1. News Brief: Rates of diagnosed autism spectrum disorder have risen steadily since 2000. The American journal of nursing. 2023; 123(7): 11.

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2. Artık A, Öztelcan Gündüz B, Mızrak S, Işık Ü. Increased serum levels of tumour necrosis factor-like weak inducer of apoptosis in children with autism spectrum disorder. International journal of developmental disabilities. 2023; 69(4): 611-6.

Introduction: A previous study has evaluated the association between serum tumour necrosis factor-like weak apoptosis inducer (TWEAK) levels and autism spectrum disorder (ASD). In line with this investigation, the present study aimed to measure serum TWEAK levels to determine whether their eventual alteration might have etiopathogenetic significance in children with ASD. Methods: A total of 40 treatment-naive children with ASD and 40 healthy children as controls were included in the present study. The Schedule for Affective Disorders and Schizophrenia for School-Aged Children-Present and Lifetime Version, DSM-5 was used by a psychiatrist to screen the healthy controls for psychiatric disorders after a physical examination by a paediatrician. The clinical severity of the ASD symptoms was assessed by the Childhood Autism Rating Scale. Venous blood samples were collected, and serum TWEAK levels were measured. Results: This study included 80 children in total, with 40 (50.0%) in the patient group and 40 (50.0%) in the healthy control group. Thirty four (85.0%) of the participants in the patient group, and 31 (77.5%) in the healthy control group, were male, and the remainder were female. The distribution of the gender ratio was statistically similar between groups (p = 0.568). The volunteers were between 36 and 59 months old. The average age in the patient group was 46.0 ± 6.5, while that in the healthy control group was 45.2 ± 6.7. The ages were also statistically similar between groups (p = 0.615). The TWEAK values of the patient group were found to be statistically higher than those of the healthy control group (p < 0.001). Discussion: This study examined whether serum TWEAK levels were related to ASD in childhood. Our findings indicate that children with ASD have higher TWEAK levels when compared to other children. The findings further indicate that serum TWEAK levels could be related to ASD etiopathogenesis independent of ASD symptom severity.

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3. Brewer N, Georgopoulos MA, Lucas CA, Young RL. Autistic adults’ perspectives on appropriate empathic responses to others’ emotions. Autism research : official journal of the International Society for Autism Research. 2023.

Although the ability of autistic adults to recognize others’ emotions has been extensively studied, less attention has been given to how they respond to these emotions. We examined two aspects of autistic and non-autistic adults’ responsiveness to the emotional expressions of non-autistic actors: their perspectives on the appropriate way of responding to others’ emotions and their awareness of others’ perceptions of the likely appropriateness of such responses. Autistic (N = 63) and non-autistic (N = 67) adult samples viewed videos of 74 dyadic social interactions displaying different examples of 12 emotions expressed by one actor in response to the behavior of the other. After each video, participants (a) nominated the emotion expressed by the first actor, (b) offered their perspective on what would constitute an appropriate empathic response by the second actor, and (c) indicated their confidence in that response. Although the autistic group provided fewer appropriate empathic responses-operationalized via a panel’s interpretations of normative responses-than the non-autistic group, within-group variability was marked, and the effect was weak and largely confined to basic emotions. Autistic individuals were, however, considerably less confident in their responses. Examination of the relationships between confidence in and the appropriateness of empathic responses provided no indication in either group of reliable discrimination of appropriate from inappropriate empathic responses or finely tuned metacognitive awareness of variations in appropriateness. In sum, autistic adults’ perspectives on the appropriate empathic reactions to non-autistic adults’ emotions were not unilaterally or markedly different to those of non-autistic adults.

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4. Bruce H, Munday K, Kapp SK. Exploring the Experiences of Autistic Transgender and Non-Binary Adults in Seeking Gender Identity Health Care. Autism in adulthood : challenges and management. 2023; 5(2): 191-203.

BACKGROUND: This study sought to obtain an in-depth understanding of autistic transgender and/or non-binary adults’ experiences in accessing, or trying to access, gender identity health care (GIH). To our knowledge, no prior study researched this topic. METHODS: Through semi-structured interviews, we obtained the first-hand experiences of 17 participants. H.B. (cisgender, non-autistic) conducted a reflexive thematic analysis using an inductive approach, in collaboration with K.M., an autistic transgender disability community researcher, and under the supervision of S.K.K., a cisgender autistic autism researcher. RESULTS: Thematic analysis determined that poor knowledge of professionals, accessibility issues, and bureaucratic and economic barriers impacted participants’ experiences when accessing GIH. Participants experienced a perceived lack of professional knowledge around autism and gender diverse health care needs, limited communication methods and accommodations, and misdiagnosis of mental health difficulties. Accessibility issues included unmet sensory needs, disruption to routine, and a lack of local provision. Further, participants shared that they struggled with unclear processes, standardization of care, long waiting lists, and confusing or inaccessible insurance coverage. Recommendations for improvements highlighted the need to listen to service users to positively impact their experiences in accessing GIH. CONCLUSION: This study suggests that more training needs to be given to health care providers and professionals around autistic experience to help improve providers’ competence in communication and providing person-centered accommodations. More training around gender diverse identities is needed, as well as increased knowledge on the co-occurrence of autism and transgender/non-binary identities, to positively impact patient experiences and help improve access to care. WHY IS THIS AN IMPORTANT ISSUE? Many gender-diverse adults are also autistic. Gender Identity Health care (GIH) provides care to transgender people (those whose gender does not correspond with their assigned sex at birth), and non-binary individuals, who identify with a gender outside of the gender binary (female or male). Treatments can include hormone replacement therapy, voice coaching, talking therapies, and surgery. Past research has shown how both the gender diverse community and autistic people face similar difficulties when accessing health care. It is, therefore, important that autistic people can access this care without worry and fear of rejection. WHAT WAS THE PURPOSE OF THIS STUDY? We wanted to understand the experiences of autistic adults in accessing, or trying to access, GIH. We wanted to know what worked well and what might need improvement. WHAT DID THE RESEARCHERS DO? The lead researcher’s (H.B.’s) experiences supporting a transgender autistic person who was denied GIH inspired this study. For her master’s thesis H.B. (cisgender, non-autistic) worked with Katie Munday, an autistic transgender and non-binary researcher and also a master’s student at the time. H.B. was supervised by S.K.K., a cisgender autistic autism researcher.H.B. interviewed 17 transgender autistic adults about their experiences in accessing or trying to access GIH, and their recommendations for improvements. The researchers looked at the similarities across the participants’ experiences. WHAT WERE THE RESULTS OF THE STUDY? We found that many different things impacted participants’ experience when accessing GIH. Participants felt that many professionals had little knowledge on autism or the health care needs of gender diverse people. They had difficulty in accessing clinics they needed for their health care, because of the lights or sounds in the clinic, the disruptions to their routine, or the distance to the clinic. Broader issues affected access to the GIH that participants needed, such as long wait lists and poor or confusing health insurance coverage. Further, participants gave recommendations for improvements, which highlighted the need to listen to service users to positively impact their experiences in accessing GIH. WHAT DO THESE FINDINGS ADD TO WHAT WAS ALREADY KNOWN? Work around gender diverse autistic adults’ experiences is growing and this work adds to that knowledge around GIH specifically. These findings highlight the issues that gender-diverse autistic adults have when trying to access GIH, allowing professionals to reflect on their practice and the place in which they work. WHAT ARE POTENTIAL WEAKNESSES IN THE STUDY? Participants consisted mostly of white English-speaking individuals, recruited online. HOW WILL THESE FINDINGS HELP AUTISTIC ADULTS NOW OR IN THE FUTURE? Participants’ experiences and recommendations for GIH services could help improve the experiences of autistic adults, and other individuals who access GIH.This work, and the methods used within it, highlight the importance of centering the lived experiences of gender-diverse autistic adults as experts on their own experiences. eng.

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5. Bureau R, Clément C. « Survival classes for a neurotypical world »: What French autistic adults want and need after receiving an autism diagnosis. Autism : the international journal of research and practice. 2023: 13623613231183071.

Adults receiving an autism diagnosis might not react the same depending on their countries or cultures. We also know that autistic people are rarely asked what they think would be best for them following this diagnosis. In this study, we asked 12 French autistic adults about their experiences of receiving an autism diagnosis as well as what they thought might be useful afterwards. Overall, we found that some experiences were similar to experiences related by English or American participants, but some were specific to the French culture, suggesting that such research should expand into new territories and cultures, especially non-European ones. Our participants also had quite a few ideas as to what would be useful for people in the same situation. Some of the suggestions can be put into action by peers and professionals alike, while others are wishes relating to how our participants would like society to behave toward them and people like them, for example. This article allows for a better comprehension of how cultural differences can impact the experience of receiving an autism diagnosis as an adult and provides some insight into what these adults want and desire following such a diagnosis.

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6. Bureau R, Riebel M, Weiner L, Coutelle R, Dachez J, Clément C. French Validation of the Camouflaging Autistic Traits Questionnaire (CAT-Q). Journal of autism and developmental disorders. 2023.

PURPOSE: Autistic camouflaging is a collection of strategies used to hide autistic characteristics. It can have serious consequences on autistic people’s mental health and needs to be addressed and measured in clinical practice. The purpose of this study is to evaluate the psychometric properties of the French adaptation of the Camouflaging Autistic Traits Questionnaire. METHODS: 1227 participants (744 autistic, 483 non-autistic) answered the French version of the CAT-Q in an online survey or on paper. Confirmatory factor analysis, measurement invariance testing, internal consistency analysis (McDonald’s ω), and convergent validity with the DASS-21 depression subscale were conducted. Test-rest reliability was assessed on a sample of 22 autistic volunteers using intraclass correlation coefficient. RESULTS: A good fit was found for the original three-factor structure as well as a good internal consistency, excellent test-retest reliability and highly significant convergent validity. Measurement invariance testing indicates however that the meaning behind items is different for autistic vs. non-autistic people. CONCLUSION: The French version of the CAT-Q can be used in clinical settings to assess camouflaging behaviors and intent to camouflage. Further research is needed to clarify the camouflage construct and whether reported measurement noninvariance are due to cultural differences or a true difference in what camouflaging might mean for non-autistic people.

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7. Buyers EM, Hutchens KJ, Kaizer A, Scott SM, Huguelet PS, Holton C, Alaniz VI. Caregiver goals and satisfaction for menstrual suppression in adolescent females with developmental disabilities: A prospective cohort study. Disability and health journal. 2023: 101484.

BACKGROUND: Adolescents with developmental disabilities and their caregivers often seek menstrual management. Caregivers frequently serve as medical decision-makers, and little is known about caregiver goals for menstrual management and satisfaction over time. OBJECTIVE: Assess caregiver reasons for initiating menstrual management in adolescents with disabilities and satisfaction over 12 months. METHODS: Prospective cohort study of caregivers of adolescents with developmental disabilities seeking menstrual management at a pediatric and adolescent gynecology clinic. Data derive from caregiver surveys and adolescents’ electronic medical records. RESULTS: Ninety-two caregiver-adolescent pairs enrolled. The mean age of adolescents was 14.4 (±2.6). The most common method started was levonorgestrel intrauterine device (LNG-IUD; 52, 56.5%), followed by oral norethindrone acetate (21, 22.8%). Caregivers cited hygiene concerns (84.8%), behavioral problems (52.2%), and heavy/excessive bleeding (48.9%) as reasons for initiating menstrual suppression. Caregivers who identified hygiene or heavy/excessive bleeding as the most important reason for management were more likely to select LNG-IUD (p = 0.009). Caregivers who cited behavioral/mood or seizure concerns as the most important reason were more likely to choose other methods (p < 0.05). At 12 months, caregiver satisfaction with all methods was high (66.2-86.9 on a 100-point scale). For every additional day of bleeding, satisfaction decreased by 3.7 points (95% CI: 2.3-5.0). CONCLUSIONS: Caregiver satisfaction with all methods is high; however, it negatively correlates with days of bleeding. Caregiver reasons for menstrual suppression influence the method chosen. Management may reflect both patient and caregiver priorities; research is needed to better understand shared decision-making models that promote reproductive autonomy in adolescents with a developmental disability.

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8. Chu L, Lee M. Automatic design and optimization of educational space for autistic children based on deep neural network and affordance theory. PeerJ Computer science. 2023; 9: e1303.

In recent years, the incidence of autistic children has shown rapid growth worldwide. The rapid development of education and rehabilitation institutions for autistic children is of great significance to the rehabilitation of this group. However, the research on indoor space environments and functional facilities for autistic children in China is still in its infancy. Reasonably and effectively, zoning the education and rehabilitation space for autistic children can promote better communication and learning between autistic children and rehabilitation therapists and effectively promote the rehabilitation progress of autistic children. However, the existing education and rehabilitation space for autistic children has some problems, such as unscientific indoor partition, indoor space layouts mainly relying on manual work, heavy workload and low efficiency. Therefore, it is of great research value and practical significance to explore the intuitive design and optimization of the education and rehabilitation space layout for autistic children. This study first evaluates and optimizes the educational space for autistic children based on the affordability theory. Then, this study proposes a layout recommendation algorithm based on deep learning, which is used to improve the layout efficiency of the education and rehabilitation space for autistic children and realize real-time online layout. The scene information is digitized in binary code. The segmentation and layout network models are constructed through bidirectional long short-term memory (LSTM) to discover the long segment pre-segmentation of house type and obtain the layout results. The word embedding algorithm is used to abstract the cross features between each vector segment, and the dimension of the feature matrix is reduced to improve the speed and accuracy of the layout scheme recommendation. The experimental results show that our method can learn the design rules from the data set and has achieved better results than the existing methods. This study provides an adequate theoretical basis and design reference for the research of residential education space for autistic children.

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9. Chung ST, Lok EYC, Chan QKN, Cheng KM, Lam SM, Lui SSY. Psychometric Properties of the Caregiver Strain Questionnaire in a Chinese Sample of Caregivers of Children with Autism Spectrum Disorder. Journal of autism and developmental disorders. 2023.

The Caregiver Strain Questionnaire assesses the three dimensions of caregiver strain, namely the objective, subjective externalized and subjective internalized strain. It was validated among caregivers of children with Autism Spectrum Disorder (ASD) in the United States and Mainland China with promising psychometric properties.This study aimed to develop and validate the Chinese (traditional script) version of the Caregiver Strain Questionnaire (C-CGSQ) among 198 caregivers of children with ASD in Hong Kong. The C-CGSQ showed excellent internal consistency (α = 0.958) and test-retest reliability (Spearman’s r = 0.966). Concurrent, convergent, divergent validity and a three-factor structure (consistent with previous studies) were established. The C-CGSQ demonstrated promising psychometric properties in measuring caregiver strain among caregivers of Chinese ASD children in Hong Kong.

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10. Coburn KL, Williams DL. Quantitative Analysis of Narrative Discourse by Autistic Adults of Underrepresented Genders. Autism in adulthood : challenges and management. 2023; 5(2): 154-64.

BACKGROUND: Narrative production is an important part of the diagnostic process for autism. Most existing research on narrative production by autistic people has focused on cisgender men and boys. Members of other genders (i.e., nonbinary people, transgender men, and trans and cisgender women) are underrepresented in the research literature. Research with non-autistic adults consistently reports gender differences in narrative production. When adults whose genders are underrepresented seek autism diagnosis as adults, they may be misdiagnosed due to misconceptions about autistic communication that are based on cisgender male speakers. METHODS: Twenty autistic adults of various genders each told four narratives: two based on a picture and two about their personal experiences. Dependent variables measured narrative length, grammatical complexity, vocabulary diversity, filled pauses, and internal state terms. Researchers used nonparametric statistics to compare groups of (1) cisgender men and all other participants, (2) participants assigned male at birth and those assigned female, and (3) self-identified women, nonbinary people, and men. RESULTS: Women used significantly less diverse vocabulary than men. Women used more terms to refer to internal states than both nonbinary people and men, but this finding was not significant after correction for multiple comparisons. All other comparisons were not statistically significant. CONCLUSIONS: Autistic narrators of diverse genders have more linguistic similarities than differences. Autistic women may be more likely to talk about emotions and other internal states than autistic men. Gender-based expectations for spoken communication about internal states should be carefully reconsidered. More research is necessary to determine whether the results of this small study will generalize to larger samples of autistic people whose genders are currently underrepresented in the research literature. WHY IS THIS AN IMPORTANT ISSUE? How a person tells stories can help clinicians diagnose autism. Only a few research studies have explored how autistic adults tell stories. Most autism research is based on cisgender boys and men. Nonbinary people, transgender people, and cisgender women are underrepresented in research. Research with non-autistic adults has shown gender differences in how people tell stories. When cisgender women, nonbinary people, and transgender people seek autism diagnosis in adulthood, they might be misdiagnosed if clinicians do not know how autistic people of their gender might tell stories. WHAT WAS THE PURPOSE OF THIS STUDY? The purpose of this study was to find out whether autistic people of different genders tell stories in different ways. WHAT DID THE RESEARCHERS DO? We recruited autistic nonbinary people, transgender people, and cisgender women and men. On a Zoom call with a researcher, each participant told two stories about a picture and two stories about their experiences. We measured how long the stories were, how long their sentences were, how many different words people used, how many words they used about emotions and thoughts, and how often they said um and uh. We made three sets of comparisons: (1) cisgender men compared with all other participants; (2) participants assigned male at birth compared with participants assigned female at birth; (3) self-identified women, nonbinary people, and men compared with each other. We used a high standard for statistical significance because we made so many comparisons. WHAT WERE THE RESULTS OF THE STUDY? 1.Stories told by cisgender men were the same as the stories told by everyone else, on all the measures. Stories told by participants assigned female at birth and participants assigned male at birth were the same on all the measures.2.When women, nonbinary people, and men were compared with each other, no group differences were statistically significant using our high standard. Despite this, there were two interesting patterns: Women used each different word more times in their stories than men did. Women used more words about emotions and thoughts than men did. None of the other comparisons showed gender differences. WHAT DO THESE FINDINGS ADD TO WHAT WAS ALREADY KNOWN? These findings suggest that autistic women may be more likely to talk about emotions and thoughts than autistic men. Clinicians evaluating women for autism should not necessarily expect autistic women to talk about the same things that they expect autistic men to talk about. In general, autistic speakers of diverse genders had more similarities than differences, and it did not matter how we grouped their genders. WHAT ARE POTENTIAL WEAKNESSES IN THE STUDY? The group of participants was small, and the gender groups were uneven. The participants were mostly white and highly educated. Repeating the study with a larger, more diverse group of people could help researchers to understand similarities and differences in autistic communication better. HOW WILL THESE FINDINGS HELP AUTISTIC ADULTS NOW OR IN THE FUTURE? These findings can help autistic adults by teaching clinicians who diagnose autism about ways that women and nonbinary people tell stories. The findings challenge stereotypes about autistic people that are based on cisgender men. eng.

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11. Crasta JE, Jacoby EC. The Effect of Attention on Auditory Processing in Adults on the Autism Spectrum. Journal of autism and developmental disorders. 2023.

This study examined the effect of attention on auditory processing in autistic individuals. Electroencephalography data were recorded during two attention conditions (passive and active) from 24 autistic adults and 24 neurotypical controls, ages 17-30 years. The passive condition involved only listening to the clicks and the active condition involved a button press following single clicks in a modified paired-click paradigm. Participants completed the Adolescent/Adult Sensory Profile and the Social Responsiveness Scale 2. The autistic group showed delayed N1 latencies and reduced evoked and phase-locked gamma power compared to neurotypical peers across both clicks and conditions. Longer N1 latencies and reduced gamma synchronization predicted greater social and sensory symptoms. Directing attention to auditory stimuli may be associated with more typical neural auditory processing in autism.

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12. Ebrahimi Meimand S, Amiri Z, Shobeiri P, Malekpour MR, Saeedi Moghaddam S, Ghanbari A, Tehrani YS, Shokri Varniab Z, Pourabhari Langroudi A, Sohrabi H, Foroutan Mehr E, Rezaei N, Moradi-Lakeh M, A HM, Larijani B. Burden of autism spectrum disorders in North Africa and Middle East from 1990 to 2019: A systematic analysis for the Global Burden of Disease Study 2019. Brain and behavior. 2023: e3067.

INTRODUCTION: Autism spectrum disorders (ASD) encompass a range of neurodevelopmental disorders that affect the patient’s communication and behavior. There are some reports about the increasing prevalence of ASD in recent decades, mostly due to the improvement in diagnosis and screening status. Few studies suggested a lower prevalence of ASD in North Africa and Middle East compared to more developed regions. The aim of this study is to provide a comprehensive outlook of ASD in the region. METHODS: We used Global Burden of Disease (GBD) data from 1990 to 2019 in North Africa and Middle East, which is one of the seven super regions of the GBD categorization. In this study, we reported the epidemiologic indices, including prevalence, incidence, and years lived with disability (YLDs) for ASD in the 21 countries of the super region. We also compared these indices between the countries based on their sociodemographic index (SDI) which was calculated according to income per capita, mean education, and fertility rate. RESULTS: Age-standardized prevalence rate (ASPR) of ASD in the region is 304.4 (95% uncertainty interval 251.2-366.1) per 100,000 in 2019 with less than one percentage change since 1990. Age-standardized YLDs and incidence rates were 46.4 (30.4-67.5) and 7.7 (6.3-9.3) per 100,000 in 2019. The ASPR was 2.9 times greater in males compared to females in 2019. The highest age-standardized prevalence, incidence, and YLD rates among the countries were seen in Iran in 2019 (370.3, 9.3, and 56.4 per 100,000, respectively). High SDI countries had higher age-standardized YLDs rates compared to the other countries of the region. CONCLUSION: In conclusion, the trends of age-standardized epidemiologic indices remained approximately steady through the years 1990-2019 in the region. Though, there was a wide discrepancy between the countries of the region. The difference of YLDs among the countries of this region is related to the SDI of the countries. Monetary and public awareness status are the SDI factors that may affect the quality of life of ASD patients in the region. This study provides valuable information for governments and health systems to implement policies for maintaining the improving trend, achieving more timely diagnosis, and bettering the supportive actions in this region.

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13. Ekas NV, Kouros CD, Rigsby BA, Madison S, Hymel J, Filippi M. A longitudinal examination of mental health and marital functioning of mothers and fathers of autistic adolescents during COVID-19. Autism : the international journal of research and practice. 2023: 13623613231182180.

Parents of autistic children may be especially vulnerable to the negative effects of COVID-19. The current study examined changes in mental health and marital functioning of mothers and fathers of autistic children across three time points between April and October 2020. The study also explored whether pre-COVID factors could predict outcomes during the pandemic. Participants were 94 mothers and 58 fathers of autistic children drawn from a larger study about family relationships and autistic children’s mental health that began prior to the pandemic. Results indicated that mothers reported higher levels of mental health problems compared to fathers in July and October 2020. Levels of mental health and marital functioning did not change between April and October 2020. Pre-pandemic child functioning and marital satisfaction predicted changes in mother’s ratings of marital satisfaction. The findings have implications for ways to best support families during challenging periods.

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14. Fan Y, Xiong H, Sun G. DeepASDPred: a CNN-LSTM-based deep learning method for Autism spectrum disorders risk RNA identification. BMC bioinformatics. 2023; 24(1): 261.

BACKGROUND: Autism spectrum disorders (ASD) are a group of neurodevelopmental disorders characterized by difficulty communicating with society and others, behavioral difficulties, and a brain that processes information differently than normal. Genetics has a strong impact on ASD associated with early onset and distinctive signs. Currently, all known ASD risk genes are able to encode proteins, and some de novo mutations disrupting protein-coding genes have been demonstrated to cause ASD. Next-generation sequencing technology enables high-throughput identification of ASD risk RNAs. However, these efforts are time-consuming and expensive, so an efficient computational model for ASD risk gene prediction is necessary. RESULTS: In this study, we propose DeepASDPerd, a predictor for ASD risk RNA based on deep learning. Firstly, we use K-mer to feature encode the RNA transcript sequences, and then fuse them with corresponding gene expression values to construct a feature matrix. After combining chi-square test and logistic regression to select the best feature subset, we input them into a binary classification prediction model constructed by convolutional neural network and long short-term memory for training and classification. The results of the tenfold cross-validation proved our method outperformed the state-of-the-art methods. Dataset and source code are available at https://github.com/Onebear-X/DeepASDPred is freely available. CONCLUSIONS: Our experimental results show that DeepASDPred has outstanding performance in identifying ASD risk RNA genes.

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15. Gratton FV, Strang JF, Song M, Cooper K, Kallitsounaki A, Lai MC, Lawson W, van der Miesen AIR, Wimms HE. The Intersection of Autism and Transgender and Nonbinary Identities: Community and Academic Dialogue on Research and Advocacy. Autism in adulthood : challenges and management. 2023; 5(2): 112-24.

Many transgender people are autistic. Community expressions of the autism transgender intersection abound. Some commentators have questioned the proportional overrepresentation of autism among gender-diverse people, suggesting these individuals may not be truly autistic or truly transgender. However, increasing evidence challenges assertions that deny the authenticity of co-occurring autistic and transgender identities. Specifically, research by authors of this article indicates autistic transgender people show neurophenotypes generally consistent with cisgender autistic people and implicit gender phenotypes consistent with nonautistic transgender people. This article features a dialogue between eight leading experts in the field of intersectional autism and gender diversity, including clinicians, researchers, community advocates, and experts who are themselves autistic transgender. Key topics of discussion included: how research findings on autism and gender diversity inform respectful and supportive responses to autistic transgender people; the benefits and harms of increased societal attention toward the autism transgender intersection; and research and advocacy priorities. The expert panel concluded the following: (1) it is important to respect transgender autistic people’s wellness and resilience, while also acknowledging the pathologization and stigmatization they face; (2) autistic gender-diverse people are experts of their own identity and should be involved in all aspects of research and clinical care; (3) research is needed to understand the disparities autistic transgender people face; (4) attempts to restrict autistic transgender people’s access to gender care are unsupported by existing research; (5) adult gender care may benefit from incorporating universal design principles and neurodiversity-affirming strategies to reduce barriers to care and improve clinician-client communication in treatment delivery and the informed consent process; (6) cross-cultural and cross-societal research will improve best care practices in diverse contexts; (7) research and advocacy must be inclusive across ethnoracial identities, including in leadership and perspectives represented; and (8) a life span developmental framework is needed for adult research in this field.

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16. Haugland M, Hartmann K, Feinn R, Gowdy L, Marquis-Eydman T. Interprofessional Approach to Educate Health Care Students About Intellectual and Developmental Disabilities: Adaptive Communication and Physical Activity Planning. MedEdPORTAL : the journal of teaching and learning resources. 2023; 19: 11317.

INTRODUCTION: People with intellectual and/or developmental disabilities (IDD) are a historically marginalized population and often require complex team-based health care services. Health care students receive little, if any, training about caring for this population. Improving training at the student level can improve health care quality for this population. METHODS: We developed a two-part interprofessional seminar series to increase students’ knowledge, attitudes, and skills regarding caring for patients with IDD. The seminars were taught over Zoom and utilized presentation slides, prerecorded mock video interviews, and breakout room discussions focused on adaptive communication and developing adaptive physical activity plans for people with IDD. Participants comprised undergraduate and graduate students from various health care professional programs, including occupational therapy, medicine, and nursing. RESULTS: Part 1 had 208 participants, and part 2 had 107 participants. Both seminars were assessed using pre- and postsurveys that demonstrated increased participant comfort and confidence with the respective subjects. Competence of learned skills was not assessed. Participants in both seminars felt they would benefit from more direct interaction with people with IDD to practice learned skills. DISCUSSION: The results are encouraging for continued implementation at Quinnipiac University, with potential for use in other programs. Further iterations may include people with IDD serving as seminar cofacilitators, opportunities for students to directly interact with people with IDD, and use of an assessment approach evaluating learned skills competence. Curriculum expansion should cover the unique health care inequities faced by people with IDD who also belong to other marginalized groups.

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17. Hughes MM, Kirby AV, Davis J, Bilder DA, Patrick M, Lopez M, DaWalt LS, Pas ET, Bakian AV, Shaw KA, DiRienzo M, Hudson A, Schwenk YD, Baroud TM, Washington A, Maenner MJ. Individualized Education Programs and Transition Planning for Adolescents With Autism. Pediatrics. 2023.

OBJECTIVES: The study objectives were to examine the contents of individualized education programs (IEPs) of adolescents with autism spectrum disorder (ASD), including postsecondary transition goals, services, and changes in special education classification over time. METHODS: This study involved a longitudinal population-based surveillance cohort from the Autism Developmental Disabilities Monitoring Network from 2002 to 2018 in 3 catchment areas in the United States. The sample included 322 adolescents who were born in 2002, identified with ASD, and had an IEP available for review at ages 15-16 years. RESULTS: We found that 297 (92%) adolescents with ASD had an IEP including a transition plan. Those without intellectual disability (ID) were more likely to have postsecondary education and employment goals and have those goals be to pursue higher education or competitive employment compared with those with ID. Forty-one percent of adolescents with ASD had a postsecondary living arrangement goal. Although 28% of adolescents with ASD received school-based mental health services, none of these adolescents were Black; additionally, 15% of those with ID received mental health services compared with 34% without ID. The percentage of adolescents with ASD served under an autism classification increased from 44% at age 8 years to 62% by age 16. CONCLUSIONS: We identified gaps and disparities in school-based postsecondary transition planning. Working with education partners, families, and adolescents will be important to identify what challenges contribute to these findings and what supports are needed to improve the equity and quality of the transition planning process for adolescents with ASD so they are prepared for adulthood.

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18. Kallitsounaki A, Williams DM. Brief Report: An Exploration of Alexithymia in Autistic and Nonautistic Transgender Adults. Autism in adulthood : challenges and management. 2023; 5(2): 210-6.

BACKGROUND: Research has shown that many autistic people have alexithymia, a psychological trait characterized by difficulties in identifying and describing emotions. It is also now clear that there is a high rate of autism among transgender people, but we know little about the intersection of autism and gender diversity or about the clinical features of autistic transgender individuals. METHODS: Seventy-eight nonautistic transgender, 56 autistic transgender, 106 nonautistic cisgender, and 107 autistic cisgender adults completed the Toronto Alexithymia Scale-20 and the Autism-spectrum Quotient as part of an online study. We also used the General Alexithymia Factor Score-8 as an additional alexithymia score. RESULTS: We found that nonautistic transgender participants reported significantly higher mean levels of alexithymia than nonautistic cisgender participants, and that there was a significant overrepresentation of individuals in this group who met the clinical cutoff for alexithymia. The difference in alexithymia between autistic cisgender and autistic transgender participants was nonsignificant, with >50% of each group scoring above the clinical cutoff point. Of note, when we used the General Alexithymia Factor Score-8, the difference between autistic transgender participants and autistic cisgender participants was significant, with autistic transgender participants reporting higher mean levels of alexithymia. CONCLUSION: Results suggest that nonautistic transgender individuals might be more prone to experience alexithymia (including at clinically significant levels) than nonautistic cisgender people. When autism occurs in transgender people, the average level and clinical rate of alexithymia is higher than among nonautistic transgender people and potentially higher than among autistic cisgender people. Our findings are in keeping with evidence of a subgroup of transgender people with « subclinical autism » and inconsistent with the notion that autism among transgender and gender diverse people is a « phenomimic » of autism. Lastly, our study highlights the potential importance of screening autistic and nonautistic transgender people for alexithymia. WHY IS THIS AN IMPORTANT ISSUE? Alexithymia is when a person has difficulty recognizing and describing their emotional feelings. It also includes an externally oriented thinking style. Research has shown that many autistic people experience alexithymia. Autistic people with alexithymia might require additional and specialized support and care. WHAT WAS THE PURPOSE OF THIS STUDY? There are a large number of transgender and gender diverse people who are autistic. However, we know little about the intersection of autism and gender diversity or about the clinical characteristics of autistic people who identify as transgender. The purpose of this study was to explore alexithymia in autistic and nonautistic transgender individuals. WHAT DID THE RESEARCHERS DO? We conducted an online study that included questions about people’s ability to recognize and describe their emotional feelings as well as about their preference to engage with the world around them than the world inside them. Participants also answered questions that tap characteristics of autism. WHAT WERE THE RESULTS OF THE STUDY? We found that nonautistic transgender adults had more difficulty identifying and describing their emotional feelings than nonautistic cisgender adults. We also found that autistic transgender adults reported significantly higher levels of alexithymia than nonautistic transgender adults and potentially higher than autistic cisgender adults. WHAT DO THESE FINDINGS ADD TO WHAT WAS ALREADY KNOWN? This study showed, for the first time, that (1) it is not always easy for nonautistic transgender people to identity and describe their emotional feelings and (2) autistic transgender people find at least as difficult as autistic cisgender individuals to describe and identify their emotional feelings. WHAT ARE POTENTIAL WEAKNESSES IN THE STUDY? We did not examine depression and anxiety in our participants. People with depression and/or anxiety might score high on the scale we used to measure alexithymia. This was also an exploratory study, so other researchers should replicate our findings before we draw strong conclusions. HOW WILL THESE FINDINGS HELP AUTISTIC ADULTS NOW OR IN THE FUTURE? Our findings are consistent with the notion that autism in transgender people is “real,” meaning that it has the same underlying basis in autistic cisgender and autistic transgender people, and suggest that autistic transgender people might benefit from receiving support for difficulties related to autism independently of the support and treatment they might receive for gender-related needs. eng.

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19. Kilpatrick S, Irwin C, Singh KK. Human pluripotent stem cell (hPSC) and organoid models of autism: opportunities and limitations. Translational psychiatry. 2023; 13(1): 217.

Autism spectrum disorder (ASD) is a complex neurodevelopmental disorder caused by genetic or environmental perturbations during early development. Diagnoses are dependent on the identification of behavioral abnormalities that likely emerge well after the disorder is established, leaving critical developmental windows uncharacterized. This is further complicated by the incredible clinical and genetic heterogeneity of the disorder that is not captured in most mammalian models. In recent years, advancements in stem cell technology have created the opportunity to model ASD in a human context through the use of pluripotent stem cells (hPSCs), which can be used to generate 2D cellular models as well as 3D unguided- and region-specific neural organoids. These models produce profoundly intricate systems, capable of modeling the developing brain spatiotemporally to reproduce key developmental milestones throughout early development. When complemented with multi-omics, genome editing, and electrophysiology analysis, they can be used as a powerful tool to profile the neurobiological mechanisms underlying this complex disorder. In this review, we will explore the recent advancements in hPSC-based modeling, discuss present and future applications of the model to ASD research, and finally consider the limitations and future directions within the field to make this system more robust and broadly applicable.

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20. Li X, Shen H, Kong H, Xie J. Autistic traits predict social avoidance and distress: The chain mediating role of perceived stress and interpersonal alienation. Scandinavian journal of psychology. 2023.

Social avoidance and distress are the primary aspects of social anxiety. Nonautistic people with high levels of autistic traits are more likely to exhibit social avoidance and distress. However, research has yet to reveal how autistic traits induce social avoidance and distress. To fill this gap, the present study recruited 708 participants to complete the 25-item Autism Spectrum Quotient, Social Avoidance and Distress Scale, Chinese Perceived Stress Scale, and Interpersonal Alienation Subscale. The results indicated that autistic traits significantly predicted social avoidance and distress in nonautistic people. In addition, autistic traits induced social avoidance and distress through perceived stress and interpersonal alienation, respectively. Importantly, perceived stress and interpersonal alienation (including the subdimensions of interpersonal alienation: sense of loneliness, sense of social isolation, and alienation between family members) partially mediated the relationships between autistic traits and social avoidance and distress. Overall, autistic traits predict social avoidance and distress via perceived stress and interpersonal alienation. This finding extends the hypothetical model of clinical anxiety in autism spectrum disorders. Furthermore, reducing perceived stress and interpersonal alienation in nonautistic people with high levels of autistic traits may be a valid intervention method to prevent and eliminate their social avoidance and distress.

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21. Li Z, Qi C. Why can’t children with autism integrate into society in China? Study based on the perspective of NGO classification. Frontiers in public health. 2023; 11: 1041815.

INTRODUCTION: In the field of protecting children with autism, NGOs have become a major force that cannot be ignored. Although NGOs for children with autism have expanded the number and improved the quality of the services they provide, a large number of autistic children still cannot achieve the goal of social inclusion in China. The existing literature has mostly tried to explain the reason from the perspective of the common characteristics of NGOs and has paid insufficient attention to the huge differences between these NGOs, so it is impossible to identify the obstacles that children with autism encounter accurately. METHODS: From the perspective of NGO classification, this study conducted an in-depth investigation of 4 NGO cases in City N, China, to show the impact of the difference of NGOs on the obstacles to the social inclusion of autistic children. RESULTS: The research has found that under the authoritarian regime, NGOs for children with autism that rely heavily on external funds include three common groups: government-oriented NGOs, foundation-supported NGOs, and individual-financed NGOs. The structural characteristics of the funders and their interaction with the NGOs for children with autism shape their different action logics, as the result that the desire of children with autism to integrate into society cannot be achieved as expected. DISCUSSION: The results of this study give more accurate insights into the barriers in social service provision for children with autism that impede their social inclusion and provide a reference for those seeking a solution to this problem.

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22. Maroney MR, Levitt HM, Horne SG. Exploring the Efficacy of an Online Intervention in Processing Experiences of Heterosexism Among Autistic-LGBQ + Individuals. Journal of autism and developmental disorders. 2023.

This experimental study explored the use of online expressive writing interventions to cope with distress from heterosexist events among a sample of autistic-LBGQ + individuals. This study included an open writing condition and an emotion focused therapy guided writing condition. Over 89% of the participants indicated that the writing exercises were helpful in processing the event, with significant decreases for measures of depressive and trauma/stressor symptoms. A thematic analysis identified specific aspects of each condition that were helpful for participants in coping with heterosexist distress, such as the development of insight through the emotion-focused exercises. This low-demand exercise is promising as a solo exercise or as a therapy homework assignment, especially given the accessibility of this online intervention for autistic-LGBQ + people.

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23. McAuliffe C, Walsh RJ, Cage E. « My whole life has been a process of finding labels that fit »: A Thematic Analysis of Autistic LGBTQIA+ Identity and Inclusion in the LGBTQIA+ Community. Autism in adulthood : challenges and management. 2023; 5(2): 127-38.

BACKGROUND: Being nonheterosexual and noncisgender appears to be more common among autistic people. This intersection of identities is often stigmatized in research and society. However, we know that community involvement can protect against negative mental health outcomes associated with being a minority; researchers found this effect in separate studies examining participation in the autistic and Lesbian, Gay, Bisexual, Trans, Queer, Intersex, Asexual plus other gender and sexual orientation-based identity (LGBTQIA+) communities. This study examined how autistic LGBTQIA+ individuals navigate their multiple marginalized identities and the LGBTQIA+ community. METHODS: Twelve autistic LGBTQIA+ people from the United Kingdom took part in semistructured interviews. Questions focused on identity and community. We analyzed the interviews using reflexive thematic analysis. RESULTS: We identified four overarching themes-Identity (Re)Development, Navigating Authenticity, Exclusion from Community Spaces, and Creating Change. Participants viewed accessing a community of similar others as a means of increasing understanding, self-knowledge, and self-acceptance. We identified several barriers to inclusion, including accessibility and gatekeeping. Participants discussed strategies to combat these obstacles, such as the creation of intersectional community spaces and activism and representation as a means of increasing autism understanding. CONCLUSIONS: This study suggests that similar to other marginalized groups, autistic LGBTQIA+ individuals are motivated to engage in communities relevant to their identities. However, community spaces for autistic LGBTQIA+ are often inaccessible due to social, sensory, and identity-based barriers. Participants highlighted autism understanding as a barrier to coming out both in community and noncommunity settings. This suggests that improving autism acceptance and understanding is crucial to achieve accessible, intersectional, and inclusive community spaces. WHY IS THIS AN IMPORTANT ISSUE? Autistic people are more likely to be part of the Lesbian, Gay, Bisexual, Transgender, Queer, Intersex, Asexual plus other gender- or sexual orientation-based identity (LGBTQIA+) communities. Being part of a community may boost well-being. Because of a history of viewing autistic and LGBTQIA+ identities in a negative medicalized way, we have limited understanding of autistic people’s experiences of having both identities and being part of both communities. We think everyone could listen and learn more from autistic LGBTQIA+ people and think about ways of creating accessible spaces where autistic LGBTQIA+ people can flourish. WHAT WAS THE PURPOSE OF THIS STUDY? We looked at autistic LGBTQIA+ people’s experiences of the LGBTQIA+ community. We were also interested in understanding how autistic LGBTQIA+ people experienced their different identities (e.g., being both autistic and LGBTQIA+, and how these connect). WHAT DID THE RESEARCHERS DO? We developed interview questions with a trans autistic collaborator. The questions were about experiences and identities as an autistic LGBTQIA+ person and getting involved in communities. We did interviews with 12 LGBTQIA+ autistic adults from the United Kingdom, who were diverse in age, gender identity, and sexuality. We then identified patterns in what the interviewees said. WHAT WERE THE RESULTS? Interviewees talked about how they had made sense of “who they were” over time and tried to be true to themselves. However, they mentioned many barriers when trying to access the LGBTQIA+ community. These barriers included community spaces that were overwhelming in social and sensory ways. Although nonautistic LGBTQIA+ individuals might welcome autistic people into the community, they did not really understand autism. Interviewees were also concerned about “gatekeeping,” which means that some LGBTQIA+ community members decided who belonged in the community. Despite these barriers, interviewees still wanted to be part of LGBTQIA+ communities and suggested solutions, such as flexible online spaces, more autistic LGBTQIA+ role models, and fighting for change in society. WHAT DO THESE FINDINGS ADD TO WHAT WAS ALREADY KNOWN? These findings help us to better understand a topic there is not much research on—the experiences of autistic LGBTQIA+ people. Our findings tell us about how our interviewees came to appreciate their different identities, and the benefits and challenges of being included in LGBTQIA+ communities. WHAT ARE POTENTIAL WEAKNESSES IN THE STUDY? Our findings reflect the experiences of a small group of people in the United Kingdom, so their experiences will not apply to everyone. Our group lacked diversity in some ways—all interviewees were White and no one reported having a co-occurring learning disability. We do not know how our findings would apply to people with other minority identities. HOW WILL THESE FINDINGS HELP AUTISTIC ADULTS NOW OR IN THE FUTURE? This study helps us better understand the experiences of autistic LGBTQIA+ people and the barriers they face. Community spaces specifically for autistic LGBTQIA+ could be good, to help people explore their identities and find similar people. These spaces need funding, and we must make sure that they are accessible to everyone, regardless of how they identify. eng.

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24. McQuaid GA, Gendy J, Lee NR, Wallace GL. Sexual Minority Identities in Autistic Adults: Diversity and Associations with Mental Health Symptoms and Subjective Quality of Life. Autism in adulthood : challenges and management. 2023; 5(2): 139-53.

BACKGROUND: Although disparities in mental health and subjective quality of life (QoL) have been reported for autistic adults, reasons for these disparities are poorly understood. A potential factor in these disparities is exposure to social stressors related to minority status (i.e., minority stress), including stigma and discrimination. Autistic individuals are more likely than nonautistic individuals to be from groups with other minority identities, including sexual minorities (i.e., sexual orientations such as asexual, bisexual, gay). However, to date, few studies have examined whether sexual minority autistic adults experience diminished mental health relative to heterosexual autistic adults, and no research has examined subjective QoL for sexual minority compared with heterosexual autistic adults. METHODS: Participants were 651 autistic adults aged 18.5 to 83.3 years recruited through Simons Powering Autism Research’s Research Match. All participants resided in the United States. Participants completed surveys online, including measures of anxious and depressive symptomatology, perceived stress, and subjective QoL. Participants reported their sexual orientation and other sociodemographic variables. RESULTS: A large proportion of autistic adults reported a sexual minority identity (41.2%), and a diversity of sexual identities was reported. Sexual minority autistic adults reported poorer mental health and lower subjective QoL across all assessed domains relative to heterosexual autistic adults. CONCLUSION: Understanding factors that may be associated with poorer mental health and decreased subjective QoL in autistic adults is critical and has been identified as a research priority by autistic stakeholders. The findings reported here underscore the need to examine mental health and subjective QoL disparities among autistic individuals within a societal context, taking into consideration the potential of intersecting minority identities and increased social stressors, as these added stressors may increase risks for poorer outcomes. WHY IS THIS AN IMPORTANT ISSUE? Autistic people are at risk for mental health problems, such as depression and anxiety, and report lower quality of life. Autistic people are more likely than nonautistic people to identify as a sexual minority. Sexual minority identities are sexual orientations other than heterosexual, such as asexual, bisexual, or gay. Sexual minority persons are also at risk for mental health problems and lower quality of life. Autistic people who are sexual minorities may have even higher risk of mental health problems and lower quality of life. WHAT WAS THE PURPOSE OF THIS STUDY? There is little research on mental health and quality of life in persons who are both autistic and identify as a sexual minority. Sexual minority autistic adults may be exposed to more minority-related stress than heterosexual autistic adults. People who belong to minority groups face added stress created by society. This added stress is referred to as minority stress, which includes things such as discrimination, rejection, or violence. Minority stress could increase risk for poor outcomes. We compared heterosexual and sexual minority autistic adults to see if having more than one minority identity (an autistic identity and a sexual minority identity) was associated with mental health or subjective quality of life. Subjective quality of life refers to how a person feels about parts of their life, such as their physical and psychological health or their living arrangements. WHAT DID THE RESEARCHERS DO? We asked 651 autistic adults living in the United States to complete surveys online. Participants rated their anxiety, depression, and everyday stress; answered questions about their subjective quality of life; and reported their sexual orientation, sex assigned at birth, and gender identity. We compared sexual minority with heterosexual autistic adults to see if they differed for mental health or subjective quality-of-life ratings. WHAT WERE THE RESULTS OF THE STUDY? A total of 41.2% of autistic adults reported a sexual minority identity. Autistic adults reported a diversity of sexual orientations, including asexual, bisexual, gay, and pansexual. Sexual minority autistic adults reported more depression, anxiety, and stress compared with heterosexual autistic adults. Sexual minority autistic adults reported poorer subjective quality of life across different areas of their lives compared with heterosexual autistic adults. Sexual minority autistic adults reported having less energy and more physical pain than heterosexual autistic adults. Sexual minority autistic adults also reported feeling more negative emotions and having problems with thinking/concentration. Sexual minority autistic adults reported more concerns about things such as having health care and transportation and greater worries about feeling safe in their homes and neighborhoods. Finally, sexual minority autistic adults were more likely to report that they faced barriers in their everyday lives (such as sensory sensitivities making it hard to grocery shop). WHAT ARE THE POTENTIAL WEAKNESSES IN THE STUDY? Although we found significant differences between sexual minority and heterosexual autistic groups, other factors likely play a role in these results. For example, we know that not having enough social support can contribute to worse mental health and quality of life. Measuring other such factors is needed in future studies. HOW WILL THESE FINDINGS HELP AUTISTIC ADULTS NOW OR IN THE FUTURE? These findings highlight the need for more awareness of sexual minority identities in autistic adults. Understanding factors that may contribute to worse mental health and quality of life for autistic adults can help us improve well-being for all autistic people. eng.

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25. Pemment J. Life As a Sapiosexual Autist. Autism in adulthood : challenges and management. 2023; 5(2): 125-6.

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26. Schwartzman JM, Bonner HR. Behavioral and Social Activation in Autism and Associations with Youth Depressive Symptoms from Youth and Caregiver Perspectives. Journal of autism and developmental disorders. 2023.

Autistic youth are more likely to experience depression than their non-autistic peers, yet research on risk and protective factors to depression in this population is limited. Behavioral activation (i.e., prioritizing and engaging in meaningful activities), including social activities, is an important mechanism in the pathway to depression in non-autistic youth that is understudied in autism. Ratings of youth depressive symptoms and behavioral and social activation at one timepoint from 100 autistic youth without intellectual disability and 100 of their caregivers were analyzed. The study aims were to examine caregiver and youth ratings of youth internalizing symptoms and behavioral and social activation, inter-rater reliability on study variables, and associations between depressive symptoms and behavioral and social activation in autistic youth by rater. Results revealed significant differences in youth and caregiver ratings on all variables and inter-rater reliability ranged from poor to moderate. Across both raters, more severe anxiety symptoms and lower behavioral activation were associated with more severe depressive symptoms; social activation, specifically the number of friends youth have, was significant in caregiver ratings only. Findings can be leveraged to enhance risk stratification and intervention efforts for autistic youth experiencing depression.

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27. Shakeshaft A, Heron J, Blakey R, Riglin L, Davey Smith G, Stergiakouli E, Tilling K, Thapar A. Co-development of attention deficit hyperactivity disorder and autistic trait trajectories from childhood to early adulthood. Journal of child psychology and psychiatry, and allied disciplines. 2023.

BACKGROUND: Attention deficit hyperactivity disorder (ADHD) and autism, defined as traits or disorders, commonly co-occur. Developmental trajectories of ADHD and autistic traits both show heterogeneity in onset and course, but little is known about how symptom trajectories co-develop into adulthood. METHODS: Using data from a population cohort, the Avon Longitudinal Study of Parents and Children, we examined correlations between ADHD and autistic traits across development, using the Social Communication Disorders Checklist and ADHD subscale of the Strengths and Difficulties Questionnaire. We modelled joint developmental trajectories of parent-reported ADHD and autistic traits between 4 and 25 years, then characterised trajectory classes based on sociodemographic, perinatal, psychopathology, cognition and social functioning variables and tested for associations with neurodevelopmental/psychiatric polygenic scores (PGS). RESULTS: Three classes of trajectories were identified; a typically developing majority with low-stable ADHD-autistic traits (87%), a male-predominant subgroup with child/adolescent-declining traits (6%) and a subgroup with late-emerging traits (6%). ADHD-autistic trait correlations were greatest in young adulthood for the two nontypically developing classes. There were higher rates of emotional and conduct problems, low IQ, childhood seizures and poor social functioning in the declining and late-emerging classes compared to the low-stable class. Emotional, conduct and peer problems were more prevalent during childhood in the childhood/adolescent-declining class compared to other classes, but were more prevalent in young adulthood in the late-emerging class. Neurodevelopmental/psychiatric PGS also differed: both nontypically developing classes showed elevated ADHD PGS compared to the low-stable group, and the late-emerging group additionally showed elevated schizophrenia PGS and decreased executive function PGS, whereas the declining group showed elevated broad depression PGS. CONCLUSIONS: Distinct patterns of ADHD-autism co-development are present across development in the general population, each with different characterising factors and genetic signatures as indexed by PGS.

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28. Silva AE, Harding JE, Chakraborty A, Dai DW, Gamble GD, McKinlay CJD, Nivins S, Shah R, Thompson B. Associations Between Autism Spectrum Quotient and Integration of Visual Stimuli in 9-year-old Children: Preliminary Evidence of Sex Differences. Journal of autism and developmental disorders. 2023.

PURPOSE: The dorsal stream vulnerability hypothesis posits that the dorsal stream, responsible for visual motion and visuo-motor processing, may be particularly vulnerable during neurodevelopment. Consistent with this, autism spectrum disorder (ASD) has been associated with deficits in global motion integration, though deficits in ventral stream tasks, such as form identification, have also been reported. In the current study, we examined whether a similar pattern of results is found in a cohort of 381 children born with neurodevelopmental risk factors and exhibiting a wide spectrum of caregiver-reported autistic traits. METHODS: We examined the associations between global motion perception, global form perception, fine motor function, visual-motor integration, and autistic traits (autism spectrum quotient, AQ) using linear regression, accounting for possible interactions with sex and other factors relevant to neurodevelopment. RESULTS: All assessments of dorsal stream function were significantly associated with AQ such that worse performance predicted higher AQ scores. We also observed a significant sex interaction, with worse global form perception associated with higher AQ in boys (n = 202) but not girls (n = 179). CONCLUSION: We found widespread associations between dorsal stream functions and autistic traits. These associations were observed in a large group of children with a range of AQ scores, demonstrating a range of visual function across the full spectrum of autistic traits. In addition, ventral function was associated with AQ in boys but not girls. Sex differences in the associations between visual processing and neurodevelopment should be considered in the designs of future studies.

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29. Steinberg H, Garfield T, Becker A, Shea L. What Category Best Fits: Understanding Transgender Identity in a Survey of Autistic Individuals. Autism in adulthood : challenges and management. 2023; 5(2): 204-9.

INTRODUCTION: Calls for improved measures of gender identity to understand the experience of transgender individuals have grown rapidly in the past 5 years. The need for methodological innovation in this topic area has particular importance for the autistic population since a higher co-occurrence of transgender identities among autistic people has been documented but is not well understood. We use a survey with questions that reflect standards in 2018 to demonstrate how binary conceptualizations of gender did not adequately capture gender identities of transgender autistic individuals. METHODS: Using descriptive statistics from a statewide survey of 1527 autistic adults (mean age 27.5 years), this study compared self-reported survey responses to close-ended standard questions at the time about gender identity to understand shortcomings in capturing this population authentically. RESULTS: We found a mismatch between respondents answering that they were transgender, the sex assigned at birth, and gender identity on separate questions. We postulate that transgender men and women were likely selecting binary responses when asked about gender identity. Furthermore, we found that many qualitative responses reported in the self-selected « other » category reflected nonbinary identities and utilized specific terminology that revealed nuance in how they understood gender identities. CONCLUSIONS: We urge researchers to provide multiple flexible options when measuring gender identity in autistic populations as they are likely to encompass many identities. We endorse best practices for measuring gender identity for autistic research. WHY IS THIS AN IMPORTANT ISSUE? Autistic people may be more likely to identify as transgender, or a gender identity different from their sex assigned at birth. Transgender autistic people may identify with binary gender identities, as men or women. Some transgender autistic people have nonbinary gender identities or identities that are different from these binary gender identities. If standard measures do not work well for transgender autistic people, their use may result in less accurate research. We present better ways to ask gender identity questions in autism research surveys. WHAT WAS THE PURPOSE OF THIS STUDY? This study explored how accurately standard questions about sex and gender measure gender identity for transgender autistic people. We looked at how autistic people responded to sex and gender questions in a statewide survey completed in 2018. We suggest improvements in gender identity questions to include diverse gender identities reported by autistic people. WHAT DID THE RESEARCHERS DO? We collected 1527 responses from autistic adults using the Pennsylvania Autism Needs Assessment completed in 2018. We examined descriptive statistics for how respondents answered one question about current gender identity, one question about transgender identity, and one question about sex assigned at birth. WHAT WERE THE RESULTS OF THE STUDY? We found that these three standard questions did not reflect the gender identities of autistic people who took the survey. In response to the transgender identity question, 4% of autistic adults reported that they were transgender or nonbinary. Most (93.9%) of the sample reported binary identities, as male or female. Some autistic adults (2.3%) chose the “other” category on the current gender identity question. They reported a variety of binary gender identities or nonbinary identities. Many autistic adults did not answer questions about sex assigned at birth (26.7%) or transgender identity (27.1%). WHAT DO THESE FINDINGS ADD TO WHAT WAS ALREADY KNOWN? We did not know if standard gender identity questions measured transgender identities in autistic people correctly. These findings show that they do not, but also that current measures may not fully address a variety of gender identities, including nonbinary identities. WHAT ARE POTENTIAL WEAKNESSES IN THE STUDY? We use three survey questions from a survey that had already been used. The measures we used might not have captured how transgender autistic adults see themselves. Autistic adults who had support in completing the survey might have felt pressure from other people, such as caregivers, to answer a certain way. HOW WILL THESE FINDINGS HELP AUTISTIC ADULTS NOW OR IN THE FUTURE? Transgender autistic people have not been studied or supported extensively in the past. Better gender measures could help us learn more about transgender autistic people and possible unmet needs within this population. We suggest best practices that autism researchers can implement in surveys. This will ensure that research more accurately reflects transgender autistic adults’ gender identities. Respectful and appropriate methods will improve autism research and translate into better understanding, support, and quality of life for transgender autistic adults. eng.

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30. Strang JF, Fischbach AL. A Special Issue of Autism in Adulthood Dedicated to the Intersection of Autism and the Broad LGBTQ. Autism in adulthood : challenges and management. 2023; 5(2): 109-11.

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31. Strang JF, McClellan LS, Raaijmakers D, Caplan R, Klomp SE, Reutter M, Lai MC, Song M, Gratton FV, Dale LK, Schutte A, de Vries ALC, Gardiner F, Edwards-Leeper L, Minnaard AL, Eleveld NL, Corbin E, Purkis Y, Lawson W, Kim DY, van Wieringen IM, Rodríguez-Roldán VM, Harris MC, Wilks MF, Abraham G, Balleur-van Rijn A, Brown LXZ, Forshaw A, Wilks GB, Griffin AD, Graham EK, Krause S, Pervez N, Bok IA, Song A, Fischbach AL, van der Miesen AIR. The Gender-Diversity and Autism Questionnaire: A Community-Developed Clinical, Research, and Self-Advocacy Tool for Autistic Transgender and Gender-Diverse Young Adults. Autism in adulthood : challenges and management. 2023; 5(2): 175-90.

BACKGROUND: Autistic transgender people face unique risks in society, including inequities in accessing needed care and related mental health disparities. Given the need for specific and culturally responsive accommodations/supports, the characterization of key experiences, challenges, needs, and resilience factors within this population is imperative. This study developed a structured self-report tool for autistic transgender young adults to communicate their experiences and needs in a report format attuned to common autistic thinking and communication styles. METHODS: This cross-nation project developed and refined the Gender-Diversity and Autism Questionnaire through an iterative community-based approach using Delphi panel methodology. This proof-of-principle project defined « expertise » broadly, employing a multi-input expert search approach to balance academic-, community-, and lived experience-based expertise. RESULTS: The expert collaborators (N = 24 respondents) completed a two-round Delphi study, which developed 85 mostly closed-ended items based on 90% consensus. Final item content falls within six topic areas: the experience of identities; the impact of experienced or anticipated discrimination, bias, and violence toward autistic people and transgender people; tasks and experiences of everyday life; gender diversity- or autism-related care needs and history; the experience of others doubting an individual’s gender identity and/or autism; and the experience of community and connectedness. The majority of retained items relate to tasks and experiences of everyday life or the impact of experienced or anticipated discrimination, bias, and violence. CONCLUSIONS: This study employed a multipronged multimodal search approach to maximize equity in representation of the expert measure development team. The resulting instrument, designed for clinical, research, and self-advocacy applications, has parallel Dutch and English versions and is available for immediate use. Future cross-cultural research with this instrument could help identify contextual risk and resilience factors to better understand and address inequities faced by this large intersectional population. WHY IS THIS AN IMPORTANT ISSUE? Transgender and gender-diverse are words used to describe people whose gender varies from their assigned sex at birth. Many autistic people identify as being transgender/gender-diverse. Autistic gender-diverse/transgender young adults often describe difficulties getting the care they need, which can increase their chances of experiencing stress and mental health challenges. This study created a self-report questionnaire for autistic transgender/gender-diverse young adults to share about their health care, support needs, and broader experiences. WHAT WERE THE RESULTS OF THE STUDY? A diverse group of experts in the autism and gender diversity co-occurrence, including autistic transgender people, worked together to develop the questionnaire. The researchers found experts by searching the internet and talking to people in the community and research field. The questionnaire is called the Gender-Diversity and Autism Questionnaire and has 85 questions that are grouped into 6 different areas: the experience of identities; the impact of experienced or anticipated discrimination, bias, and violence toward autistic people and transgender people; tasks and experiences of everyday life; gender diversity- or autism-related care needs and history; the experience of others doubting an individual’s gender identity and/or autism; and the experience of community and connectedness. The questionnaire has English and Dutch versions so it can be used for research in different countries. WHAT DO THE AUTHORS RECOMMEND FOR FUTURE RESEARCH ON THIS TOPIC? Researchers are currently using the new questionnaire to compare the experiences and needs of autistic transgender young adults in the Netherlands and the United States. The results may help explain why some outcomes are different between autistic transgender young people in the two countries and how culture and society play a role. HOW WILL THESE FINDINGS HELP AUTISTIC ADULTS NOW OR IN THE FUTURE? We created the questionnaire to be used in different settings, including clinics and in research. The questionnaire gives autistic transgender young adults a structured way to communicate their experiences, needs, challenges, and areas of strength. The answers that an autistic transgender young adult gives on the questionnaire could help other people understand the clinical and community supports that the young adult wants and needs. Future studies may use the questionnaire to understand obstacles that autistic transgender young adults may face. eng.

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32. Tang Y, Wang C, Liu X, Li F, Dai Y, Cui L, Li F. Children with autism spectrum disorder perform comparably to their peers in a parent-child cooperation task. Experimental brain research. 2023.

This study investigates whether and how parent’s cooperation affects child’s cooperation, and whether that differs between children with/without autism spectrum disorder (ASD). The experiment involved a cooperative key-pressing task completed first by parent-parent dyads and then by parent-child dyads, meanwhile brain activity in the right frontal-parietal cortex of dyad partners was measured synchronously. The results showed the following: ASD children exhibited performance comparable to those of their peers, as was the level of brain synchronization with their parents, which was mainly due to parents with ASD children tending to adjust their own response patterns to match those of their children. These findings suggest that parents can somewhat actively mitigate the lower interpersonal synchronization ability of ASD children, in behavioral or/and neural level.

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33. Tullo D, Levy B, Faubert J, Bertone A. Characterizing Attention Resource Capacity in Autism: A Multiple Object Tracking Study. Journal of autism and developmental disorders. 2023.

The extant literature aimed at characterizing attentional capability in autistics has presented inconsistent findings. This inconsistency and uncertainty may be the product of different theoretical and methodological approaches used to define attention in autism. In the current study, we investigate whether the allocation of attentional resources to task demands, and attention resource capacity, differs between autistics with no comorbid attention-deficit diagnosis (n = 55) and age-matched neurotypicals (n = 55). We compared differences in capacity and the allocation of resources by manipulating attentional load in a Multiple Object-Tracking (MOT) task, a robust, versatile, and ecological measure of selective, sustained, and distributed attention. While autistics demonstrated lower MOT performance, this difference disappeared when we accounted for fluid reasoning intelligence. Additionally, the similarity in the trend of MOT performance at increasing levels of attentional load between autistics and neurotypicals suggests no differences in the allocation of attentional resources to task demands. Taken together, our study suggests that higher-order cognitive abilities, such as intelligence, should be considered when characterizing attention across the autistic population in research. Similarly, our findings highlight the importance of considering cognitive competence when assessing attentional capabilities in autistic individuals, which could have significant implications for clinical diagnosis, treatment, and support.

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34. Wallisch A, Boyd BA, Hall JP, Kurth NK, Streed CG, Jr., Mulcahy A, McMaughan DJ, Batza K. Health Care Disparities Among Autistic LGBTQ+ People. Autism in adulthood : challenges and management. 2023; 5(2): 165-74.

BACKGROUND: Lesbian, gay, bisexual, transgender, or queer (LGBTQ+) people and disabled people experience disparities in access to health care compared with others. However, we have yet to understand how health care disparities may be further exacerbated at the intersection of disability and LGBTQ+ identity, particularly among autistic people. OBJECTIVES: The primary goals of this study were to (1) examine differences in unmet health care needs and health status between LGBTQ+ autistic people and straight/cisgender autistic people and (2) explore how state policies and demographics predict the unmet health care needs of the autistic LGBTQ+ people. METHODS: We conducted a cross-sectional analysis using data from the 2019 National Survey on Health and Disability that included a subsample of autistic participants, with 62 LGBTQ+ adults and 58 straight/cisgender adults. To address our first study goal, we used an independent samples t-test, and to address our second study goal, we used Poisson regression. RESULTS: The LGBTQ+ group reported significantly more days of poor physical and mental health, more co-occurring diagnoses, and more unmet health care needs than the straight/cisgender group. For LGBTQ+ people, protective state health care laws and a lower income resulted in significantly more health care needs being met. CONCLUSIONS: Findings from this study suggest that the intersection of an LGBTQ+ identity and autism is associated with greater disparities in physical and mental health as well as unmet health care needs; however, state policies prohibiting discrimination of LGBTQ+ people may act as a protective factor and result in fewer unmet health care needs. Future research should examine additional structural factors that may mitigate health inequities for autistic LGBTQ+ people. WHY IS THIS AN IMPORTANT ISSUE? More people in the autistic community identify as lesbian, gay, bisexual, transgender, or queer (LGBTQ+) as compared with the general population. Previous research described poorer health outcomes and issues in accessing health care for LGBTQ+ people. We need to understand how identifying as both autistic and LGBTQ+ is related to health outcomes and getting health care needs met. This is important information to improve future health care access and reduce health care issues. WHAT WAS THE PURPOSE OF THIS STUDY? We wanted to see whether there were differences between autistic/LGBTQ+ people and autistic/straight/cisgender people in accessing health care and health status. We also wanted to understand what factors contributed to unmet health care needs for autistic/LGBTQ+ people. WHAT DID THE RESEARCHERS DO? Our team used data from the second wave of the National Survey on Health and Disability (NSHD) fielded from October 2019 through January 2020. The NSHD sample included 2175 disabled participants, and 120 participants of the sample self-identified as autistic. We compared responses of autistic/LGBTQ+ people with autistic/straight/cisgender respondents. We compared these two groups on responses related to the number of good mental and physical health days, number of unmet health care needs, and number of additional diagnoses. We also looked at whether a person’s income, location, race, or ethnicity, as well as whether state laws that supported LGBTQ+ health care related to the increased unmet health care needs of the LGBTQ+ group. WHAT WERE THE RESULTS OF THE STUDY? The results suggested that the autistic/LGBTQ+ group reported fewer good health days, more unmet health care needs, and more diagnoses. The authors also found that state-wide health care laws that protected LGBTQ+ people related to more health care needs being met. LGBTQ+ people with a lower income also had fewer unmet health care needs. WHAT DO THESE FINDINGS ADD TO WHAT WAS ALREADY KNOWN? These findings are like other studies suggesting that identifying as autistic and LGBTQ+ results in more unmet health care needs and poorer health status. Our study adds to what is already known by exploring how other factors relate to the increased unmet health care needs among autistic/LGBTQ+ people. WHAT ARE POTENTIAL WEAKNESSES IN THE STUDY? The NSHD subsample was small that may affect the study findings. Our sample also lacked diversity and primarily included White non-Hispanic/non-Latine participants, and those living in urban areas. The lack of diversity limits the generalizability of our findings. There are also many other factors (e.g., culture and provider knowledge) that may relate to unmet health care needs in autistic/LGBTQ+ people. Future research should investigate additional factors related to unmet health care needs. HOW WILL THESE FINDINGS HELP AUTISTIC ADULTS NOW OR IN THE FUTURE? The findings are important because few research studies have focused on health care access among autistic/LGBTQ+ people in the United States. This study indicates the health care system is not supporting positive health outcomes and health care needs of autistic/LGBTQ+ adults. We need to continue to develop ways to support training of providers to reduce unmet health care needs and support better health outcomes. eng.

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35. Xie J, Chen J, Wu J, Liu Y, Gu X, Jiang W, Yang M, Huang Y. Interpersonal matching of autistic trait levels in typically developed individuals is associated with spontaneous gaze following and initiation during face-to-face social interaction. The British journal of clinical psychology. 2023.

OBJECTIVES: People with autism spectrum disorders (ASD) usually exhibit typical behaviours and thoughts that are called autistic traits. Autistic traits are widely and continuously distributed among typically developed (TD) and ASD populations. Previous studies have found that people with ASD have difficulty in following the eye gaze of social peers. However, it remains unknown whether TD adults with high or low autistic traits also differ in spontaneous gaze following and initiation in face-to-face social interactions. To fill this gap, this study used a novel and naturalistic gaze-cueing paradigm to examine this research question. DESIGN: A 4 (group: high-high, high-low, low-high or low-low autistic traits) × 3 (congruency: congruent, neutral, or incongruent) mixed-measures design was used. METHODS: Typically developed adults who were high or low in autistic traits completed a visual search task while a confederate who was high or low in autistic traits sat facing them. Critically, the match of autistic traits within a participant-confederate pair was manipulated. The confederate gazed at (congruent) or away from (incongruent) the location of the target prior to the appearance of the target. Participants were not explicitly instructed to follow the confederate’s gaze. RESULTS: Autistic traits were associated with spontaneous gaze following and initiation in face-to-face social interactions. Specifically, only when both the participant and confederate were low in autistic traits did the incongruent gaze cues of confederates interfere with the participants’ responses. CONCLUSIONS: Autistic traits impeded gaze following and initiation by TD adults. This study has theoretical and practical implications regarding autistic trait-induced social deficits and indicates a new approach for social skill interventions.

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