three ongoing research projects. Nine autistic participants without an ID provided feedback on the Research Passport (via a survey), as did three nonautistic researchers (via interviews). We found that the Research Passport (1) promoted positive participant?researcher relationships, (2) provided a structure and framework to support existing practices, and (3) needed to be adapted slightly to facilitate usability and manage expectations. Overall, the Research Passport was useful in promoting empathetic autism research. Further design and development of the Research Passport are warranted. Lay summary Why was this research developed? Autistic adults taking part in research do not always have good experiences. An autistic member on our team thought that a Research Passport could help improve people’s experiences. This idea was inspired by ?passports? or ?toolkits? that autistic people can use when visiting professionals such as doctors (so the doctor knows about the person and how to support them). What does the Research Passport do? The Research Passport lets autistic people tell researchers about themselves before taking part in a research study. Autistic people can decide how much, or how little, they tell the researcher. Autistic and/or nonautistic researchers can use the Research Passport to try and make sure that their autistic participants have good experiences when taking part in research. How did the researchers evaluate the Research Passport? First, nine autistic adults (who did not have an intellectual disability) and six autism researchers took part in group discussions. We asked what they thought about our Research Passport idea and what it should include. We made a Research Passport mock-up based on these discussions. Nine autistic participants who did not have an intellectual disability used the mock-up in one of three university research projects. Autistic participants completed a survey to tell us good and not-so-good things about the Research Passport. Also, we interviewed three researchers about using the Research Passport (asking what they liked and what could have been better). What were the findings? Autistic adults and researchers involved in designing the Research Passport thought the Research Passport (1) could be useful but could not solve all problems in autism research, (2) needed to be suitable for many different people, and (3) could have many different benefits (e.g., collecting participants’ scores on tests that researchers use a lot, so participants do not have to keep doing the same tests each time they take part in a new research study). Autistic adults and researchers used the Research Passport in ongoing studies and told us that it (1) led to good relationships between participants and researchers, (2) helped researchers make sure that the way they did their research was acceptable, and (3) was useful. However, participants need to be told what the Research Passport can/cannot help them with. What were the weaknesses of this projec ? This study involved a small group of autistic adults and researchers, and the results may not be the same with autistic adults and researchers who have different needs. Also, participants said the Research Passport was not very easy to complete, and a bit long. We need to change the Research Passport so that a wider range of autistic people (like those with intellectual disability) can use it. What are the next steps? The Research Passport needs to be professionally designed so it is easier to be used by a wider range of autistic people. A bigger evaluation of the Research Passport could allow us to test it with more participants and in more research studies. How will this work help autistic adults now or in the future? Using the Research Passport could, with some changes and alongside other supports, improve the experience of autistic adults taking part in research.

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