1. Al Ansari M, Edwards C, Gibbs V. « Living Independently Means Everything to Me »: The Voice of Australian Autistic Adults. Autism Adulthood;2024 (Sep);6(3):312-320.

BACKGROUND: Despite the desire of many autistic adults to live independently, recent studies suggest that only about one in six autistic adults do. This includes living alone, with a partner, or with friends. This is a rate that is lower than adults with other disabilities. Existing studies from other countries have explored the potential barriers to independent living, with very few exploring the actual experiences of autistic adults. To the best of our knowledge, there have been no published studies exploring the firsthand moving out experiences of autistic adults globally and none that have explored their independent living experiences in Australia. METHODS: Autistic adults with independent living experience in Australia were invited to partake in an interview to understand their moving out and independent living experiences. Interviews were held virtually, audio recorded, and transcribed. Transcriptions were coded in NVivo and thematically analyzed. RESULTS: A total of 11 autistic adults were interviewed (aged 21-50 years). Three key themes were derived from the interviews. Autistic adults perceived independent living as important to have their own space with added autonomy and control (Theme 1). However, autistic adults shared that the moving out process and independent living comes with many challenges, and currently supports are limited (Theme 2). Nine of the 11 participants were diagnosed as adults, and they shared the importance of diagnosis and how an earlier diagnosis may have influenced their choice of accommodation and living arrangements (Theme 3). CONCLUSIONS: Findings from this study reiterate the importance of independent living to autistic adults and shed light on the challenges of transitioning to independent living. It further adds to the growing literature about the importance of early diagnosis on later life choices. Better pathways toward adult diagnosis and the provision of supports for the moving out process would be useful to ease transition to independent living for autistic adults. Why is this an important issue? Many autistic youth and adults say that they want to live on their own, with friends, or with a partner. However, many still live with their family. Most of the research in this area talks about what autistic people and their parents think might happen when they move out of home. Yet there is not much that has explored the experiences of autistic adults who have moved out already to live independently, and none within Australia. This is important, as we need to understand their experiences so we can make them better. What was the purpose of this study? The researchers wanted to understand the moving out and independent living experiences from autistic adults in Australia. What did the researchers do? A researcher conducted 11, one-on-one interviews with autistic adults living independently in Australia. These interviews were online or over the phone depending on what participants wanted, and ranged from ∼27 to 105 minutes. Autistic adults were asked questions about when they moved out and their current independent living experiences. What were the results of the study? We looked at what participants told us and created three ideas that described the independent living experiences of autistic adults in Australia. These ideas included how the control/choice/freedom/space are important, that some parts are hard, and that people may have made different living decisions if they were diagnosed at a younger age. What do these findings add to what was already known? These findings help show how important it is to the autistic community to live independently and that the challenges in Australia are similar to other countries. Our findings also suggest that if people realized that they were autistic earlier in their lives, they may have better understood themselves and followed living situations that better suited their needs. What are potential weaknesses in the study? This was quite a small group of autistic adults, where the majority identified as female and were highly educated. How will these findings help autistic adults now or in the future? By better understanding the moving out and independent living experiences of autistic adults in Australia, these findings can help identify areas of support (such as finding a good home and help with money). It also provides further support to improve the diagnostic processes for autistic adults, as diagnosis can help adults better understand themselves and find homes suited to them. eng

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2. Anderson C, Hochheimer S, Warren Z, Butter E, Hyman SL, Wang H, Wallace L, Levato L, Martin R, Stephenson KG, Norris M, Jacqueline W, Smith T, Johnson CR. Comparative effectiveness trial: Modular behavior approach for young autistic children compared to comprehensive behavioral intervention. Autism Res;2024 (Oct 7)

This 24-week single-blind trial tested a modular approach for young autistic children (MAYAC) that was delivered for fewer hours per week and modified based on child progress and parental input compared to comprehensive behavioral intervention treatment as usual (CBI, TAU). Participants were autistic children, ages 18-60 months of age. MAYAC was initially 5 h of intervention per week, one of which was parent training and the other four direct therapy focusing on social communication and engagement, but additional modules could be added for up to 10 h per week. Comprehensive behavior intervention was delivered for ≥15 h per week. Outcome measures included the Vineland Adaptive Behavior Scales; VABS, the Ohio Autism Clinical Improvement Scale – Autism Severity; OACIS – AS and the Pervasive Developmental Disorder Behavior Inventory – Parent; PDDBI-P. Implementation and parent satisfaction measures were also collected. Fifty-six children, mean age of 34 months, were randomized. Within-group analysis revealed significant improvements from baseline to week 24 for both MAYAC (p < 0.0001) and CBI, TAU (p < 0.0001) on the VABS. The noninferiority test was performed to test between group differences and MAYAC was not inferior to CBI, TAU on the VABS (p = 0.0144). On the OACIS - AS, 48.0% of MAYAC and 45.5% of CBI were treatment responders there were no significant changes on the PDDBI-P, for either group. Treatment fidelity was high for both groups (>95%) as was parent satisfaction. Findings from this small trial are promising and suggest MAYAC may be an alternative for some young autistic children and their families to CBI, TAU.

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3. Andrzejewski T, Gomez Batista S, Abu-Ramadan T, Breitenfeldt KE, Tassone AU, Winch A, Rozek DC, McDonnell CG. Examining Rates of Traumatic Events and Posttraumatic Stress Disorder Symptoms Among Autistic Adults. Autism Adulthood;2024 (Sep);6(3):374-387.

BACKGROUND: Autistic adults experience high rates of traumatic events and posttraumatic stress disorder (PTSD) symptoms. However, less is known about how autistic adults experience (i.e., by directly experiencing, witnessing, and/or learning about) distinct types of traumatic events (e.g., social, nonsocial traumas). Little research has considered whether the four-factor structure of PTSD symptom domains (e.g., avoidance, intrusions, hypervigilance, negative mood/cognition) can be applied for autistic adults. Lastly, understanding how demographic factors (e.g., gender, race/ethnicity) relate to rates of traumatic events and symptoms among autistic adults is critical for understanding disparities relating to PTSD. Therefore, the current study aims to examine self-reported traumatic events and PTSD symptoms, and identify associations with demographic factors, among autistic adults. METHODS: Participants included 276 autistic adults and a nationally representative sample of 361 nonautistic adults who completed online measures, including the Life Events Checklist for DSM-5, Posttraumatic Stress Disorder Checklist for DSM-5 (PCL-5), Autism-Spectrum Quotient-Short, and Patient Health Questionnaire-4. Analyses focused on evaluating group differences in traumatic events and symptoms and considered associations with demographic factors. RESULTS: Autistic adults reported significantly higher rates of directly experiencing, witnessing, and learning about traumatic events than nonautistic adults, including more interpersonal events (e.g., physical assault, sexual assault) and fewer transportation accidents than nonautistic adults. Autistic adults also reported significantly higher levels of all PTSD symptom clusters than nonautistic adults. A confirmatory factor analysis and follow-up invariance analyses of the PCL-5 revealed that the four-factor Diagnostic and Statistical Manual of Mental Health Disorders, Fifth Edition (DSM-5) PTSD symptom subscale structure was equivalent across groups of autistic and nonautistic adults. CONCLUSION: Autistic adults experienced more traumatic events and PTSD symptoms overall, particularly more interpersonal traumas and hyperarousal and negative mood/cognition symptoms than nonautistic adults. Future research should examine outcomes of trauma exposure, identify protective factors, and examine efficacy of trauma-focused treatments for autistic individuals, in partnership with autistic adults. Why is this an important issue? Autistic people experience more traumatic events and more symptoms of posttraumatic stress disorder (PTSD) than nonautistic people. Little is known about if PTSD symptoms can be measured similarly among autistic and nonautistic people. Studying trauma, PTSD, and how PTSD is measured is helpful for developing useful resources for autistic adults who experience trauma and PTSD. What was the purpose of this study? We wanted to compare how autistic adults and nonautistic adults experience traumatic events and symptoms of PTSD. What did the researchers do? Two-hundred seventy-six autistic adults and 361 nonautistic adults completed questionnaires through an online research platform. We used the Life Events Checklist for DSM-5 (LEC-5) to ask about traumatic events that adults may have experienced directly, witnessed, learned about, or experienced as part of one’s job. We used the Posttraumatic Stress Disorder Checklist for DSM-5 (PCL-5) to measure PTSD symptoms, including intrusions (thinking about trauma when one does not want to), avoidance (staying away from thoughts or rteminders of trauma), hyperarousal (feeling restless, having difficulty concentrating), and negative thoughts and feelings (feeling depressed, thinking the world is unsafe). Participants also filled out the Autism-Spectrum Quotient-Short to measure autistic traits and the Patient Health Questionnaire-4 to measure depression and anxiety. The researchers looked to see if the PCL-5 questionnaire works differently when it is used by autistic and nonautistic adults. What were the results of the study? More traumatic events directly happened to autistic adults than nonautistic adults. Autistic adults also witnessed and learned about more traumatic events. Autistic adults experienced more interpersonal events than non-autistic adults (such as physical assault, sexual assault, other unwanted sexual experiences, and severe human suffering). They experienced fewer transportation accidents than non-autistic adults. Autistic adults had more PTSD symptoms than nonautistic adults, including more overall symptoms and more symptoms in each of the PTSD symptom categories (intrusions, avoidance, hyperarousal, negative thoughts and feelings). Also, the PCL-5 questionnaire measures PTSD symptoms similarly among autistic and nonautistic adults. What do these findings add to what was already known? Our results are consistent with other research showing more traumatic events for autistic than non-autistic people, and also show higher rates of seeing or learning about traumatic events. We also contribute new information about using the PCL-5 with autistic adults, which can help clinicians and other researchers. What are potential weaknesses in the study? This study only asked autistic adults about traumatic events on the LEC-5, which does not include other traumatic events such as bullying nor sensory trauma. It is possible that autistic adults interpreted the questions differently than non-autistic adults. More than half of our participants were White, so we know less about trauma experiences for autistic people from other racial and ethnic backgrounds. How will these findings help autistic adults now or in the future? The findings of this study provide useful information about how autistic adults experience traumatic events and PTSD symptoms, which is important for improving support services for autistic adults. eng

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4. Braüner T, Ghosh A, Ghosh S. Understanding responses of people with ASD in diverse reasoning tasks: A formal study. Cogn Process;2024 (Oct 7)

Recent studies have shown that in some reasoning tasks people with Autism Spectrum Disorder perform better than typically developing people. This paper compares four such tasks, namely a syllogistic task, two decision-making tasks, and a task from the heuristics and biases literature, the aim being to identify common structure as well as differences. In the terminology of David Marr’s three levels of cognitive systems, the tasks show commonalities on the computational level in terms of the effect of contextual stimuli, though an in-depth analysis of such contexts provides certain distinguishing features in the algorithmic level. We also make some general remarks on our approach, so as to set the stage for further studies in the area which could provide a better understanding of the reasoning process of ASD individuals.

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5. Glackin A, Pearson A, Davis R. « You Are the Expert of Your Own Experience »: A Thematic Analysis of Experiences of Autism and Gender Diversity in Adulthood. Autism Adulthood;2024 (Sep);6(3):300-311.

BACKGROUND: Autistic people are more likely to report gender dysphoric traits, and transgender and gender-expansive individuals frequently report higher scores on self-report measures of autistic traits. Despite the clear association between autism and gender diversity, there is a dearth of qualitative research exploring the lived experiences of autistic adults. METHODS: This study contributes to the evidence base by exploring the strengths and challenges of the intersectional experiences of autism and gender diversity in adulthood. Twelve transgender/gender-expansive autistic people participated in an online semi-structured interview or an open-ended survey, and reflexive thematic analysis was used to analyze the data. RESULTS: Three main themes were identified: (1) Navigating a gender journey, (2) The impact of social context on self, and (3) Provision of health care. CONCLUSION: The findings highlight the importance of acknowledging the unique experiences of being both an autistic and transgender/gender-expansive person to further understand the intersection between autism and gender diversity. Why is this an important issue? Qualitative research investigating the experiences of autistic people who identify as transgender and gender-expansive (TGE) is limited. However, the overlap between autism and gender diversity is evident. Transgender and gender-expansive people often score higher on measures of autistic traits, and autistic people score higher on measures of gender dysphoric traits. The lack of qualitative research investigating this overlap needs to be addressed to understand how individuals navigate being an autistic transgender/gender-expansive (ATGE) adult. What was the purpose of this study? We aimed at identifying the experiences and needs of an underserved community. The questions developed for this study aimed at capturing an understanding of the intersection of autism and gender diversity in adulthood, beyond gender dysphoria. By focusing on the needs and preferences of ATGE adults within health care, this study aimed at informing future policy, research, and clinical practice. What did the researchers do? We recruited 12 ATGE adults through social media. Participants answered questions about their experiences of being an ATGE adult through a semi-structured interview or an online open-ended survey. We then analyzed their interviews and identified patterns and themes in what they said. All the data was then combined to tell the story of this sample of ATGE adults. What were the results of the study? The adults in this study said that exploring their gender identity as an autistic person was a different journey to neurotypical cisgender people. Some described how being autistic had led them to differences in understanding gender, and many participants described how being a part of two marginalized groups led to increased discrimination and invalidation. Despite this, participants described a strong desire to be their authentic selves regardless of societal expectations. Having access to friendships with ATGE peers was useful for reducing isolation and providing a safe outlet for discussion. These friendships were essential, as many spoke about their strained relationships with familial and romantic/intimate bonds. Participants described their frustration with the health care system when working with ATGE adults and expressed their desires for good health care. What do these findings add to what was already known? The study adds to our understanding of the experiences of ATGE adults; in particular, the impact that being ATGE can have on intimate/romantic relationships. The ATGE adults also describe increased resilience against the effects of dual marginalization. Some participants also felt that their understanding of their gender identity was not impacted by being an autistic person. What are potential weaknesses in the study? A key weakness of this study was the lack of ethnic/racial diversity of the sample. The use of qualitative surveys could be considered a potential weakness. However, by offering participation through an online semi-structured interview or an online open-ended survey, this study promoted the inclusion of autistic adults in research. How will these findings help autistic adults now or in the future? Our findings show that it is important for medical providers and academics to listen to ATGE adults. Their voices should also be highlighted within academic research to further understand the overlap between autism and gender diversity. Participants said that they were happy that people were talking and willing to learn more. This helped them understand themselves more, which, in turn, can help other autistic people to understand themselves. eng

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6. Graham J, Rodgers J, Cassidy S. Why Are Autistic People More Likely to Experience Suicidal Thoughts? Applying the Integrated Motivational-Volitional Model with Autistic Adults. Autism Adulthood;2024 (Sep);6(3):272-283.

BACKGROUND: Autistic people are at considerably greater risk of suicidality than non-autistic people, and the reasons behind this are not fully understood. Current suicide theories may be useful to help further our understanding of the mechanisms behind autistic suicidality. We aimed to test the key predictors of suicidal ideation-defeat and entrapment-as described in the integrated motivational-volitional (IMV) model of suicide behavior, in an autistic group. We also looked to extend the IMV model by including autism-related constructs of camouflaging and intolerance of uncertainty (IU). METHODS: We recruited 374 autistic adults from the community (female 42.5%; 18-63 years of age), who completed a cross-sectional online survey between August 2020 and January 2021. We collected data on lifetime suicidality, depression symptoms, defeat, entrapment, camouflaging, and IU. RESULTS: We found that entrapment significantly mediated the relationship between defeat and suicidal ideation. Camouflaging and IU were not found to moderate this pathway but were found to be significantly associated with suicidal ideation. CONCLUSIONS: We found that entrapment mediates the relationship between defeat and suicidality in autistic adults. This is consistent with the predictions in the motivational phase of the IMV model of suicidal behavior, suggesting that this model is useful for understanding autistic suicidality. We did not find evidence that camouflaging and IU act as moderators within the mediated model. Nevertheless, there is some evidence that camouflaging and IU are worthwhile constructs to be aware of for future work researching autistic suicidality. Why is this an important issue? Autistic people are more likely to think about and die by suicide than non-autistic people. Understanding why autistic people experience suicidal thoughts and behaviors could help develop better suicide prevention strategies. What was the purpose of this study? We wanted to examine how well an existing model for understanding suicide applies to autistic people. We explored the integrated motivational–volitional (IMV) model of suicide. This model suggests that feeling entrapped in an impossible situation with no escape route and feeling defeated by life increase the risk of experiencing suicidal thoughts in non-autistic people. We wanted to know whether feeling entrapped and defeated are also relevant for autistic people experiencing suicidal thoughts. We also wanted to observe whether the IMV model could be tailored to include experiences that are more relevant to autistic people. Therefore, we also looked at camouflaging, or masking autistic traits to fit in social situations, and intolerance of uncertainty as potential contributors to suicidal thoughts in autistic adults. What did the researchers do? We recruited 374 autistic adults (aged 18–63 years) to complete online questionnaires measuring the feelings of defeat, entrapment, camouflaging, intolerance of uncertainty, and suicidal thoughts and behaviors. What were the results of this study? Our results suggest that autistic adults who feel defeated also tend to feel entrapped and suicidal. These results support the IMV model in autistic adults. Autistic adults who reported high levels of camouflaging or intolerance of uncertainty were more likely to score highly on the measure of suicidal thoughts and behaviors. However, camouflaging and intolerance of uncertainty alone were not able to predict suicidal thoughts in autistic adults. What do these findings add to what was already known? Our study is the first to explore this well-supported model of suicide in autistic adults. Our findings provide some insight into some of the reasons underpinning suicidality in autistic adults. This is important as lots of previous research has focused on what the problem is, that is, reporting rates of suicidal thoughts and behaviors. Our study also identifies a number of questions to pursue in future work and shows that it is important for researchers to include experiences that are relevant and important to autistic adults. What are the potential weaknesses of this study? Data were collected at one time point, and therefore, it is not possible to comment on causal relationships across the information collected. We did not ask participants to confirm their diagnosis or complete an autism screening tool. This was driven by a wish to respect self-identification as well as in response to feedback on completing screening tools. The questionnaires we used were not all developed or tested for use in autistic groups. We did not measure socioeconomic status, which is commonly associated with suicide risk. How will these findings help autistic adults now or in the future? Understanding why autistic people are at risk of suicide is important for informing clinical approaches to care and support as well as informing suicide prevention strategies. This study expands the current understanding of suicide in autism and provides further avenues for future research to build upon and broaden the evidence base. eng

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7. Hao Y, Banker S, Trayvick J, Barkley S, Peters A, Thinakaran A, McLaughlin C, Gu X, Foss-Feig J, Schiller D. Understanding Depression in Autism: The Role of Subjective Perception and Anterior Cingulate Cortex Volume. Res Sq;2024 (Sep 20)

Background The prevalence of depression is elevated in individuals with autism spectrum disorder (ASD) compared to the general population, yet the reasons for this disparity remain unclear. While social deficits central to ASD may contribute to depression, it is uncertain whether social interaction behavior themselves or individuals’ introspection about their social behaviors are more impactful. Although the anterior cingulate cortex (ACC) and amygdala are frequently implicated in ASD, depression, and social functioning, it is unknown if these regions explain differences between ASD adults with and without co-occurring depression. Methods The present study contrasted observed vs. subjective perception of autism symptoms and social performances assessed with both standardized measures and a lab task, in 65 sex-balanced (52.24% male) autistic young adults. We also quantified ACC and amygdala volume with 7-Tesla structural neuroimaging to examine correlations with depression and social functioning. Results We found that ASD individuals with depression exhibited differences in subjective evaluations including heightened self-awareness of ASD symptoms, lower subjective satisfaction with social relations, and less perceived affiliation during the social interaction task, yet no differences in corresponding observed measures, compared to those without depression. Larger ACC volume was related to depression, greater self-awareness of ASD symptoms, and worse subjective satisfaction with social interactions. In contrast, amygdala volume, despite its association with clinician-rated ASD symptoms, was not related to depression. Limitations : Due to the cross-sectional nature of our study, we cannot determine the directionality of the observed relationships. Additionally, we included only individuals with an IQ over 60 to ensure participants could complete the social task, which excluded many on the autism spectrum. We also utilized self-reported depression indices instead of clinically diagnosed depression, which may limit the comprehensiveness of the findings. Conclusions Our approach highlights the unique role of subjective perception of autism symptoms and social interactions, beyond the observable manifestation of social interaction in ASD, in contributing to depression, with the ACC playing a crucial role. These findings imply possible heterogeneity of ASD concerning co-occurring depression. Using neuroimaging, we were able to demarcate depressive phenotypes co-occurring alongside autistic phenotypes.

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8. Hersh L, Dwyer P, Kapp SK, Shevchuk-Hill S, Gurba AN, Kilgallon E, Mair APA, Chang DS, Rivera SM, Gillespie-Lynch K. Community Member Views on Autism Intervention: Effects of Closeness to Autistic People with Intellectual Disabilities And Nonspeaking Autistic People. Autism Adulthood;2024 (Sep);6(3):253-271.

BACKGROUND: Controversy regarding the neurodiversity movement (NDM), the social and medical models of disability, autism intervention goals, and causal attributions of disability contributes to divides in the autistic and autism communities. The present study investigates the views of autistic and non-autistic autistic and autism community members on these topics. We explored whether these views are shaped by having close relationships to autistic people with intellectual disabilities (ID) and nonspeaking autistic (NSA) people. METHODS: A total of 504 autistic and autism community members (278 autistic, 226 non-autistic) completed an online survey about theoretical models and intervention goals. Participants reported whether they had one or more close relationships with NSA people, autistic people with ID, neither, or both. RESULTS: Overall, there was considerable consensus regarding desired intervention goals: normalization goals were generally opposed, while participants generally supported well-being, societal reform, supportive environment, and adaptive skill goals. While autistic participants reported less support for normalization and adaptive skills goals than non-autistic participants, they expressed somewhat more enthusiasm for societal reform and supportive environments than non-autistic people. Autistic people supported the NDM more and the medical model less than non-autistic people. Those close to autistic people with ID gave higher ratings to adaptive skill goals. On average, participants not close to autistic people with ID saw the challenges of those without ID as being slightly more due to environmental/social factors than the challenges of those with ID; there was no such statistical difference among those close to autistic people with ID. CONCLUSION: Further research investigating community views, with the inclusion of more autistic people with ID and NSA people themselves, is needed, but the results of this study suggest that the broader autistic and autism communities see NDM-consistent intervention goals as appropriate for all autistic people, including NSA people and those with ID. As autism interventions have often pursued unpopular normalization goals, this suggests directions for reform. Why is this an important issue? Disagreements about the neurodiversity movement have divided autistic people, their family members, and autism professionals. These include debates about whether the neurodiversity movement includes and represents the interests of autistic people who may have higher support needs, such as nonspeaking individuals and autistic people with intellectual disabilities. They also include debates about what goals autism interventions and supports should focus on. What is the purpose of this study? The purpose of this study is to explore the views of autistic and autism community members (e.g., autistic people, family members, and professionals) on: the neurodiversity movement,the social model of disability (which views society as the source of disability-related challenges),the medical model of disability (which says disabled people’s own characteristics cause disability-related challenges), anddifferent autism intervention goals. We explored whether these views are related to whether participants were autistic and/or had close relationships with autistic people with higher support needs. What did the researchers do? We collected online survey responses from 504 autistic people, family members, and autism professionals. Participants shared whether they were close to nonspeaking autistic people or autistic people with intellectual disabilities. Participants answered questions about various intervention goals and their support for the neurodiversity movement and other models of disability. What were the results of this study? Both autistic and non-autistic participants supported the neurodiversity movement and interventions that aim to change society, create supportive environments for autistic people, and promote well-being. Both autistic and non-autistic participants generally opposed interventions trying to make autistic people more normal, but autistic people were especially unlikely to support the goals of making autistic people normal. Autistic people were less enthusiastic about the goal of teaching “useful” skills and more strongly opposed to the medical model. Autistic people were more likely than non-autistic people to support the neurodiversity movement, reforming society and creating better environments for autistic people, but these differences were not large. Participants close to autistic people with intellectual disabilities supported teaching useful skills slightly more than those not close. What do these findings add to what is already known? These findings further our understanding of the perspectives of autistic and autism community members on neurodiversity, models of disability, and preferred intervention goals. What are the potential weaknesses of this study? The participants in this study were mostly White women from North America and Europe. We obtained few responses from people who more strongly oppose the neurodiversity movement or from autistic individuals who have the highest support needs. This means that our findings do not represent all autistic and autism community members. Different participants may also have understood the idea of a “close relationship” differently. How will these findings help autistic adults now or in the future? These findings may be useful to autistic adults and other members of the autistic and autism communities who want to connect with others and advocate for autism intervention research that fits their shared goals. Results can help professionals to develop interventions that better match the goals of different members of the autistic and autism communities. eng

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9. Hill AT, Ford TC, Bailey NW, Lum JAG, Bigelow FJ, Oberman LM, Enticott PG. EEG During Dynamic Facial Emotion Processing Reveals Neural Activity Patterns Associated with Autistic Traits in Children. bioRxiv;2024 (Aug 28)

Altered brain connectivity and atypical neural oscillations have been observed in autism, yet their relationship with autistic traits in non-clinical populations remains underexplored. Here, we employ electroencephalography (EEG) to examine functional connectivity, oscillatory power, and broadband aperiodic activity during a dynamic facial emotion processing (FEP) task in 101 typically developing children aged 4-12 years. We investigate associations between these electrophysiological measures of brain dynamics and autistic traits as assessed by the Social Responsiveness Scale, 2nd Edition (SRS-2). Our results revealed that increased FEP-related connectivity across theta (4-7 Hz) and beta (13-30 Hz) frequencies correlated positively with higher SRS-2 scores, predominantly in right-lateralized (theta) and bilateral (beta) cortical networks. Additionally, a steeper 1/ f -like aperiodic slope (spectral exponent) across fronto-central electrodes was associated with higher SRS-2 scores. Greater aperiodic-adjusted theta and alpha oscillatory power further correlated with both higher SRS-2 scores and steeper aperiodic slopes. These findings underscore important links between FEP-related brain dynamics and autistic traits in typically developing children. Future work could extend these findings to assess these EEG-derived markers as potential mechanisms underlying behavioural difficulties in autism.

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10. Huang H, Liu L, You C, Chen K, Xing Y, Li Y, Deng H. Screening and Prediction of Autism in Toddlers Using SORF in Videos of Brief Family Interactions. J Autism Dev Disord;2024 (Oct 7)

The purpose of this study was to validate the utility of the Systematic Observation of Red Flags (SORF) for autism screening during 10-minute parent-child interactions at ages 15-24 months. A total of 54 children participated in this study, including 19 with autism spectrum disorder (ASD), 23 with developmental delay, and 12 typically developing children. Coders coded 10-minute videos of parent-child interactions based on the defined scoring criteria. The discriminative ability for outcome diagnosis was evaluated for total score, social communication score, restricted repetitive behavior score, number of red flags, and composite score. SORF scores demonstrated good discriminative ability between ASD and non-ASD children, with the composite score (AUC = 0.884) showing the best discriminative ability for outcome diagnosis and predicting likelihood of ASD in young children. The composite score represented a simplified measurement, with the cutoff score of 7 and sensitivity and specificity of 0.789 and 0.800, respectively.

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11. Huang Z, Wiebe S, Marsal-García L, Gantois I, Sonenberg N. Strategies for Assessing Autistic-Like Behaviors in Mice. J Vis Exp;2024 (Sep 20)(211)

Autism spectrum disorder (ASD) is a neurobiologically complex condition with a heterogeneous genetic etiology. Clinically, ASD is diagnosed by social communication impairments and restrictive or repetitive behaviors, such as hand flapping or lining up objects. These behavioral patterns can be reliably observed in mouse models with ASD-linked genetic mutations, making them highly useful tools for studying the underlying cellular and molecular mechanisms in ASD. Understanding how genetic changes affect the neurobiology and behaviors observed in ASD will facilitate the development of novel targeted therapeutic compounds to ameliorate core behavioral impairments. Our lab has employed several protocols encompassing well-described training and testing procedures that reflect a wide range of behavioral deficits related to ASD. Here, we detail two assays to study the core features of ASD in mouse models: self-grooming (a measure of repetitive behavior) and the three-chamber social interaction test (a measure of social interaction approach and preference for social novelty).

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12. Kimber L, Verrier D, Connolly S. Autistic People’s Experience of Empathy and the Autistic Empathy Deficit Narrative. Autism Adulthood;2024 (Sep);6(3):321-330.

BACKGROUND: There is a dominant discourse, both in clinical texts and throughout the academic literature, that autistic people lack empathy; however, over the past decade, both clinicians and academics have increasingly rejected deficit-based descriptions of autism in favor of more nuanced explanations of the experience of autistic individuals in a social world. METHODS: This study asked 76 autistic individuals about their own experience of empathy and the oft-cited empathy deficit. Data were thematically analyzed and revealed a wide array of empathic self-concepts among respondents. RESULTS: Notably, there was a high proportion of hyper-empathic experiences. Many respondents reported their empathic responses to be overwhelming, or even distressing. These different experiences of empathy contrast with societal expectations of empathy, which often result in additional labor for autistic people as they navigate the non-autistic centered world. CONCLUSION: Although the academic literature is, in some areas, slowly moving away from a deficit perspective, more broadly there is still a negative impact from misconceptions around autistic people and empathy. Further work needs to be done to not only explore this misconception at a societal (rather than academic) level, but also better bridge the gap around the changing ideas of empathy and real-world understanding of autistic empathy. Why is this an important issue? There is a stereotype that autistic people lack empathy, which can potentially lead to negative perceptions and biased behaviors. This stereotype has roots in earlier academic literature around autism. However, although this literature has become more nuanced over time, the stereotype persists among the general population. What is the purpose of this study? This study directly asked autistic people about their own experience of empathy and of the empathy deficit narrative to provide a richer description than is afforded by traditional studies that typically use questionnaire measures. What did the researchers do? We asked a diverse group of 76 autistic adults to tell us how they experience empathy and what their views were of the autistic empathy deficit narrative via an online survey. These data were then analyzed, and themes created, using qualitative content analysis. What were the results of the study? The first theme, heterogeneity of empathic experiences, captured the diverse ways in which autistic people experience empathy. Some did report a lack of empathy, whereas others did not, and some reported experiencing extreme emotional responses (hyper-empathy). The second theme, empathy as an effortful process, captured some of the challenges experienced during the empathy process and the strategies used to overcome these. The third theme, conditional empathy, captured the features of others that made it more or less likely that empathy would be experienced. Some participants found it easier to empathize with close others, animals, and other autistic people. The fourth theme, challenging the empathy deficit narrative, captured participants’ perspectives on the empathy deficit narrative, which ranged from firm agreement to firm disagreement, and the perception of harm that comes from this narrative, such as interpersonal prejudice or poor clinical practice. What do these findings add to what was already known? Previous quantitative studies using self-report measures have found various differences in empathy between autistic and non-autistic people. This study added qualitative nuance to these findings; described diverse lived experiences of empathy among autistic people, particularly in relation to hyper-empathic experiences; and articulated the resistance of autistic people to the harmful stereotypes that are based on the empathy deficit narrative. What are potential weaknesses in the study? Due to our recruitment method, the participant sample included only those who were engaged in active online autism communities. As such, the findings here may be limited in terms of how well they capture a broad range of experiences. In addition, although an online survey allowed data collection from a relatively large number of people for a qualitative study, it also meant that, unlike more typical qualitative data collection methods, it was not possible to ask participants to elaborate or to clarify their views. How will these findings help autistic adults now or in the future? We hope that this study highlights the need for greater attention to the experience of empathy in autistic people. Articulation of these issues may help autistic people reflect on their own experiences and feel “seen.” Simultaneously, education at a societal level is needed to increase awareness of these issues and reduce dehumanization, stereotyping, and prejudice among non-autistic people. eng

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13. Klein J, Krahn R, Howe S, Lewis J, McMorris C, Macoun S. A systematic review of social camouflaging in autistic adults and youth: Implications and theory. Dev Psychopathol;2024 (Oct 7):1-15.

Social camouflaging (SC) is a set of behaviors used by autistic people to assimilate with their social environment. Using SC behaviours may put autistic people at risk for poor mental health outcomes. Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, the goal of this systematic review was to investigate the development of SC and inform theory in this area by outlining the predictors, phenotype, and consequences of SC. This review fills a gap in existing literature by integrating quantitative and qualitative methodologies, including all gender identities/age groups of autistic individuals, incorporating a large scope of associated factors with SC, and expanding on theory/implications. Papers were sourced using Medline, PsycInfo, and ERIC. Results indicate that self-protection and desire for social connection motivate SC. Camouflaging behaviors include compensation, masking, and assimilation. Female individuals were found to be more likely to SC. Additionally, this review yielded novel insights including contextual factors of SC, interpersonal relational and identity-related consequences of SC, and possible bidirectional associations between SC and mental health, cognition, and age of diagnosis. Autistic youth and adults have similar SC motivations, outward expression of SC behavior, and experience similar consequences post-camouflaging. Further empirical exploration is needed to investigate the directionality between predictors and consequences of SC, and possible mitigating factors such as social stigma and gender identity.

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14. Lund SK, Quach W, Weissling K, McKelvey M. Augmentative and Alternative Communication Assessment for Children on the Autism Spectrum: Protocol Development and Content Validation. Lang Speech Hear Serv Sch;2024 (Oct 7):1-16.

PURPOSE: Previous research has shown that many speech-language pathologists (SLPs) lack confidence in conducting augmentative and alternative communication (AAC) evaluations. The AAC Clinical Assessment Project team developed a protocol to help guide SLPs to complete AAC assessments for children with autism spectrum disorder (ASD). This article describes the creation and content validation of the protocol. METHOD: Two studies were conducted. The first study developed the content of the protocol using information from previous research, observation of two AAC clinical specialists, and interviews with these specialists. In the second study, five specialists in AAC and ASD provided content validation by rating the appropriateness of each item in the protocol. Advisory group meetings were held with the specialists to discuss how to edit the protocol based on the survey results. RESULTS: The final protocol contains a description of each area to be assessed, a rationale for assessing it, and suggested methods to conduct the assessment. CONCLUSIONS: The final version of the protocol has excellent content validity. Future research will evaluate the feasibility of using the protocol in clinical practice and whether using the protocol improves the clinical decision making of SLPs when planning AAC assessments. SUPPLEMENTAL MATERIAL: https://doi.org/10.23641/asha.27156207.

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15. Maneeton P, Maneeton B, Winichaikul Y, Kawilapat S, Kienngam N, Maneeton N. Updated Systematic Review and Meta-Analysis of Randomized Controlled Trials: Antidepressants for Restricted and Repetitive Behaviors in Autism Spectrum Disorder. Neuropsychiatr Dis Treat;2024;20:1711-1723.

In previously randomized controlled trials (RCTs) on the efficacy of antidepressants in restricted and repetitive behaviors (RRBs) in autism spectrum disorder (ASD), outcomes overwhelmingly showed no benefits of antidepressants studied in the larger multisite RCTs over placebo. However, the positive effect of antidepressants in the RRBs found in the small preliminary studies requires confirmation in larger trials. We aimed to systematically review the efficacy of antidepressants in the treatment of RRBs in ASD by including RCTs from the SCOPUS, PubMed, Embase, Cochrane Controlled Trials Register, Clinical Trials.gov, and other databases in January 2024. Analyzing data from 609 participants across nine RCTs showed no significant difference in the overall pooled mean-end score for RRBs between antidepressant- and placebo-treated groups [SMD (95% CI) of -0.25 (-0.53, 0.02), I(2) = 54%, Tau(2) = 0.10, prediction interval = -1.03, 0.53]. In small preliminary studies by one group, the clomipramine-treated group’s pooled mean endpoint for obsessive-compulsive symptoms in ASD individuals showed a significantly better outcome than the desipramine-treated group, but in unconfirmed studies. Of the individual antidepressants investigated only clomipramine, and fluvoxamine illustrated some efficacy over placebo in small preliminary studies. These findings need confirmation in larger, multisite randomized controlled trials. There were no significant differences in the overall discontinuation rates or discontinuation due to adverse events between the antidepressant- and placebo-treated groups [RR (95% CI) of 1.30 (0.95, 1.78), I(2) = 0%, and 1.33 (0.71, 2.47), I(2)=0%, respectively]. Common side effects included agitation, appetite disturbance, anorexia, gastrointestinal issues, and sleep disturbance, with no significant differences between the antidepressant and placebo groups. In conclusion, the results regarding the efficacy of antidepressants in the treatment of RRBs in ASD are inconsistent. Since previous evidence found a correlation between attention-deficit hyperactivity disorder (ADHD) symptoms including overactivity and impulsivity, and RRBs, further trials including the use of non-stimulants such as atomoxetine could be conducted.

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16. Metcalf K. Categorical misalignment: Making autism(s) in big data biobanking. Soc Stud Sci;2024 (Oct 7):3063127241288223.

The opaque relationship between biology and behavior is an intractable problem for psychiatry, and it increasingly challenges longstanding diagnostic categorizations. While various big data sciences have been repeatedly deployed as potential solutions, they have so far complicated more than they have managed to disentangle. Attending to categorical misalignment, this article proposes one reason why this is the case: Datasets have to instantiate clinical categories in order to make biological sense of them, and they do so in different ways. Here, I use mixed methods to examine the role of the reuse of big data in recent genomic research on autism spectrum disorder (ASD). I show how divergent regimes of psychiatric categorization are innately encoded within commonly used datasets from MSSNG and 23andMe, contributing to a rippling disjuncture in the accounts of autism that this body of research has produced. Beyond the specific complications this dynamic introduces for the category of autism, this paper argues for the necessity of critical attention to the role of dataset reuse and recombination across human genomics and beyond.

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17. Muscatello RA, McGonigle T, Simon V, Blythe AC. Social Context in Stress and Autism: Comparing Physiological Profiles Across Two Social Paradigms in Youth with and without Autism Spectrum Disorder. Res Autism Spectr Disord;2024 (Apr);112

BACKGROUND: The social world is often stressful for individuals with autism spectrum disorder (ASD). Research shows youth with ASD demonstrate physiological hyperreactivity to some social stressors (e.g., interaction) but not others (e.g., evaluation); therefore, this study examined diagnosis (ASD or typical development (TD)), social context, perceived anxiety, and physiological responsivity across multiple stress systems; namely, the hypothalamic pituitary adrenal (HPA) axis and autonomic nervous system (ANS). METHOD: This study examined 244 ten-to-thirteen-year-olds with ASD (N = 140) or TD (N = 104). Physiological responses, measured by salivary cortisol, heart rate (HR), and respiratory sinus arrhythmia (RSA), were assessed before and after a social evaluative threat paradigm (Trier Social Stress Test; TSST) and social interaction (Trier Social Stress Test- Friendly; TSST-F). Mediation models examined the relationships between anxiety, diagnosis, and physiology. RESULTS: Significant three-way interactions were observed for cortisol (p=0.007) and HR (p=0.002), suggesting diagnostic groups respond differently across context and time points. There was no significant interaction for RSA (p=0.149), although ASD youth had significantly lower RSA overall (p=0.038). State and trait anxiety did not mediate the relationship between diagnosis and physiology (all p>0.05). CONCLUSIONS: Findings emphasize the critical role of context and a multisystem approach in examination of physiological social stress in youth with ASD. Results provide a foundation to elucidate unique response patterns across physiological systems to more precisely identify those with heightened physiological arousal across social contexts. It is proposed that future identification of subtypes may ultimately inform approaches for enhancing social engagement.

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18. Philip P, Amulyavathy B, Lim M, Armstrong G, Grills N. Access to dental care among individuals with intellectual and developmental disabilities in India: A scoping review. Spec Care Dentist;2024 (Oct 7)

INTRODUCTION: Individuals with intellectual and developmental disabilities (IDDs) face numerous challenges in accessing dental care. Despite difficulties, more evidence exploring difficulties among this cohort in India is needed. This study aims to conduct a scoping review of articles published in India exploring access to dental care among individuals with IDD. METHOD: We followed the Arksey O’Malley framework for scoping reviews and the PRISMA guidelines for reporting studies. Findings were analyzed based on Levesque’s framework for access. RESULTS: Seventeen articles were collated from five databases. The perceived need for dental care was low, and dental visits were mainly need-based and infrequent. Knowledge regarding dental care did not translate to dental visits. Patient-related barriers were cost, transportation difficulties, fear, lack of dentist skills, patient behavior, and cooperation. From the providers’ perspective, most dentists were willing to treat but noted infrastructural and knowledge-based limitations. CONCLUSION: Access to dental care was limited due to infrastructure constraints and a lack of dentist training. Caregivers and individuals with IDD did not prioritize dental health, faced communication barriers, and were afraid of dental procedures. It is important to improve preventive dental care and raise awareness among caregivers of individuals with IDD in India. Training dentists and incorporating special care dentistry into the standard dental curriculum will improve access.

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19. Qdtua L, Williams G, Mulcahy J, Larsson DEO, Silva M, Arnold AJ, Critchley HD, Garfinkel SN. « I’m Trying to Reach Out, I’m Trying to Find My People »: A Mixed-Methods Investigation of the Link Between Sensory Differences, Loneliness, and Mental Health in Autistic and Nonautistic Adults. Autism Adulthood;2024 (Sep);6(3):284-299.

BACKGROUND: Rates of loneliness are substantially higher among autistic compared with nonautistic individuals. This observation refutes the persistent stereotype that autistic individuals are not motivated to seek meaningful social relationships. More plausibly, social environments systematically exclude people with higher levels of sensory differences, impeding on opportunities for autistic individuals to form meaningful relationships. In this study, we sought to quantify the level of distress associated with loneliness (Study A) and provide complementary qualitative insight into experiences of loneliness in relationship to sensory differences in autistic adults (Study B). METHODS: In Study A, N = 209 participants completed a range of self-report questionnaires. In Study B, nine autistic adults took part in 10-minute unstructured dyadic conversations around the topic of loneliness. We derived a qualitative understanding of autistic individuals’ experience of loneliness, enriched by inductive and deductive analyses. RESULTS: In Study A, the autistic group showed significantly higher levels of loneliness, loneliness distress, anxiety, depression, and sensory reactivity. We found significant positive correlations between variables, but no group differences in differential relationships. The effect of sensory reactivity on anxiety and depression was mediated by levels of loneliness in both groups. In Study B, autistic participants described the pain of feeling lonely and socially disconnected, while simultaneously experiencing a need for restorative solitude after social overstimulation. DISCUSSION: Our results indicate that sensory differences are related with higher loneliness and associated poor mental health in both autistic and nonautistic adults. This effect was exacerbated in autistic adults due to higher levels of sensory reactivity. First-hand reports from autistic adults on intense loneliness and the obstructive role of sensory environments refute stereotypes about a lack of social motivation in autistic adults. We conclude that to enable meaningful and inclusive social interaction, a societal effort is needed to create spaces that consider the sensory needs of all neurotypes. Why is this an important issue? Research shows that autistic people experience loneliness more often than nonautistic adults. It also shows that sensory differences contribute to higher loneliness, and that both sensory differences and loneliness are related to poor mental health, such as anxiety and depression. However, we do not know if this is unique to autistic adults, or something that also occurs in nonautistic adults. There are also not many studies where autistic people themselves describe loneliness, and how they link their loneliness to sensory differences. Finding out about whether there are differences in autistic and nonautistic people regarding loneliness, and letting autistic people put their thoughts about loneliness into their own words is important to learn more about how we can start to tackle the high rates of loneliness in autistic adults. What was the purpose of this study? Our goal was to ask autistic people how they experience loneliness, and to empirically test whether the links between sensory differences, loneliness, and anxiety and depression are present in autistic people only, or also in nonautistic people. What did the researchers do? We conducted two separate studies. In Study A, we asked autistic and nonautistic adults to fill out questionnaires about their loneliness, how distressed they are by loneliness, anxiety, depression, and how they experience the sensory environment. In Study B, we asked eight autistic adults to speak with each other and nonautistic participants about their experiences with loneliness. We gave them some conversation starters and then looked for common themes that came up in the conversations. What were the results of the study? In Study A, we found that autistic people were more distressed about being lonely, and had higher levels of loneliness, depression, anxiety, and sensory differences than nonautistic participants. However, in both groups, sensory differences were related to higher anxiety and depression, and loneliness was an important influence on this relationship. This finding was supplrted by Study B, where autistic participants described that they often struggle to make meaningful connections because their sensory sensitivities keep them from going out. What do these findings add to what was already known? Our findings show in a scientific way that loneliness is just as bad for autistic as nonautistic people. We also find that sensory sensitivities might play a role in making autistic people lonelier. What are potential weaknesses in the study? Our study sample does not represent the entire autism spectrum. All our participants were able to speak and travel to the study venues with little support. Our study participants were also mostly White, and our study can, therefore, not speak about the experiences of autistic people across different ethnic groups. How will these findings help autistic adults now or in the future? We hope that our findings will support the idea that loneliness is indeed a distressing experience for autistic people, and that society as a whole recognizes the need to create welcoming sensory environments that help to overcome the disconnect that many autistic adults experience. eng

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20. Rapaport H, Clapham H, Adams J, Lawson W, Porayska-Pomsta K, Pellicano E. « In a State of Flow »: A Qualitative Examination of Autistic Adults’ Phenomenological Experiences of Task Immersion. Autism Adulthood;2024 (Sep);6(3):362-373.

BACKGROUND: There is considerable conceptual overlap between Autistic hyperfocus and flow, yet these phenomena have seldom been associated in the literature. Moreover, no studies have provided an in-depth empirical investigation of Autistic people’s flow-like or hyperfocus experiences. In this study, we sought to address this gap by investigating Autistic people’s phenomenological experiences of task immersion, and how their experiences relate to existing conceptualizations of flow, hyperfocus, and monotropism. METHODS: To address this aim, we drew on data from a broader qualitative study, designed in partnership with Autistic community members, to understand Autistic people’s experiences of Autistic inertia. For that broader study, Autistic and non-Autistic researchers conducted semi-structured interviews with 24 Autistic adults about their everyday experiences of starting and stopping tasks. During these interviews, participants repeatedly discussed their experiences of task immersion and the benefits and challenges associated with it. We analyzed these responses specifically, using reflexive thematic analysis, adopting a combination of deductive and inductive approaches within an essentialist framework. RESULTS: Our participants’ accounts closely matched conceptual understandings of flow, Autistic hyperfocus, and monotropism. Specifically, the analysis revealed the all-encompassing nature of task immersion experiences, and how it could be difficult to « find the balance » between the joy and other aspects of everyday life. Despite the drawbacks, participants were glad to be immersed because they felt they could be themselves, with no pretences. CONCLUSIONS: These results are important for reframing task immersion as a state of great potential value to Autistic people’s lives, but one that may require additional support if it is to play its role in enabling Autistic people to flourish. Why is this an important issue? Flow is a state of mind where a person becomes completely absorbed in what they are doing and does not notice anything around them. Autistic people’s experiences of flow has not been studied enough, possibly because Autistic “voices” have not been taken seriously by autism researchers in the past. This means we know little about Autistic people’s experiences of flow-like states. What was the purpose of this study? We wanted to know about Autistic people’s experiences of flow and what effect these experiences had on their everyday lives. What did the researchers do? One Autistic and one non-autistic researcher spoke to 24 Autistic adults about their experiences of becoming fully engaged and focused on tasks. During the interview, we asked participants to tell us about moments when they felt so immersed in a task, or a thought, that they could not (or did not want to) stop. We also asked how not being able (or not wanting to) stop a task or a thought impacts their lives. What were the results of the study? Our Autistic participants’ descriptions of their flow-like experiences seemed to be closely related to other concepts that are often talked about in the Autistic community, such as hyperfocus and monotropism. They spoke of how their flow-like experiences were all-encompassing and could bring much pleasure. But they also told us how flow could bring a great deal of struggle, as it could lead to exhaustion or neglect of other tasks (including personal care). Despite the challenges, participants enjoyed being in flow as it allowed them to be themselves. What do these findings add to what was already known? This study showed that Autistic flow (or “hyperfocus”) can be “the most amazing feeling in the world.” It also showed that being in flow can cause challenges. We need to work with Autistic community members to develop strategies to help Autistic people manage the negative effects on everyday life and physical health and well-being. What are potential weaknesses in the study? Most of our Autistic participants were women who were White, well-educated, and employed. Most also used traditional forms of communication. We do not know if our participants’ flow-like experiences are similar to Autistic people who do not use traditional forms of communication, have an intellectual disability and come from different cultures. It will also be important to work with Autistic people and their allies to find new ways to investigate flow experiences in a diverse range of Autistic people. How will these findings help autistic adults now or in the future? These findings show how important it is to focus on things that can bring Autistic people joy. We need to know more about how increasing optimal flow experiences—at home, in schools, at work—could help Autistic people to thrive. eng

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21. Shi H, Hirai M. Autistic traits linked to anxiety and dichotomous thinking: sensory sensitivity and intolerance of uncertainty as mediators in non-clinical population. Sci Rep;2024 (Oct 7);14(1):23334.

A recent theoretical cognitive model posits that three cognitive constructs-intolerance of uncertainty, lack of predictive processing, and dichotomous thinking-may interact with anxiety in autistic individuals. However, the interrelationships among these constructs remain unclear. We investigated this relationship in a non-clinical population using five questionnaires (Autism Spectrum Quotient, Glasgow Sensory Questionnaire, Short Intolerance of Uncertainty Scale, Penn State Worry Questionnaire, and Dichotomous Thinking Inventory) and conducted a path analysis. Data were collected from 405 adults (aged 20-22 years) in Experiment 1 and 628 (aged 20-49 years) in Experiment 2. In both experiments, autistic traits were significantly associated with both anxiety and dichotomous thinking, mediated by intolerance of uncertainty. Autistic traits were linked to intolerance of uncertainty, mediated by atypical sensory processing. Furthermore, autistic traits were directly associated with anxiety. No direct association was observed between anxiety and dichotomous thinking. Our results confirm the validity of Stark’s cognitive model in a non-clinical population. These findings provide new insights into anxiety and dichotomous thinking and shed light on the cognitive styles of autistic individuals.

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22. Sun M, Fu N, Li T, Miao M, Chen WM, Wu SY, Zhang J. Childhood anaesthesia and autism risk: population and murine study. Brain Commun;2024;6(5):fcae325.

Early childhood exposure to general anaesthesia has been linked to potential changes in infant brain morphology and behaviour in preclinical studies, contributing to long-term behaviours associated with autism spectrum disorder. This study investigates the association between early childhood exposure to general anaesthesia and the risk of autism, using a population-based cohort study with matching for baseline characteristics and evaluates the effect of sevoflurane exposure on autism-like behaviour in mice, using the Taiwan Maternal and Child Health Database. Children aged 0-3 who received at least one exposure to general anaesthesia between 2004 and 2014 were matched 1:1 with children who were not exposed. Risk ratios and confidence intervals were used to assess the relationship between general anaesthesia and the occurrence of autism. Additionally, mice were exposed to sevoflurane for 2 h on postnatal days 5-7, and changes in behaviour related to autism were evaluated. Propensity score matching resulted in 7530 children in each group. The incidence rates (IRs) of autism were 11.26 and 6.05 per 100 000 person-years in the exposed and unexposed groups, respectively. The incidence ratio for autism following exposure to general anaesthesia was 1.86 (95% confidence interval, 1.34-2.59). In mice, sevoflurane exposure induced autism-like behaviours and led to the downregulation of high-risk autism genes, including ARID1B, GABRA5, GABRB3, GRIN2B, SHANK3 and SUV420H1. Early childhood exposure to general anaesthesia is associated with an increased risk of autism. Repeated exposure to sevoflurane in mice induces autism-like behaviours, suggesting a potential link between anaesthesia and the development of autism.

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23. Thayer N, Marsack-Topolewski C, Wilson K. Parental Perceptions of Community and Professional Attitudes Toward Autism. J Autism Dev Disord;2024 (Oct 7)

The purpose of this study was to examine parent perceptions of professional and community attitudes about autism through the lens of parenting their autistic children from birth through adulthood. Implications of this research may assist with future development and study of professional and community supports of individuals on the autism spectrum and their families. The study participants consisted of 51 parents who had an adult-aged child on the autism spectrum. One-on-one interviews were conducted with parents about their experiences raising a child with autism. Data were double-coded and analyzed using a qualitative, phenomenological approach to explore parents’ experiences with and perceptions of society members’ attitudes towards autism. Positive and negative themes were identified across parents’ perceptions of professionals and of community members. Themes regarding professional attitudes included cooperating with family requests, presuming competence of individuals with autism, complacency towards the needs of families and individuals with autism, and discrimination towards the individual with autism based on age or level of need. Themes regarding community member attitudes included valuing the strengths of individuals with autism, accommodating autistic differences, intolerance of autistic traits, and prejudice towards individuals with autism. Findings indicate that professional and community members presented with both positive and negative attitudes towards autism and individuals on the autism spectrum, with negative attitudes proving more prevalent in parent recollections. Results suggest a need for further research and related training to improve interactions with and support of individuals with autism and their families.

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24. Tomas V, Kingsnorth S, Anagnostou E, Kirsh B, Lindsay S. « I Wish This Tool Was Available to Me Sooner »: Piloting a Workplace Autism Disclosure Decision-Aid Tool for Autistic Youth and Young Adults. Autism Adulthood;2024 (Sep);6(3):331-344.

BACKGROUND: For autistic youth and young adults, deciding whether to disclose their autism at work may be complex since they are newly entering the workforce and are at an impressionable developmental period. Decision-aid tools can help someone make a choice regarding a topic/situation. We developed a workplace autism disclosure decision-aid tool called DISCLOSURE (Do I Start the Conversation and Let On, Speak Up, and REveal?) to support autistic youth and young adults navigate disclosure decision-making. In this study, we aimed to assess the DISCLOSURE tool’s (1) impact on decision-making and self-determination capabilities and (2) usability, feasibility, and acceptability. METHODS: This was a single-arm pre-post pilot study. The DISCLOSURE tool comprises three interactive PDF documents and videos. Thirty participants (mean age of 23.5 years) completed online surveys before and after interacting with the DISCLOSURE tool. We used descriptive statistics for usability, feasibility, and acceptability. We calculated the Wilcoxon signed rank and paired t-tests to determine pre-post changes in decision-making and self-determination capabilities (Decisional Conflict Scale-Low Literacy Version [DCS-LL]; adapted Arc’s Self-Determination Scale). We analyzed open-ended data using conventional (inductive) content analysis. RESULTS: There were significant decreases in DCS-LL total and subscale scores (p < 0.0001) and a significant increase in Arc's total score (p = 0.01), suggesting important improvements. There were no significant increases for Arc's psychological empowerment and self-realization subscales (p = 0.05; p = 0.09). Median scores (4.0/5.0) indicate that participants agreed that the DISCLOSURE tool is acceptable, feasible, and meets the usability criteria. We developed four categories to describe the open-ended data: (1) disclosure capabilities, (2) the role of others, (3) positive tool impact and feedback, and (4) minimal tool impact and constructive feedback. DISCUSSION: Findings are suggestive of the DISCLOSURE tool's ability to support workplace autism disclosure decision-making. Future studies should ascertain the DISCLOSURE tool's effectiveness, explore others' feedback (e.g., employers), and how to incorporate the tool into relevant employment and vocational programs. Why is this topic important? Autistic youth and young adults face a dilemma when starting their first jobs: should they disclose their autism at work? This is a complicated decision and involves considering many factors, benefits, and risks. Our team developed a decision-aid tool to help with this decision-making process called DISCLOSURE (Do I Start the Conversation and Let On, Speak Up and REveaL?). This study is important because it is the first to assess the DISCLOSURE tool and explore if it may be helpful. What is the purpose of this article? This study had two main goals. First, we assessed if the DISCLOSURE tool helps to build self-determination and decision-making knowledge, skills, and confidence. Second, we explored if participants thought that the DISCLOSURE tool is usable, acceptable, and can be used in the real world (feasible). What did the researchers do? We recruited 30 participants (average age of 23.5 years) to complete two online surveys—one before and one after using the DISCLOSURE tool. We analyzed the data to observe if there were changes in decision-making and self-determination knowledge, skills, and confidence. We also explored how participants rated the acceptability, feasibility, and usability of the DISCLOSURE tool. We read through open-ended answers to group them into categories. What did the researchers find? We found important improvements in participants' decision-making knowledge, skills, and confidence. The DISCLOSURE tool shows promise to improve self-determination. Participants agreed that the DISCLOSURE tool is usable, acceptable, and feasible. Many participants said that the DISCLOSURE tool can help them make disclosure decisions at work. Some participants said that the tool was not as helpful for them. This is because they already had disclosure knowledge and experience. Overall, the study results suggest that the tool may support some autistic young people with the disclosure decision-making process. What do these findings add to what is already known? Few tools exist that support disclosure decision-making. Research also shows that young autistic people find it hard to make autism disclosure decisions at work and may need help. This study is the first to assess a tool that may close important gaps and help autistic young people make disclosure choices. What are potential weaknesses in the study? We need to continue testing the DISCLOSURE tool since this is the first time that we assessed it. We also missed some important perspectives in this study. Most participants were white, cisgender women, or nonbinary from Ontario, Canada, and needed internet and a tech device to take part. How will these findings help autistic young people now or in the future? Results show that the DISCLOSURE tool may help autistic youth and young adults make disclosure choices at work. We will continue to assess the DISCLOSURE tool to make sure it is effective. Autistic youth and young adults could use the DISCLOSURE tool in the future to help guide their disclosure choices at work. Relevant service providers could also use the DISCLOSURE tool with their autistic clients. eng

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25. Tsurutani M, Goto T, Hagihara M, Irie S, Miyamichi K. Selective vulnerability of parvocellular oxytocin neurons in social dysfunction. Nat Commun;2024 (Oct 6);15(1):8661.

Selective vulnerability offers a conceptual framework for understanding neurodegenerative disorders such as Parkinson’s disease, where specific neuronal types are selectively affected and adjacent ones are spared. However, the applicability of this framework to neurodevelopmental disorders, particularly those characterized by atypical social behaviors, such as autism spectrum disorder, remains uncertain. Here we show that an embryonic disturbance, known to induce social dysfunction in male mice, preferentially impaired the gene expression crucial for neural functions in parvocellular oxytocin (OT) neurons-a subtype linked to social rewards-while neighboring cell types experienced a lesser impact. Chemogenetic stimulation of OT neurons at the neonatal stage ameliorated social deficits in early adulthood, concurrent with cell-type-specific sustained recovery of pivotal gene expression within parvocellular OT neurons. Collectively, our data shed light on the transcriptomic selective vulnerability within the hypothalamic social behavioral center and provide a potential therapeutic target through specific neonatal neurostimulation.

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26. Winter AS, Yartel AK, Fountain C, Cheslack-Postava K, Zhang Y, Schieve LA, Kissin DM, Bearman P. The role of multiple birth and birth complications in the association between assisted reproductive technology conception and autism diagnosis. Am J Epidemiol;2024 (Oct 7);193(10):1426-1432.

In recent decades, the use of assisted reproductive technology (ART) has increased rapidly. To assess the relationship between ART and autism diagnosis, we linked California birth records from 2000 through 2016 with contemporaneous records from the National ART Surveillance System (NASS) and autism caseload records from California’s Department of Developmental Services from 2000 through November 2019. All 95 149 birth records that were successfully linked to a NASS record, indicating an ART birth, were matched 1:1 using propensity scores to non-ART births. We calculated the hazard risk ratio for autism diagnosis and the proportions of the relationship between ART conception and autism diagnosis mediated by multiple birth pregnancy and related birth complications. The hazard risk ratio for autism diagnosis following ART compared with non-ART conception is 1.26 (95% CI, 1.17-1.35). Multiple birth, preterm birth, and cesarean delivery jointly mediate 77.9% of the relationship between ART conception and autism diagnosis. Thus, increased use of single embryo transfer in the United States to reduce multiple births and related birth complications may be a strategy to address the risk of autism diagnosis among ART-conceived children.

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27. Wolfer P, Baumeister F, Rudelli N, Corrigan G, Naigles LR, Durrleman S. Exploring Metalinguistic Awareness in School-Aged Autistic Children: Insights from Grammatical Judgment. J Autism Dev Disord;2024 (Oct 7)

Metalinguistic awareness, the ability to manipulate and reflect upon language, remains largely unexplored in the autistic population. To address this gap, this observational cross-sectional study examines the metalinguistic abilities of school-aged autistic children in comparison to neurotypical peers in a novel tablet-based Grammatical Judgment Task (GJT) of reduced linguistic complexity engaging two kinds of metacognitive resources. Children had to judge non-verbally whether pre-recorded sentences were grammatically correct or not, following the traditional GJT paradigm assessing metamorphosyntactic skills. In addition, sentences with anomalous meaning that were either grammatically correct or grammatically incorrect were introduced to test metasemantic knowledge. Findings reveal no difference in performance between the groups, with participants performing on average above chance level both on the sentences assessing mere metamorphosyntactic skills and on the sentences placing an additional demand on metasemantics. This study shows that autistic individuals are able to mobilize metalinguistic resources when tested via a task of reduced linguistic complexity.

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28. Zhu Y, Davis NO, Franz L, Goldstein B, Green J, Herkert D, Howard J, Reed A, Spanos M, Dawson G. Factors Associated with Caregivers’ Decisions to Pursue a Diagnostic Evaluation After a Positive Autism Screen in Primary Care. J Autism Dev Disord;2024 (Oct 7)

PURPOSE: We sought to understand whether a child’s sex, age, race, ethnicity, caregiver education, family income, and/or number of endorsed autism signs are associated with a caregiver’s decision to pursue an autism diagnostic evaluation after their child received a positive autism screen. METHODS: 129 children, 17-30 months, received a positive autism screen on the Modified Checklist for Autism in Toddlers-Revised with Follow-Up, and all caregivers were offered ready access to a diagnostic evaluation by a trained professional in English or Spanish at no cost. RESULTS: 88 children received an evaluation and 41 did not. The likelihood of receiving an evaluation was associated with the child’s race. Only 58.1% of Black children were evaluated, compared to 80% of Hispanic/Latino and 88.5% of White children. Children of Spanish-speaking caregivers showed high rates of evaluation completion (85.7%). Children who were evaluated versus were not evaluated did not significantly differ in terms of child’s sex, number of autism signs endorsed by the caregiver, caregiver’s education and preferred language (English versus Spanish), or household income. CONCLUSION: Even though the present study removed many common barriers to receiving a timely diagnostic evaluation, caregivers of Black children were less likely to pursue an autism diagnostic evaluation for their child. Future research is needed to understand the needs and perspectives of Black families to promote engagement in clinical care and reduce disparities in receiving a timely autism diagnosis which is important for accessing supports and services that can improve children’s outcomes.

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