Autism in Adulthood – 3-4 – December 2021

Revues de sommaires

1. Shogren KA, Mosconi MW, Raley SK, Dean EE, Edwards B, Wallisch A, Boyd B, Kiblen JC. Advancing the Personalization of Assessment and Intervention in Autistic Adolescents and Young Adults by Targeting Self-Determination and Executive Processes. Autism in Adulthood;2021 (2021/12/01);3(4):289-299.

As autistic adolescents and young adults navigate the transition to adulthood, there is a need to partner with them to identify strengths and needed supports to enable goal-directed actions. This article conceptually integrates research on self-determination, defined by Causal Agency Theory, and executive processes in autism to provide direction for future research and practice. We describe how integrating research on self-determination and executive processes could enable autistic adolescents and young adults to be engaged in the process of assessing executive processes and self-determination. We discuss how this can better inform personalization of supports for self-determination interventions by focusing on support needs related to executive processes, including inhibitory control and cognitive flexibility, from a strengths-based perspective. We discuss how this can enable self-determination interventions that promote outcomes aligned with the values of the autistic community.

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2. Flower RL, Dickens LM, Hedley D. Barriers to Employment: Raters’ Perceptions of Male Autistic and Non-Autistic Candidates During a Simulated Job Interview and the Impact of Diagnostic Disclosure. Autism in Adulthood;2021 (2021/12/01);3(4):300-309.

Background: Autistic individuals face low rates of engagement in the labor force. There is evidence that job interviews pose a significant barrier to autistic people entering the workforce. In this experimental study, we investigated the impact of diagnostic disclosure on decisions concerning candidate suitability during job interviews. Methods: Participants (n?=?357; 59% female) from the general population rated 10 second ?thin slices? of simulated job interviews of one male autistic and one male non-autistic candidate. In a between-subjects design, autism diagnostic disclosure was manipulated (None, Brief, and Detailed), so that neither (?None? condition) or both (?Brief? and ?Detailed? conditions) candidates were labeled as autistic before the simulated interview (with additional information provided about autism in the ?Detailed? condition). Results: Results for 255 non-autistic raters (57.6% female) were analyzed. Participants gave more favorable ratings of first impressions, employability, and endorsement for candidates labeled as autistic, irrespective of the actual diagnostic status (i.e., autistic and non-autistic) of the individual. Participants rated non-autistic candidates more favorably on all employment measures (first impressions, employability, and endorsement), and ?hired? non-autistic candidates more frequently, compared with autistic candidates. Providing additional information about autism did not result in improved ratings. However, the discrepancy between autistic and non-autistic people chosen for ?hire? was reduced when more information was provided. Conclusions: Although we found some support for the benefits of diagnostic disclosure during a simulated interview, these benefits were not restricted to autistic candidates and may be a positive bias associated with the diagnostic label. Contrary to our predictions, providing information about autism in addition to the diagnostic label did not have an overall impact on results. More research is required to determine whether benefits outweigh any risks of disclosure for autistic job candidates, and whether training interviewers about autism might improve employment outcomes for autistic job seekers.

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3. Nolte K, Fletcher-Watson S, Sorace A, Stanfield A, Digard BG. Perspectives and Experiences of Autistic Multilingual Adults: A Qualitative Analysis. Autism in Adulthood;2021 (2021/12/01);3(4):310-319.

Background: The combined experience of autism and bilingualism is poorly understood, leading to poor support for autistic people in multilingual environments or those interested in languages. While most available studies focus on the language and cognitive profiles of autistic bilinguals, or on the experiences of parents, little is known about the lived experiences of autistic multilinguals. Methods: To address this question, this study examined the impact of autism and multilingualism on the lives of 54 autistic multilingual adults who completed an online survey assessing the profiles of autistic bi- and multilinguals. We conducted a thematic analysis of responses to the survey’s open-ended questions to explore motivations for learning languages and the perceived benefits of being both autistic and multilingual. Results: There was a wide range of language profiles in the sample, with various levels of proficiency, ages of acquisition, and learning environments. Respondents felt that being autistic can both positively and negatively influence language learning. They reported various motivating factors for the acquisition of multiple languages, including social aspects and a predisposition for language learning. Respondents reported many benefits of multilingualism, such as educational, employment, or leisure opportunities; social skills and understanding of other people; self-confidence in their own abilities; and relationships with family, friends, and the worldwide autistic community. Conclusions: Unlike previous work with autistic multilinguals involving case studies, the larger sample involved here offers valuable insight into the profiles and experiences of this overlooked population. Importantly, autistic people can experience numerous benefits from multilingualism. These findings will have implications for language education practices as well as for multilingual families and the practitioners who support them.

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4. Bradley L, Shaw R, Baron-Cohen S, Cassidy S. Autistic Adults’ Experiences of Camouflaging and Its Perceived Impact on Mental Health. Autism in Adulthood;2021 (2021/12/01);3(4):320-329.

Background: Camouflaging (also referred to as ?masking?) is a commonly reported strategy used by autistic adults in everyday life to help them cope in social situations. Autistic adults report that camouflaging can have a devastating effect on mental health and well-being, yet little is known about the lived experiences of camouflaging and its impact. Methods: We designed an online survey in partnership with autistic adults, to explore the experiences of camouflaging and its impact on mental health. Participants self-reported the lifetime experience of camouflaging, where they camouflaged the frequency and length of time spent camouflaging. Four open questions allowed participants to elaborate their answers to the closed questions on frequency and length of time, and subsequently any positive and negative aspects of their experience of camouflaging. Two hundred seventy-seven autistic adults who self-reported a diagnosis of an autism spectrum condition (128 female, 78 male) or self-identified as autistic (56 female, 15 male) were included in the analysis of qualitative responses to the open-ended questions. Findings: We thematically analyzed participant answers from the open questions. Three main themes emerged. First, ?dangers of camouflaging? described how the amount of time spent camouflaging led to exhaustion, isolation, poor mental and physical health, loss of identity and acceptance of self, others’ unreal perceptions and expectations, and delayed diagnosis. Second, ?positive aspects of camouflaging? included greater access to social spaces, and protection from harm. Camouflaging was, therefore, seen as necessary to survive in a world designed for the neurotypical majority. Third, autistic adults described being diagnosed and accepted for who they are as reasons for ?why I don’t need to camouflage like I used to.? Conclusions: Time spent camouflaging is what seems to be most damaging for the participants’ mental health. The main reason reported for needing to spend so much time camouflaging is society’s lack of awareness and acceptance of autism.

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5. Miller D, Rees J, Pearson A. “Masking Is Life”: Experiences of Masking in Autistic and Nonautistic Adults. Autism in Adulthood;2021 (2021/12/01);3(4):330-338.

Background: Autistic masking is an emerging research area, and so far, research has suggested that masking has a negative effect on autistic people. Masking relates to general social practices (such as identity management) and is often driven by stigma avoidance. Many nonautistic people also experience stigma that might drive them to suppress aspects of their identity. In this study, we investigate similarities and differences in experiences of masking in autistic and nonautistic people. Methods: We conducted an online survey about experiences and views of masking in autistic people (n?=?144), neurodivergent people without an autism diagnosis (n?=?49), and neurotypical people (n?=?45) recruited via social media. We used thematic analysis to analyze responses to open-ended items about masking, using an inductive approach, at a semantic level, with a critical realist paradigm. Results: Thematic analysis revealed that some aspects of masking are shared across autistic and nonautistic people, such as utilizing mimicry of others as a social strategy or feeling exhausted from masking. All groups reported that masking made them feel disconnected from their true sense of identity and had a negative effect on them. Other aspects of masking seemed more specific to autistic people, such as sensory suppression, and masking leading to suicidal ideation. Conclusions: Our findings suggest that many aspects of masking are experienced across different neurotypes and are likely related to outside perceptions of difference and stigma. It is likely that what we call ?autistic masking? is similar to other forms of stigma management previously theorized. Some aspects of masking do seem more specific to the autistic neurotype (e.g., suppression of stimming) and should be explored further to provide support for autistic people recovering from the negative impact of masking.

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6. Adams D, Stainsby M, Paynter J. Autistic Mothers of Autistic Children: A Preliminary Study in an Under-Researched Area. Autism in Adulthood;2021 (2021/12/01);3(4):339-346.

Background: Much research exists on the mental health and well-being of parents of autistic children; however, parents who are themselves autistic have received little attention in the literature. We aimed to compare parenting stress and family outcomes in mothers who do, and do not, identify as being autistic. Methods: We matched 20 mothers who identified as being autistic to 20 mothers who do not identify as being autistic on variables associated with parental well-being: child externalizing behaviors, score on the Social Communication Questionnaire, child adaptive functioning, family income, and child and maternal age. All mothers had at least one autistic child. Outcome variables were family outcomes (Family Outcome Survey-Revised) and parenting stress (Parent Stress Index 4-Short Form). Paired t-tests were used to compare scores between the two samples. Results: There were no statistical differences in achievement of family outcomes between the autistic and nonautistic mothers. The small effect size on Family Outcome 4 may suggest that autistic mothers develop stronger support networks, but as a statistical comparison for this item nonsignificant, this should be interpreted with caution. Autistic and nonautistic mothers reported equally high levels of parenting stress. Conclusions: Further research with larger samples is required to explore this under-researched area. Such research would be of value to understand any interaction between parental and child autism characteristics, well-being, and parenting. This could then inform development of supports, which can be tailored for each child’s family.

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7. Hand BN, Gilmore D, Harris L, Darragh A, Hanks C, Coury D, Moffatt-Bruce S, Garvin J. “They Looked at Me as a Person, Not Just a Diagnosis”: A Qualitative Study of Patient and Parent Satisfaction with a Specialized Primary Care Clinic for Autistic Adults. Autism in Adulthood;2021 (2021/12/01);3(4):347-355.

Background: Autistic adults have complex physical and mental health care needs that necessitate specialized approaches to health care. One promising approach is to embed providers with specialized training or specialty clinics for autistic adults within general primary care facilities. We previously found that autistic adults who received their health care through one specialty clinic designed with and for autistic adults had better continuity of care and more preventive service utilization than national samples of autistic adults. Objective: To characterize factors that increased or decreased satisfaction with health care received through a specialty clinic for autistic adults. Methods: We conducted 30- to 60-minute semi-structured interviews with autistic adults (N?=?9) and parents of autistic adults (N?=?12). We conducted an inductive thematic analysis using a phenomenological approach. Results: Factors that increased participants’ satisfaction included: (1) receiving personalized care from the provider; (2) spending quality time with the provider; and (3) having strong, positive patient?provider relationships. Factors that decreased participants’ satisfaction included: (1) lack of access to services due to scarcity of trained providers; (2) difficulty at times communicating with the provider; and (3) system-level barriers such as policies, practices, or procedures. Conclusions: Our findings highlight the importance of providers using personalized approaches to care that meet patients’ sensory and communication needs and spending quality time with patients to establish strong, positive patient?provider relationships. Our findings also underscore the critical scarcity of health care providers who are trained to deliver care for the growing population of autistic adults.

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8. Bross LA, Travers JC, Huffman JM, Davis JL, Mason RA. A Meta-Analysis of Video Modeling Interventions to Enhance Job Skills of Autistic Adolescents and Adults. Autism in Adulthood;2021 (2021/12/01);3(4):356-369.

Background: Autistic transition-aged youth and young adults face many societal barriers to competitive integrated employment (CIE). Existing evidence-based practices (EBPs) for autistic individuals, such as video modeling (VM), may be a viable on-the-job training method to enhance employment experiences and outcomes for this population. Methods: The purpose of this meta-analysis was to synthesize VM studies to teach job skills for autistic individuals. We applied the Council for Exceptional Children’s (CEC) Standards for Evidence-Based Practices in Special Education to evaluate the methodological rigor of included studies using a weighted coding scheme. We further evaluated methodologically sound studies by calculating an omnibus Tau-U effect size. Results: Twenty articles met our inclusion criteria, and 11 of those studies were classified as methodologically sound according to the CEC’s criteria. Results indicate that VM is an EBP to improve job skills of autistic individuals. The overall effect size for methodologically sound studies was strong (0.91), but most studies occurred in contrived or school-based employment settings rather than CIE settings in the local labor market. Conclusions: Employers, transition professionals, and related service providers can consider VM a viable method to teach job skills to autistic employees. However, additional research conducted in CIE settings is needed to better understand the effects of VM in contexts where autistic employees earn regular wages.

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