This study examined how parents of children with and without an autism diagnosis respond to their children's negative emotions. Specifically, we (1) compared levels of supportive, non-supportive, and distress reactions; (2) tested whether child characteristics (autism traits and emotion dysregulation) predicted parent responses; and (3) explored whether autism diagnosis moderated these associations. Participants were 1780 parents of 2- to 5-year-old children from the United States (812 with an autism diagnosis). Parents completed the Coping with Children's Negative Emotions Scale and reported on children's autism traits and emotion dysregulation. Results indicated that parents of autistic children reported slightly more supportive and less non-supportive and distress responses than parents of children without a diagnosis. Associations between child characteristics and parent responses differed by diagnostic group: parents of children without a diagnosis who had more autism traits reported more non-supportive and distress responses, while these associations were weaker or non-existent for parents of children with a diagnosis. Emotion dysregulation was also associated with parent responding, with subtle differences between groups. Findings suggest an autism diagnosis may shape how parents interpret and respond to children's emotions.Lay AbstractThis study looked at how parents of 2- to 5-year-old children with and without an autism diagnosis respond when their children are upset. A total of 1780 parents completed a questionnaire about how likely they were to respond to their child's negative emotions in ways that were supportive (e.g. comforting the child) and non-supportive (e.g. saying the child is over-reacting, punishing the child). The goal was to see if parents of children with autism respond differently compared to parents of children without autism, and to understand if certain traits of the child, like social-communication and emotional challenges, affect how parents respond. Parents of autistic children generally reported more supportive responding and less non-supportive responding compared to parents of children with a diagnosis, though these differences were very small. For parents of children without an autism diagnosis, having a child with more social or emotional challenges was linked to more non-supportive responses. In contrast, for parents of children with an autism diagnosis, their responses were less strongly associated with these child characteristics. Importantly, some of the young children in this study who did not have an autism diagnosis had significant social-communication challenges consistent with autism and may in fact be autistic children who haven't been diagnosed yet. These results suggest that how parents of children an autism diagnosis respond to their child's emotions may not be as impacted by their child's challenges as parents of children a diagnosis, perhaps because the autism diagnosis provides parents with understanding and support around these challenges. This highlights the importance of early identification of autism and providing support to all parents, particularly those with children who have social-communication and emotional difficulties.

Autistic people are more likely to be transgender and gender diverse than the general population. Furthermore, co-occurring trait-level autism and transgender and gender-diverse identity are associated with symptoms of depression and anxiety, and autistic adolescents who identify as transgender and gender diverse have more internalizing behaviors than both non-transgender and gender-diverse autistic adolescents and non-autistic transgender and gender-diverse adolescents. However, no study has yet examined the extent to which transgender and gender-diverse identity predicts specific co-occurring mental health diagnoses in autistic adolescents. In a sample of 9027 autistic adolescents aged 13 to 17 drawn from the Simons Powering Autism Research for Knowledge cohort, 36 of whom we identified as transgender and gender diverse, we estimated univariate models of transgender and gender-diverse identity as a predictor of individual diagnoses. Depression, but no other diagnosis, remained statistically significant after adjustment for multiple comparisons. In a multiple regression model that incorporated known risk factors for adolescent depression (e.g. language impairment and disturbed sleep), transgender and gender-diverse identity remained a significant predictor (odds ratio: 4.01, 95% confidence interval: 1.87-8.67,  = 5.94 × 10) with an effect size at least as strong as that of a depression family history. This suggests transgender and gender-diverse autistic adolescents, who often face stigma and discrimination, are particularly vulnerable to depression.Lay abstract"Transgender and gender diverse" (TGD) people have gender identities that differ from the sex they were assigned at birth. Many autistic people have a TGD identity. Autistic adolescents who are TGD have more "internalizing symptoms," which include symptoms of depression and anxiety, than autistic adolescents who are not TGD. In this study, we examined a group of 9027 autistic adolescents, 36 of whom had a TGD identity, to determine which, if any, mental health diagnoses would be associated with TGD identity, and whether those associations would remain even after accounting for known risk factors for a diagnosis. We found that depression, but no other diagnosis, was associated with TGD identity. This association remained even when accounting for known risk factors for depression, and in fact, TGD identity was associated with depression at least as strongly as a family history of that diagnosis. This strong association is perhaps not surprising. TGD adolescents often face stigma, social rejection, and discrimination, which can lead to depression. Autistic adolescents can face similar difficulties. Autistic youth who also have a TGD identity may therefore be at particular risk of developing depression. Our study highlights that providers who work with autistic youth in the community should be aware of this risk so they can identify and treat depression when it is present. Future studies should investigate the relationship between depression and TGD identity in autism further, to determine how providers and caregivers can support these youth.

There is a lack of representation of racially diverse individuals who are multilingual from low-income households in autism research. This calls into question the generalizability of research findings derived from predominantly White, English-speaking samples. In this article, we bring forth an important argument about why we as an autism field should work to expand representation in research samples. We also discuss strategies that can be used to work toward this goal. We detail the recruitment and retention of 94 Spanish-English bilingual Latinx (primarily Mexican and Central American) families from low-income households across a large urban city and its surrounding communities in the United States for an assessment validation study. We use the method of this study as an example of how to engage and include underrepresented populations in autism research, describing the efforts that were implemented to engage families and community-based organizations serving this population. We conclude the report by summarizing culturally sensitive strategies researchers can use to engage populations of different races and ethnicities from low-income households in their own research studies, in hopes of increasing representation in the autism science field and ensuring that research findings are applicable across populations, including those who have been historically underrepresented.Lay AbstractIndividuals of different races and identities from low-income households and their families are not adequately represented in research. This makes it difficult to know whether autism research findings apply to traditionally underserved individuals of color, since participants included in studies are usually White and speak English. We use our own study, where we successfully recruited 94 Spanish-English bilingual participants who are from Mexico and Central America but are currently living in the United States in low-income households for an assessment study, as an example to describe the strategies that were helpful to recruit participants with these sociodemographic characteristics. We end the article by discussing strategies that are culturally appropriate for researchers to consider when working with autistic populations of color who are from predominantly low-income households and their families.

Newspapers - particularly certain tabloid and right-leaning publications - often perpetuate negative stereotypes of Autistic people. This study examined how newspaper reading preferences relate to public attitudes towards autism. A sample of 277 UK-based non-autistic adults completed an online survey reporting demographic information, newspaper reading habits (print or online) and trustworthiness ratings for 10 major British newspapers. Participants also completed measures of autism-related knowledge and explicit attitudes towards autism, and an implicit bias task. Data were analysed using generalized additive models weighted by newspaper exposure, along with hierarchical partitioning to estimate the variance explained by reading preferences and other factors. Newspaper-related factors accounted for 4.5% of the variance in explicit attitudes and 10.7% in implicit attitudes. Crucially, selective engagement with right-leaning tabloids was associated with more negative implicit attitudes. Furthermore, selective trust in these outlets predicted relatively favourable explicit but relatively negative implicit attitudes. Overall trust in newspapers was also linked to less accurate autism knowledge. These findings suggest that engagement with media sources portraying autism more negatively is linked to more negative implicit biases towards Autistic people, even when explicit attitudes remain relatively favourable. Future research should explore causal mechanisms and the broader influence of media ecosystems on public perceptions of autism.Lay abstractWhen newspapers discuss Autistic people, they often focus on their challenges rather than their strengths. This kind of reporting - especially in some tabloids and right-leaning newspapers - can reinforce negative stereotypes, making it harder to build a more inclusive society for Autistic people. However, we do not yet fully understand how newspaper coverage relates to neurotypical people's attitudes towards autism, particularly when considering their background, knowledge of autism and personal experiences with Autistic people. This study investigated whether there is a connection between the newspapers people read and trust, and their feelings about autism. We examined both openly expressed opinions (explicit attitudes) and more instinctive, less conscious reactions (implicit attitudes). We surveyed 277 non-autistic adults in the United Kingdom. Participants reported how often they read 10 major British newspapers (in print or online) and how much they trusted them. They also answered questions about their knowledge of autism and their attitudes towards Autistic people. In addition, participants completed a short word-based task designed to reveal more subtle, instinctive responses. The results showed that individuals who regularly read right-leaning tabloids - which more frequently feature negative coverage of autism - tended to display more negative automatic responses towards autism. Interestingly, some participants who highly trusted these outlets expressed relatively positive explicit views, while their task responses suggested they might still hold relatively negative unconscious biases. Finally, greater overall trust in newspapers was linked to lower levels of autism knowledge. Taken together, these findings highlight a potential relationship between the media we consume and trust and not only what we know, believe and openly say about autism, but also our deeper, less conscious attitudes and reactions. While this study does not prove that news media directly shape or cause changes in attitudes, it underscores the importance of respectful, balanced reporting in fostering greater understanding and acceptance of Autistic people.

Ableist microaggressions-subtle forms of disability-based discrimination-constitute a key minority stressor. Amplified by autistic identity contingencies that shape how autistic identity is judged and treated in social contexts, these factors drive social camouflage in autistic adults, compelling them to conceal autistic characteristics for adapting to non-autistic groups, often resulting in negative mental health outcomes. This study proposes a novel autistic identity contingencies model to explore how autism acceptance and loneliness mediate the relationship between ableist microaggressions and social camouflage. An online survey of 330 autistic adults was conducted, followed by hierarchical multiple regression and chain mediation analyses. Results revealed that, ableist microaggressions positively predicted three social camouflage phenotypes: compensation, masking, and assimilation, with loneliness also positively predicting assimilation. Furthermore, after controlling for personal attributes, general stress and mental health conditions, lower external autism acceptance and higher loneliness mediated the positive relationship between ableist microaggressions and assimilation, whereas internal autism acceptance showed no significant effect. Assimilation is uniquely shaped by social autistic identity threats and loneliness, distinguishing it from compensation and masking. These findings highlight social camouflage as responses to minority stressors driven by social autistic identity contingencies, rooted in stigmatised behaviours rather than in stigmatised personal autistic identity.Lay AbstractSociety's perceptions of autism, reflected in subtle discrimination against autistic people, cause autistic adults to hide their true selves. They may hide their autistic traits to fit in with others, especially in groups that do not understand autism. Although this can help autistic people be accepted, it often leads to exhaustion and problems with mental health. However, the invisible ways in which autistic adults are judged and treated in daily social activities and how this impacts their strategies for camouflaging their autistic traits is poorly understood. This study examined the effects of feeling accepted as an autistic person, either by oneself or by others, and experiencing loneliness on how autistic adults camouflage being autistic when facing subtle discrimination related to their disability status. We surveyed 330 autistic adults using online questionnaires. After accounting for personal differences, subtle discrimination was positively associated with three camouflaging strategies: compensating for social challenges, covering up differences, and blending in with others. Feeling lonely was also positively associated with blending in with others. Additionally, after accounting for personal differences, stress levels, and mental health, feeling accepted by others as an autistic person and feeling lonely affected how subtle discrimination led to blending in with others. However, self-acceptance of being autistic was not associated with this relationship.This suggests that treatment by others shapes autistic adults' need to hide their identity more than their self-acceptance of being autistic. Therefore, addressing how autistic adults are judged and treated in daily social activities is more critical than focusing on personal change.

Applied behavior analysis is a widely used intervention for autistic youth, though its mental health impacts remain under-researched. This study aims to investigate the association between applied behavior analysis therapy and post-traumatic stress disorder, suicidality, mental health hospitalization rates, and length of mental health hospitalizations using a national database of privately insured youth under 18. We matched 17,120 autistic youth who received applied behavior analysis with a control group of autistic youth with no record of applied behavior analysis and clustered them into four applied behavior analysis dose groups using two-stage bisecting k-medians clustering. Then, we used negative binomial regression and logistic regression to compare outcomes for the applied behavior analysis and non-applied behavior analysis groups. Overall, applied behavior analysis receipt was associated with 30% higher odds of experiencing a mental health hospitalization (odds ratio = 1.30,  < 0.001) and a 32% higher incidence rate of these hospitalizations (incidence rate ratio = 1.32,  < 0.001). Our analysis found no relationship between applied behavior analysis dosing and the other tracked mental health outcomes. These results indicate the need for more quantitative analysis with more comprehensive records of applied behavior analysis receipt to fully investigate claims of ABA resulting in adverse adult mental health outcomes.Lay abstractAutistic youth often receive applied behavior analysis (ABA) therapy, but some autistic adults who had ABA as youth say it harmed their mental health as adults. We looked at the relationship between ABA and post-traumatic stress disorder (PTSD), suicidality, mental health hospitalization rates, and length of mental health hospitalizations among autistic youth. We used private health insurance claims data to look at how ABA receipt was related to those mental health outcomes. We divided autistic youth into groups based on how much ABA they received, so we could see if different amounts of ABA had different associations with mental health. There were 17,120 autistic youth in the group that did not receive ABA, and 17,120 autistic youth in the group that did receive ABA. In this sample, ABA therapy was associated with a greater use of acute mental health services; autistic youth in the ABA group had an overall risk that was 30% higher for mental health hospitalizations; and a 32% greater frequency of mental health hospitalizations. These results suggest that there may be a relationship between mental health hospitalizations and getting ABA. However, more work is needed to fully understand the impact of ABA therapy on mental health outcomes.

Despite their relevance to outcomes in autism, little is known about how social drivers of health affect communication, especially in transition-aged autistic adolescents and young adults with structural language impairment. This knowledge gap limits our understanding of developmental trajectories and the ability to develop supports. This cross-sectional study examined the role of social drivers of health in the communication abilities of autistic individuals ages 13-30. Participants ( = 73) completed language, nonverbal cognitive assessments, and social drivers of health (sense of community, unmet services, barriers to services) measures. Data were analyzed descriptively and using mixed-effects modeling. More unmet service needs, more barriers to services, and a lower sense of community were associated with greater social communication impairment. In turn, both unmet service needs and barriers to services were negatively associated with functional communication. In regression modeling, language scores contributed to functional communication, and sense of community to social communication impairment. Findings support the relevance of language and social drivers of health in communication. Future work should focus on possible bidirectional relationships between these variables and explore and real-world translation.Lay AbstractWhere people live, work, and spend their time is important. Environments can have more or less services or differ in how much they help people feel like they belong to their community. These parts of the environment are called social drivers of health. Social drivers of health are important for outcomes in autism, but we do not know much about them in autistic teens or young adults. We recruited 73 autistic teens and young adults (ages 13-30 years) and 52 caregivers to our study. Autistic teens and young adults did language and NVIQ tests on Zoom. Autistic teens, young adults, and caregivers also answered questionnaires. Sense of community was important for social communication impairment, and language was important for real-world communication. These findings tell us two things. First, thinking about how to create supportive communication environments for autistic teens and adults is important. Second, understanding how social drivers of health shape outcomes is important. In the future, we should focus on how improving environments can help autistic teens and adults meet their communication goals.

Autistic advocates have raised substantial concerns regarding genetics research on autism. It is yet unclear whether these concerns reflect the perspectives of the broader autism community. In sample of 1757 Dutch autistic adults, 445 parents of autistic children and 126 legal representatives of autistic adults, we explored perspectives on genetics research. We used a pilot repeated survey, consisting of questions about the perceived importance of the heritability of autism, reasons for this importance and the desire to learn more about heritability. Over 95% of the participants found it at least a little important to know that autism is highly heritable, and 67% would like to learn more about it. Participants mentioned that they find it important to increase knowledge about the causes of autism, and to improve the diagnostic process. There were no substantial differences in perspectives between stakeholder groups. Contrasting previous work, this pilot study indicates support for genetics research in autism, which highlights diversity in community perspectives. It also identifies an unmet educational need. We conclude that education on the topic of genetics, active research involvement of the autism community, and an ongoing dialogue between all parties are crucial to ethically and meaningfully move autism genetics forward.Lay abstractSome autistic people have shared strong concerns about research on the genetics of autism. However, this has not been investigated systematically in a large and diverse group of stakeholders. Therefore, researchers asked questions to over 1700 autistic adults in the Netherlands, 445 parents of autistic children and 126 legal guardians of autistic adults. The questions were (a) 'is it important to know that autism is heritable?', (b) 'why is this important to know?' and (c) 'would you want to learn more about the heritability of autism?'. Over 95% of the people said it is at least a little important to know that autism is heritable. Around 67% also said they would like to learn more about it. Many people said that learning about the genetics of autism could help us understand the causes of autism better and could help improve the diagnostic process. This study shows that there are different opinions about genetics research. It was also noted that people need clear and simple information about autism genetics. To make autism genetics research better and more respectful, it is important to give clear information about genetics; to involve autistic people and their families in research; and to have open conversations between researchers and the autism community. This way, autism genetics research can move forward in a way that is fair and helpful for everyone.

Unlike traditional autism awareness programs that often rely on didactic teaching and factual information, Human Library is a contact-based intervention that can engage "readers" in critical dialogs with "human books" to learn about their lived experience. This study reported on the pilot development of a Human Library in collaboration with a team of human books who are autistic to promote public understanding of autism in Hong Kong. Using a participatory realist evaluation framework, we conducted surveys and interviews with readers to construct a Human Library program model and evaluate its associated outcomes. Pre- and post-Human Library surveys showed a significant decrease in autism stigma and increase in neurodiversity attitudes. Interview findings revealed that readers' interests and concerns about the autistic community motivated them to participate in Human Library. Through personal interaction with autistic human books in a safe space created within Human Library, readers developed renewed understanding of autism and insights into autistic strengths. Readers became more informed of autistic people's perspectives and various sociocultural barriers that impact their well-being, which shaped how they would interact with autistic people in the community. The Human Library model has implications for promoting better understanding and attitudes of autism and fostering positive interaction between autistic and non-autistic people.Lay AbstractThere is a need to promote autism awareness and understanding in the public. Traditional methods often include direct teaching and sharing of facts about autism, but more creative and effective approaches are needed. Human Library (HL) works like an actual library, except that "books" are human beings who can share their lives and stories. This study developed and evaluated a Human Library specifically with autistic books to promote public understanding of autism in Hong Kong. We conducted surveys and interviews with the participating readers to understand how the Human Library works and its effects. After Human Library, readers reported decreased autism stigma and increased neurodiversity attitudes. Readers showed different understanding of autism contrary to their previous impressions. They appreciated more the strengths and perspectives of autistic individuals. They also considered more the autistic perspective when interacting with autistic people. Human Library can be an effective program to promote better understanding and attitudes of autism in the public.

Autistic and other neurodivergent youth face social, sensory, and environmental challenges at school that negatively impact learning and well-being. Yet, most educators are not trained in neurodevelopmental disabilities, leaving them with outdated knowledge and limited confidence about how to support neurodivergent youth at school. In a two-phase project, we sought to (1) co-design a comprehensive professional development training for school educators and (2) pilot test this training in one US public school district. First, we used community-based participatory research methods to form an interdisciplinary team of neurodivergent educators and autistic community members. We then used human-centered design methods to iteratively design the Schools Unified in Neurodiversity professional development training for US K-12 educators. In Phase 2, we demonstrated feasibility and acceptability of the resulting training in a sample of 192 educators, grades K-12. Significant improvements were noted in educator knowledge and self-efficacy in pre- to post-assessments. Together, community-based participatory research and human-centered design provided a promising community-driven approach to development, resulting in a training that was well received and conducive to implementation. Future work will test the effects of the Schools Unified in Neurodiversity training on youth outcomes and explore the role of professional learning communities to support implementation and sustain change.Lay AbstractNeurodivergent children are children who have neurodevelopmental or cognitive disabilities (e.g. autism spectrum disorder, attention deficit hyperactivity disorder, brain injury, dyslexia, Tourette's, and other neurological disorders). Neurodivergent children have heightened risk for mental health problems and poor learning outcomes compared to their peers. Sadly, school experiences contribute to these poor outcomes. Every day, neurodivergent children face a multitude of barriers and negative events at school that exacerbate their neurocognitive, sensory, and social communication differences, and even make them feel unsafe. Educators do not have the knowledge of how to support neurodivergent children and cannot practically provide individualized supports to each neurodivergent child in their classroom. A new approach is needed to ensure that school is a positive, enriching experience instead of the stressful, negative experience that it is for most neurodivergent students. This project aimed to transform schools for neurodivergent children by giving public school educators the knowledge they need to create a safe and inclusive school climate for all children. We developed the Schools Unified in Neurodiversity training with a group of researchers, teachers, counselors, principals, administrators, and advocates all with personal connections to neurodiversity. The Schools Unified in Neurodiversity training program teaches a series of practical tools to design classrooms and instruction in ways that eliminate unnecessary barriers and set neurodivergent children up for success at school. We tested the Schools Unified in Neurodiversity training program in one school district with 192 educators. Results suggest that this program is agreeable to teachers and improves their knowledge and confidence in supporting their neurodivergent children. Future work will test how the Schools Unified in Neurodiversity training program helps neurodivergent youth directly and if teachers can sustain these positive changes in knowledge and confidence.

Non-autistic adults often harbor negative attitudes about autism and show a reluctance to interact with autistic people. For autistic people with multiple marginalized identities, the compounding effects of stigma based on race and disability may worsen peer attitudes. This study investigated first impressions of Black and White autistic adults made by non-autistic observers. Autistic adults ( = 29) stratified by race (15 Black, 14 White) completed a videotaped semi-structured conversation, and non-autistic raters provided their first impressions of each participant. Black autistic people were rated as more likable and trustworthy, and raters endorsed a greater interest in interacting with them, compared to White autistic people. Evidence of intersectional effects of race, gender, and autism was also observed. White autistic men, but not Black autistic men, were evaluated less favorably than non-male autistic participants, with Black autistic men being evaluated more favorably on some items. These results suggest that the intersection of race and autism may, in some cases, counter stereotypes about Blackness and autism, and that holding multiple marginalized identities can modify the characteristics of peer stigma toward autistic adults.Lay abstractMany non-autistic adults have negative feelings about autism and may not want to interact with autistic people. For people who face more than one kind of discrimination, like being part of a racial minority and being disabled, a combination of racism and ableism might make others' opinions even more negative. This study looked at how people's race, gender, and how others judge them are connected when people view videos of Black and White autistic adults. In the first part of the study, 29 autistic adults (15 Black, 14 White) had a conversation with the main researcher, which was recorded on video. In the second part, people who were not autistic watched these videos and shared their thoughts about each person. The results showed that Black autistic people were seen as more likable and trustworthy, and the people watching the videos were more interested in getting to know them compared to White autistic people. The study also found that race, gender, and autism together influenced how people were judged. Black autistic men were often judged similarly to, or better than, non-male participants, while White autistic men were judged less positively than non-male participants. This means that having more than one identity that is discriminated against can change the ways that people view autistic adults, such as allowing Black autistic men to avoid common stereotypes.

The World Health Organization's International Classification of Functioning, Disability and Health (ICF) aligns with the neurodiversity paradigm in viewing autistic people's social communication holistically and in a strength-based manner. In this scoping review, we explored how social communication interventions for autistic children and youth map onto the domains of the International Classification of Functioning, Disability and Health in the field of speech-language pathology. OVID Medline, OVID Embase, OVID PsycINFO and Web of Science databases were searched to identify relevant articles. Population, intervention and study data were extracted, as well as data on each of the International Classification of Functioning, Disability and Health domains related to the social communication interventions. In total, 21 articles were included in our analysis. No studies explicitly mentioned the International Classification of Functioning, Disability and Health. All the studies focused on participation and environmental factors (e.g., people's attitudes, physical environment), and some studies discussed other International Classification of Functioning, Disability and Health domains such as body structures and functions, personal factors and activities. The examples provided for each International Classification of Functioning, Disability and Health domain may be helpful for clinicians and researchers looking to understand how components of social communication interventions link to International Classification of Functioning, Disability and Health categories. Future work could analyse how social communication interventions in other fields (e.g., psychology, occupational therapy) map onto the International Classification of Functioning, Disability and Health.Lay abstractThis review article investigates how the World Health Organization's International Classification of Functioning, Disability and Health can be applied to better understand speech-language pathology social communication interventions. In recent years, academic articles have supported thinking differently about how autistic people communicate, including the many strengths autistic people have and how other people and the environment influence communication. The International Classification of Functioning, Disability and Health is a holistic, widely used framework that provides a neurodiversity-affirming perspective on social communication interventions for autistic children. We did not find any published literature applying the International Classification of Functioning, Disability and Health to speech-language pathology social communication interventions for autistic children and youth and therefore wanted to explore whether and how social communication interventions reflect International Classification of Functioning, Disability and Health concepts. To answer this question, we searched the academic literature using several databases using a methodology called a scoping review. We included articles that had autistic children and youth as participants and focused on social communication interventions in the field of speech-language pathology. We found 21 articles that met our inclusion criteria. No studies talked explicitly about the International Classification of Functioning, Disability and Health. All the studies focused on participation and environmental factors (e.g., people's attitudes, physical environment), and some studies discussed other International Classification of Functioning, Disability and Health domains such as body structures and functions, personal factors and activities. It is important for speech-language pathology social communication interventions to consider how the physical environment, social environment and personal factors impact social communication. Clinicians and researchers may find our application of the International Classification of Functioning, Disability and Health to social communication interventions useful to shape how they think about interventions.

To date, no studies have investigated whether disparities in hours of applied behavior analysis (ABA) exist in the Medicaid system. We used multilevel modeling to analyze Medicaid billing claims for 1,028 autistic youth under the age of 21 years to examine the extent to which there were disparities in hours of ABA services for Medicaid-enrolled youth based on race/ethnicity and rurality. Although younger children received more hours of ABA, (1, 964.63) = 118.28, < .001, there were no statistically significant differences in hours of ABA based on minoritized race/ethnicity status or sex. On average, youth served in rural areas received significantly less hours of ABA per month than those in non-rural areas, (1, 122.13) = 7.89, = .006; youth in rural areas received 10.86 less hours per month than those in non-rural areas. Results suggest that publicly funded service systems like Medicaid may reduce ABA service disparities by race/ethnicity. Policymakers should focus on improving service provision for youth in rural areas.Lay AbstractWe used Medicaid billing claims from 1,028 autistic youth to see if there were differences in hours of applied behavior analysis (ABA) services per month for youth from different racial/ethnic groups, different service settings (rural or non-rural), different sexes, and different ages. We found that younger autistic youth received more hours of ABA per month compared to older youth, and and youth served in rural areas received about 11 hours less per month compared to youth in non-rural areas. There were no differences among different race/ethnic groups or sexes. Policymakers should focus on improving service availability for autistic youth served in rural areas.

Compared with their non-licensed peers, licensed autistic adults appear to report more positive outcomes in objective measures of quality of life, particularly participation in activities outside of the home. We examined if this is due to individual differences/factors or the ability to independently drive. We conducted a prospective follow-up survey study of 16-21 years old in the United States and compared engagement in activities outside of the home over time by licensing status. Our final sample included 111 young adults; at follow-up, 62% did not have a permit or a license, 18% had obtained a permit, and 20% were licensed. Generally, travel patterns were consistent, except for reported increases in employment. The lack of overall differences across groups over time suggests individual differences in resources, barriers/facilitators to traveling, or general characteristics may underlie objective measures of quality of life rather than the obtainment of a license. Furthermore, regardless of licensure status, most respondents were not traveling everywhere they wanted to go, and nearly 80% were interested in a transportation modality they did not currently use. Thus, there is a continued need to support autistic adults' independent use of various transportation modalities.Lay abstractAutistic adults who have a driver's license say they participate in activities outside of their home, like employment or socializing, more often than those who do not have a license. It is unclear if this is because these adults can drive or if people who obtain licenses are different in some way than those who do not obtain a license. To examine this, we administered multiple surveys to a group of autistic young adults (16-21 years old) to see if their travel patterns changed after obtaining a license. In total, 111 young adults completed our surveys. Generally, we did not see changes in adults' travel patterns, regardless of if they obtained a license or not. The only change was an increase in employment over time among young adults who never obtained a learner's permit/license and those who obtained a license. Overall, our findings suggest that individual differences may be why some adults are engaged in activities outside of the home more often than others. We also found that most adults in our sample were not traveling everywhere they wanted to go or using all the modes of transportation they were interested in. This suggests more efforts are needed that improve autistic adults' independent mobility across transportation modes (e.g., driving, public transportation).

Research on ageing in autism has sharply increased following a number of influential publications that highlighted the lack of knowledge in this area. However, much of the research on autism ageing has inadvertently treated all people aged over 50 as a homogeneous 'older adult' group, overlooking important distinctions between midlife (40-64 years) and old age (65+ years). Midlife is marked by complex role management, career pressures, health changes and identity development, while old age often involves retirement, shifts in priorities, physical and cognitive changes, and planning for less independent living. Recognising midlife and old age as distinct life phases is essential to accurately characterise the lived experiences and needs of autistic adults across the latter part of the lifespan. This letter makes conceptual and methodological suggestions that autism researchers should align with established ageing frameworks by labelling samples accurately, using appropriate keywords and, where possible, stratifying analyses by age subgroup. Doing so will enhance research accuracy, improve indexing and increase clinical relevance. This shift is vital for advancing autism ageing research and ensuring findings reflect the diverse experiences of autistic adults throughout later life.Lay AbstractResearch on autism and ageing has increased a lot in recent years. However, many studies group everyone over the age of 50 as part of the same 'older adult' group. This overlooks the fact that people in midlife (ages 40-64) and those in old age (65 and older) often face very different experiences, challenges and opportunities. Recognising that midlife and old age are separate stages of life is important for understanding what autistic adults go through as they age. This letter encourages autism researchers to be more specific when describing age groups in their studies. By doing this, research on autism and ageing will be more accurate, easier to find and more useful for researchers, healthcare professionals and autistic people alike.

Autistic individuals often show differential sensory perception, including hypo- or hypersensitivities to sound. Previous research also suggests that autistic individuals often have difficulty processing intentional and affective cues in speech acoustics. However, general speech processing difficulties remain underexplored. We investigated self-reported auditory perception using the Speech, Spatial, and Qualities of Hearing Questionnaire among autistic (self-identifying ( = 18) and clinically diagnosed ( = 45)) and non-autistic adults ( = 66). The study was conducted in the Netherlands, but the questionnaire and call for participation were in English and open to anyone regardless of country of residence. Both clinically diagnosed and self-identifying individuals with autism reported significantly lower scores on the Speech, Spatial, and Qualities of Hearing Questionnaire score and on the Speech subscale compared with non-autistic individuals, indicating challenges in overall quality of auditory perception, speech comprehension. Clinically diagnosed individuals also showed lower scores on the quality and spatial subscales compared with non-autistic individuals. Post hoc analysis further suggested that speech hearing is particularly challenging for many autistic individuals. In addition, our finding that self-identifying and clinically diagnosed autistic individuals show similar patterns of hearing difficulties emphasizes the need for more inclusive research practices that collect the experiences of all the individuals in the autistic community in the study of sensory perception in autism.Lay abstractAutistic individuals often have very different sensory experiences compared with non-autistic individuals. One anecdotally mentioned, but not well-researched phenomenon is difficulty processing what we are hearing. Rather than challenges related to language understanding, such as nonliteral or indirect language, autistic people may also have more difficulty making sense of the sounds of their environment. This may be hearing where particular sounds are coming from, or understanding what is being said, particularly in noisy situations. To bring more attention and clarity to this challenge, we asked autistic and non-autistic adults to fill out a short survey that measures one's hearing experiences in daily life. We found that autistic individuals report more difficulty across several types of hearing, and most prominently regarding speech hearing, when compared with non-autistic individuals. This finding highlights that reports of auditory processing difficulties when there is no hearing loss are not niche experiences, but rather reflect a common experience in autistic adults. In addition, we found that clinically diagnosed and self-identifying individuals reported very similar experiences. This highlights the validity of self-identification/self-diagnosis for research aimed at understanding autistic experiences. This study, therefore, emphasizes the need for more research and awareness regarding auditory perception and hearing in autistic adults. The study also emphasizes the value of more inclusive research practices that collect the experiences of all individuals within the autism community.

In recent years, referrals of youth to specialised gender services have risen sharply, with ~11% of these youth diagnosed as autistic compared with a general population rate of ~1%. In two preregistered studies, we addressed this insufficiently understood intersection. In Study 1, we examined the number and developmental trajectory of autism traits in autistic and nonautistic gender clinic-referred and cisgender youth (aged 7-16 years) using both screening measures (Autism-Spectrum Quotient Children's Version and Autism-Spectrum Quotient Adolescent Version, Social Communication Questionnaire-Lifetime) and diagnostic tools (Autism Diagnostic Interview-Revised, Brief Observation of Symptoms of Autism). In Study 2, we examined autism traits among the caregivers of participants from each group using the Autism-Spectrum Quotient Adolescent Version. Study 1 results showed the autism phenotype in autistic gender clinic-referred youth closely resembled that of their cisgender autistic peers. In addition, after addressing methodological limitations in previous research, we found no evidence of elevated autism traits in nonautistic gender clinic-referred youth, challenging findings of some earlier studies. Study 2 provided evidence of familial aggregation of both autism traits and diagnoses among caregivers of both autistic gender clinic-referred and cisgender participants. Taken together, these findings challenge the hypothesis that autism in gender-diverse youth is merely a 'phenomimic' of autism and provide valuable clinical insights into the presentation of autism in this population.Lay abstractIn recent years, more young people have been referred to specialised gender clinics for support with their gender identity. Interestingly, about 11% of these young people are also diagnosed with autism-much higher than the general population rate of only around 1%. This overlap has raised important questions about how autism and gender diversity are related, and even whether autism traits in gender-diverse people with an autism diagnosis really reflect autism. In this research, we carried out two studies to understand this link better. In the first study, we looked at autism traits in gender-diverse children and adolescents aged 7-16 years who were referred to a gender clinic for issues with their gender identity. We compared them with both autistic and nonautistic children who were not referred to gender services. We used several standard tools to assess autism-related traits, including both questionnaires and clinical interviews. We found that gender-diverse youth who were also autistic showed similar patterns of autism traits as cisgender autistic children who were not exploring their gender. Importantly, nonautistic gender-diverse youth did not show unusually high levels of autism traits, which challenges some earlier studies that suggested they might. In the second study, we explored autism traits in the caregivers (mostly mothers) of the young people in our first study. We found that caregivers of autistic children-whether the children were gender-diverse or not-were more likely to be autistic than the caregivers of nonautistic children. Moreover, even autistic caregivers of autistic children displayed more autism traits than caregivers of nonautistic children, irrespective of whether their child was gender-diverse or not. Overall, our findings challenge the idea that autism in gender-diverse youth is just a mimic of 'true' autism caused by gender-related stress or experiences. Instead, the results point to genuine autism that presents in a typical way. This research provides important insights for clinicians and families, and highlights the need to take the gender-related concerns of autistic children as seriously as of nonautistic children.

With growing numbers of adults seeking and receiving autism diagnoses, understanding subjective experiences of this process is crucial for sensitive policy and practice. The route to diagnosis can be long and circuitous, yet most evidence on adults' experiences of diagnosis relies on retrospective reports collected at a single point in time. The current study explores lived experiences of the diagnostic journey through serial qualitative interviews conducted in the weeks before and after adults' autism diagnosis. Fourteen adults participated in online interviews over videoconferencing or email. Thematic analysis of the data suggested the diagnostic process could be characterised according to three themes. identified the pursuit of diagnosis as rooted in a drive for self-understanding, propelled by anticipated benefits that were partially realised, and emotionally complex at all stages. highlighted how the process of acquiring and adjusting to a diagnosis was shaped by issues of resource access, system deficiencies, social inequalities and cognitive overwhelm. revealed how journeys that began in independent self-initiative evolved over time into community participation and advocacy. Providing original evidence of how lived experiences of adult autism diagnosis evolve across time, the current study offers valuable context for adults pursuing assessment, professionals performing assessments and policy-makers designing adult autism services.Lay abstractIncreasing numbers of people are receiving autism diagnoses in adulthood. Understanding their firsthand experience of diagnosis is crucial for improving supports for adults undergoing autism assessment. This study conducted interviews with adults at two time-points: one interview during the six weeks before their assessment, and a second interview within six weeks after their assessment. Fourteen people volunteered to participate in the study through videocall or email. The interview transcripts were analysed using a process called thematic analysis, with specialist software used to find patterns across people's experiences. The analysis suggested that adults appreciated the role of diagnosis in helping develop a better understanding of themselves. Nevertheless, people had mixed emotions both leading up to the assessment and after their autism diagnosis. Adults experienced many challenges in arranging and undergoing the autism assessment. However, the process of getting a diagnosis helped many to move from feeling isolated to feeling part of a wider community. These findings will be useful to adults at different stages of the diagnosis process, and for professionals and policy-makers developing adult autism services.

Gendered expectations significantly influence how Autism is recognised in women, often contributing to misdiagnosis and delayed identification. This study explored the experiences of Autistic women diagnosed after 30 in Australia. Using a cross-sectional qualitative design, semi-structured interviews were conducted with 10 Autistic women with a median age of 47.5 years. Participants were recruited through purposive sampling on social media, and reflexive thematic analysis was used for data examination, with careful consideration of researcher reflexivity. Seven key emotionally centred themes were identified from the participants' diagnostic journeys: (1) Frustration at the Barriers Surrounding a Diagnosis, (2) Fear and Self-Doubt on the Path to Self-Acceptance, (3) The Grief of Revisiting the Past, (4) Shock of the New Self, (5) Anger at Being Dismissed, (6) The Relief of Authenticity, and (7) Pride and Belonging in Community. The findings revealed the significant impact of 'Autistic burnout' and the challenges of accessing practitioners knowledgeable about Autism in women. Participants expressed a range of emotions stemming from having the validity of their struggles questioned and receiving a notable lack of post-diagnostic support. This study highlights the critical need for inclusive, gender-sensitive diagnosis, as well as greater understanding of the nuanced experiences of Autistic women.Understanding the Emotional Experiences of Australian Autistic Women Diagnosed Later in LifeAutistic women often experience delayed recognition and understanding that they are Autistic due to gendered expectations and stereotypes about Autism. This study explored the experiences of women in Australia who received an Autism diagnosis after the age of 30. It aimed to uncover the challenges they faced and the emotional impact of their diagnostic journey.Ten women participated in interviews where they shared their stories. They described how difficult it was to find professionals who understood how Autism presents in women and discussed the associated emotional toll. The research identified seven key themes that highlight the emotional aspects of their journeys:1. Frustration with the challenges of getting a diagnosis2. Fear and uncertainty while trying to accept themselves3. Sadness and regret when looking back on their past4. Surprise and confusion at discovering new parts of their identity5. Anger at being ignored or dismissed by others6. Relief in understanding and accepting who they truly are7. A sense of pride and belonging within the Autistic communityMany participants described experiencing 'Autistic burnout', which is extreme physical, mental, and emotional exhaustion, often due to masking their Autism to meet societal expectations. They also reported feeling invalidated when their struggles were questioned and noted a lack of support after their diagnosis.This study highlights the need for diagnostic practices that consider gender differences and societal influences, as well as better support systems for newly diagnosed Autistic women. Improving these areas could help ensure earlier diagnoses and provide better care, ultimately amplifying the voices of this often-overlooked community.

Around 50% of autistic adults meet diagnostic criteria for social anxiety disorder based on self-report questionnaires. Among non-autistic adults with social anxiety, distorted negative self-imagery in social situations stemming from fear of negative evaluation from observers can be corrected in cognitive therapy via video feedback. However, the role of social imagery in the maintenance of social anxiety has not been explored in autistic adults. This study examined in 62 autistic adults: (1) quality of social imagery elicited during social situations; (2) how image qualities were related to self-reported levels of social anxiety and fear of negative evaluation when accounting for co-occurring generalised anxiety. Many autistic adults reported social imagery from a field (i.e., looking through one's own eyes) rather than observer perspective. Using response surface analysis (RSA), autistic adults wanted to escape from/avoid social imagery and found them more upsetting when social anxiety was greater than fear of negative evaluation from others. Social imagery may be linked to autistic adults' somatic and sensory responses related to social anxiety rather than cognitive worries associated with fear of negative evaluation from others in social situations. Future studies can explore how qualitative differences in social imagery may influence maintenance of social anxiety and treatment efficacy in autistic and non-autistic adults over time.Lay abstractMany autistic adults experience social anxiety, which can negatively impact on one's quality of life and increase risk for developing other mental health difficulties if left untreated. Current treatment for social anxiety involves supporting individuals to identify their worries in social situations and explore how focusing on one's worries about being judged by others might generate an unhelpful and inaccurate negative image of oneself in social situations. In treatment, individuals use video feedback to look for differences between how they think they might come across to others, versus how they actually come across to others in conversation. Correcting any overly negative and unhelpful images of oneself in social situations is a key step in treatment for social anxiety. To date, little is known about whether autistic adults also generate negative images of oneself in social situations, and whether these images are related to one's worries about being judged by others. In this study, we interviewed 62 autistic adults and asked them to generate images about relaxed and social situations. Autistic adults found images generated about being in a social situation to be more upsetting and anxiety inducing, less controllable and wanted to escape from/avoid such images. Negative aspects of social images were more related to general feelings of social anxiety rather than specific worries about being perceived negatively by others. We propose that autistic adults may draw on bodily sensations and sensory experiences related to general distress or feelings of discomfort to generate images in social situations. This is different to non-autistic adults where images may be generated based on one's belief of how others might negative perceive oneself in social situations. Understanding such differences and the role images play in social anxiety for autistic and non-autistic adults can help clinicians better adapt treatment for social anxiety to suit autistic adults' needs.