AUTISTIC ADULTS AND ENTREPRENEURIAL OPPORTUNITY DEVELOPMENT: A CONCEPTUAL MODEL AND A RESEARCH AGENDA

Many autistic adults report interpersonal traumas (IPTs) such as physical or sexual assault, which are often associated with posttraumatic stress and dissociation. Factors such as gender might make autistic individuals particularly vulnerable to experiencing IPT and negative posttraumatic symptoms. In this study, 687 self-identified autistic adults completed an online survey on their traumatic experiences and mental health symptoms. Seventy-two percent of participants reported experiencing sexual assault, other unwanted or uncomfortable sexual experiences, or physical assault. Forty-four percent of participants met the criteria for posttraumatic stress disorder (PTSD), including 50% of those who had experienced IPT and 28% of those who had not (odds ratio = 2.50; 95% confidence interval 1.74-3.60). IPT was also significantly associated with higher levels of psychoform (p < 0.001) and somatoform (p < 0.001) dissociation. Autistic cisgender women and gender minorities experienced a significantly higher number of traumas (p = 0.004) and were significantly more likely than cisgender men to experience sexual IPT (p < 0.001) and meet the criteria for PTSD (p < 0.001). There were no significant differences between autistic individuals with and without a professional autism spectrum disorder (ASD) diagnosis. IPT is associated with potentially severe mental health outcomes for autistic adults. Autistic women and gender minorities may be particularly vulnerable to sexual IPT and adverse outcomes. Increased screening for a history of IPT and posttraumatic symptoms is recommended for all autistic adults regardless of ASD diagnosis status. Why was this study done?: Many autistic people experience interpersonal traumas (IPTs) such as sexual or physical assault. These can lead to mental health challenges such as posttraumatic stress disorder (PTSD) or dissociation (a disconnection between individuals and aspects of their perceptions or sense of self). We wanted to better understand what might make autistic adults more likely to experience trauma and how it affects them.What was the purpose of this study?: The purpose was to understand what might make autistic people more at risk of experiencing IPT and PTSD. We also wanted to know if IPT is associated with a higher risk of PTSD or dissociation.What did the researchers do?: Six hundred eighty-seven autistic adults filled out an online survey about their traumatic experiences, PTSD symptoms, and dissociation symptoms. We analyzed their responses to see how often participants reported experiencing different types of trauma and whether they met the criteria for PTSD and clinical dissociation. We then compared trauma experiences and PTSD rates across genders and those with and without a professional autism spectrum disorder (ASD) diagnosis and compared PTSD rates and dissociation rates across participants who had versus had not experienced IPT.What were the results of the study?: Seventy-two percent of autistic adults in this study reported having experienced sexual assault, another unwanted sexual experience, or physical assault. Almost half (44%) met the criteria for PTSD. Most participants (93%) also reported high levels of mind-based dissociation, and 32% reported high levels of body-based dissociation (dissociation that causes negative emotions to be experienced as physical problems such as headaches or trouble moving). Participants who had experienced IPT were almost twice as likely to meet the criteria for PTSD and scored higher on both measures of dissociation. Cisgender women and gender minorities were more likely to experience IPT and meet the criteria for PTSD than cisgender men. Participants with and without a professional ASD diagnosis did not differ.What do these findings add to what was already known?: Most previous research on trauma and PTSD for autistic people was done on children and did not look at IPT specifically or compare people based on their gender or ASD diagnosis. As far as we know, this is the first study on posttraumatic dissociation in autistic adults.What are potential weaknesses in the study?: The findings of this study may not apply to autistic adults as a whole. People who could have participated may not have been interested in the topic, may not have seen study advertisements and so been unaware of the study, or may not have had the time or energy to participate. Findings might have been different if different groups of autistic people participated more.How will these findings help autistic adults now or in the future?: If professionals who help autistic people do not talk to them about trauma, traumatized autistic adults may not get the right support. This study could encourage professionals to screen more autistic people, especially women and gender minorities, for trauma.

Our primary objective was to describe demographic characteristics and enrollment patterns in a unique 11-year full sample of adult Wisconsin Medicaid beneficiaries with identified autism spectrum disorder (ASD) or intellectual disability (ID). We obtained de-identified Medicaid claims data for adults with a recorded ASD or ID diagnosis aged 21 and older with any Medicaid fee-for-service claims between January 1, 2008 and December 31, 2018. We assessed enrollment, age, number of visits, and paid amount per year using generalized linear models with a random intercept for each beneficiary. We identified claims for 4,775 autistic adults without ID, 2,738 autistic adults with ID, 14,945 adults with ID, and 3,484 adults with Down syndrome. The age distribution of the diagnostic group with ASD diagnoses was right skewed with a majority of beneficiaries less than age 30. The ASD without ID diagnostic group had the least visits and paid amount per person per year compared to other groups. In each age category, the ASD with ID diagnostic group had the most paid amount per person per year compared to other groups. It is urgent that we identify the health and health service needs of autistic adults from young adulthood through old age. Our findings have implications for ensuring adequate health coverage across the lifespan and highlight the importance of a strong and accessible health care system for autistic people. Autism Res 2019, 12: 1541-1550. © 2019 International Society for Autism Research, Wiley Periodicals, Inc. LAY SUMMARY: Medicaid provides health insurance to disabled people who meet income requirements. We assessed patterns of enrollment and service use among autistic adults and adults with developmental disabilities in Wisconsin Medicaid. We found a consistent influx of new young autistic adults without intellectual disability into the Medicaid system, with fewer visits and lower paid amounts compared to other developmental disability groups. The changing population of autistic people using Medicaid has implications for providing health care to autistic adults in the future.

Back to table of contents Previous article Next article Clinical & ResearchFull AccessAs Number of Adults With Autism Rise, Need For Better Services ApparentNick ZagorskiNick ZagorskiSearch for more papers by this authorPublished Online:25 Feb 2021https://doi.org/10.1176/appi.pn.2021.2.12AbstractWhile there is a growing recognition of the health risks adults with autism face, much remains unknown about how best to effectively care for this population.iStock/scyther5Recent data from the Centers for Disease Control and Prevention (CDC) suggest that the prevalence of autism spectrum disorder (ASD) among U.S. children is on the rise. An estimated 1 in 54 8-year-olds was identified as having ASD in 2016, up from 1 in 150 when the CDC began national tracking in 2000.While early recognition of ASD in children and wraparound services such as speech and behavioral therapy have helped many, most people with ASD will continue to experience challenges well into adulthood.“This is a problem at a societal level, since these new adults are transitioning to a world that wasn’t set up for them,” said Brittany Hand, Ph.D., an assistant professor of health and rehabilitation science at the Ohio State University and occupational therapist.How big is the problem? According to data released by the CDC in 2020, autism effects just over 2%—or about 5.5 million—of adults aged 18 to 84 nationwide.This estimate, based on historic ASD prevalence rates in children and state-by-state mortality data, is likely an underestimate, explained psychiatrist Robert Wisner-Carlson, M.D., chief of the Autism and Neurodevelopmental Outpatient Program at Sheppard Pratt in Towson, M.D.Though child psychiatrist Leo Kanner, M.D., first described autism in 1943, the diagnosis was likely missed in children for several decades. “Many children with ASD who grew up in the 1940s, 50s, or 60s probably never got evaluated,” he said.This hidden population could present challenges, added Hand, who works with people with ASD. “I’m not sure if our health system is prepared to meet the needs of this vulnerable population as they age,” she said.Much Unknown About ASD in AdultsExperts interviewed by Psychiatric News noted that there are few data to help guide clinical and supportive care of adults with autism. Historically, only 1% to 2% of federal funding for ASD research has supported the study of adults.Wisner-Carlson believes multiple factors over the years created this widening knowledge gap, but the seeds can be traced to Kanner’s pioneering work. “This disorder was first identified by a child psychiatrist, and that set the path for future research to be child-centric,” he said. As still holds true today, researchers first diagnosing ASD in children lacked the time and resources to follow the patients over long periods of time, so they were not studied into adulthood.Additionally, adults with ASD were not likely recognized by physicians in those early years, noted Elizabeth Wise, M.D., a geriatric psychiatrist at the Johns Hopkins Adult Autism and Developmental Disorders Center. High-functioning adults received no diagnoses, while those with more severe ASD were typically misdiagnosed with schizophrenia.There is increasing awareness today of the impact that ASD has on adults, Wise said. Patients at her center have been referred by psychiatrists, neurologists, and primary care physicians. “Even patients come to us themselves sometimes, typically after they have a child who gets diagnosed and they reflect on their own condition.”As is the case with children with the disorder, adults with ASD often have difficulties communicating and recognizing socially unacceptable behaviors, and they can be prone to outbursts. Adults with ASD typically have less social anxiety than children, as they have slowly adapted to their surroundings with age.“A definitive ASD diagnosis can only be made if you know the symptoms started in early childhood,” Wisner-Carlson said. For older adults without parents or siblings who can be informants, it may not be possible to confirm symptom onset.Despite Need, Few Services AvailableAs with research funding, policy decisions funding ASD services have focused predominantly on children. Laws such as the 1975 Individuals with Disabilities Education Act—which mandates special education and wraparound services to children with ASD and other intellectual disabilities—expire at age 21.“For many children with disabilities, that’s enough time to give them a chance at success in adulthood,” said Christopher Manente, Ph.D., the executive director of Rutgers Center for Adult Autism Services in New Jersey. “But the nature of autism makes it different from every other disability and points to why we need more support.”Manente told Psychiatric News that common ASD behaviors, such as difficulties communicating and understanding social norms, hinder people’s ability to integrate into society.“Being able to connect with other humans lets them know you have value to add,” Manente explained. “But many individuals with ASD have an inherent inability to do that.”Given these social difficulties—and the limited availability of ASD services for adults, such as skills or job training—many adults with ASD are unemployed, living at home, and socially isolated.“A common thread of people with autism is that they do not handle transitions well,” Wisner-Carlson said. Even small transitions—such as a schedule change in a daily bus route—can affect the well-being of people with ASD, who are comfortable with routines. Major life transitions, such as entering a nursing home and/or the death of a caregiver, can completely derail a person with ASD emotionally.Hand has combed data from hospital records and Medicare claims to tease out some details about the health challenges adults with ASD face as they grow older. Her analyses have shown that older adults with ASD are more likely than the general Medicare population to have hypertension, diabetes, mood disorders, osteoporosis, arthritis, heart problems, and cognitive impairment.The ASD literature on children indicates that they often have comorbid attention-deficit/hyperactivity disorder, personality disorders, epilepsy, and/or gastrointestinal issues. Hand’s research has found that these problems are also prevalent among older adults with ASD. The risks of these various comorbidities may be even higher in adults who are minorities and of lower socioeconomic status, she noted.When you factor in the risks for mood problems, impulsivity problems, and social difficulties, it is no surprise that self-harm and suicide are more common in adults with ASD compared with the general population, Wisner-Carlson continued, though this connection is underappreciated. One 2017 study of 42 adults with ASD found that 50% had injured themselves, while Hand’s analysis of Medicare recipients with ASD found an 11-fold increased risk of self-harm or suicidal ideation compared with Medicare enrollees without ASD.Factors to Consider When Working With Adults With ASDEven though adults with ASD are at greater risk of health problems than those without ASD, they often have less access to specialist care and are more likely to seek care in the emergency room, Hand said. She noted that this disparity may be driven in part by health professionals who lack training in how to treat adults with ASD and may feel uncomfortable doing so, she said.This discomfort exists even among some mental health professionals, Wisner-Carlson noted. “ASD is more common than schizophrenia, which [adult] psychiatrists train for,” he said. “But we draw a lot of our clinic patients from psychiatric hospitals in the region, because they tell us they don’t have the tools to care for them.”That’s why education and training for medical residents, nurses, and social workers is an important component of the services offered at places like Sheppard Pratt, Johns Hopkins, Rutgers, and Ohio State (which recently established a Center for Autism Services and Transition to provide tailored primary care for young adults with ASD).“We need to professionalize adult autism services in the same manner they are for children,” Manente said. “We know that adults with ASD need a lot of support at any age.”In the short term, Manente implored psychiatrists to be confident when treating patients with ASD.“Many psychiatrists may get their first experience of adult ASD in the emergency room with an agitated patient, but such cases reflect a small proportion of this community,” Wise added.Wise said psychiatrists should be mindful that a common symptom of ASD is sensory sensitivity, so they should make sure to ask patients about light and sound levels and be cognizant about physical procedures, including taking blood pressure.“The presence of a mood disorder can be difficult to tease out, since many people with ASD, including high-functioning individuals, cannot tell you how they feel emotionally,” noted Wisner-Carlson, who has extensive experience managing a comprehensive outpatient program for over 600 adults with ASD and other neurodevelopmental disorders.“Communication can be difficult, but most talk-based therapies can be effective for people with autism,” Manente added. “An ASD diagnosis should not be an exclusion for behavioral therapy.” ■“National and State Estimates of Adults With Autism Spectrum Disorder” is posted here.“Prevalence of Physical and Mental Health Conditions in Medicare-Enrolled, Autistic Older Adults” is posted here.“Untended Wounds: Non-Suicidal Self-Injury in Adults With Autism Spectrum Disorder” is posted here. 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Offspring who encounter biological and psychosocial adversities early in development are vulnerable to lasting physical, mental, emotional, and social deficits across the lifespan, especially autism spectrum disorders (ASD) and socioemotional problems. Numerous individual risk factors have been linked with these problems separately in children of various ages. However, few studies have analyzed the effects of prenatal, perinatal, and early life exposure to cumulative risk factors in predicting socioemotional problems co-occurring with ASD in toddlers. The current study aimed to determine if ASD was associated with internalizing, externalizing, and dysregulation problems in toddlers, and if a novel measure of cumulative risk explained observed deficits above and beyond an ASD diagnosis. 344 participants from an ongoing multisite longitudinal study evaluating optimal timing for repeat ASD screening were divided into 3 groups based on a diagnosis given at a clinical evaluation by trained research staff: ASD (n = 107), developmental delays (DD; n = 145), and typical development (TD; n = 92). The Cumulative Risk Scale was developed from a developmental history questionnaire. The presence of a risk factor (e.g., prenatal SSRI exposure, prematurity, low birth weight, maternal psychiatric diagnosis) was coded as 1 and the absence as 0, and the sum total created each participant's Cumulative Risk Score. After handling significant amounts of missing data with five iterations of multiple imputation, three multiple hierarchical regressions were conducted to determine if an ASD diagnosis was significantly associated with the Externalizing, Internalizing, and Dysregulation domain standard scores of the Infant-Toddler Social-Emotional Assessment (ITSEA). A second block of the hierarchical regression containing the novel Cumulative Risk Scale was added to determine if cumulative risk predicted these outcomes and increased the predictive ability of the model. The "segmented" package of R was then utilized to identify a linear or threshold relationship between cumulative risk and ITSEA outcomes. Results show that an ASD diagnosis was significantly associated with Internalizing problems ([beta] = .143, p = .035, 95% CI [.305, 8.430]), partially supporting the first hypothesis that an ASD diagnosis would be associated with internalizing, externalizing, and dysregulation problems. Further analyses show that both an ASD ([beta] = .278, p &lt; .001, 95% CI [.088, .231]) and DD diagnosis ([beta] = .157, p = .010, 95% CI [.020, .149]) predict Depression/Withdrawal symptoms when controlling for child age. The addition of the Cumulative Risk Scale to the regression model improved prediction of Dysregulation problems only ([beta] = .103, p = .039, 95% CI [.027, 1.010], R2 change = .009, p = .039), partially supporting the second hypothesis that Cumulative Risk would significantly predict socioemotional problems. Further hierarchical multiple linear regressions showed cumulative risk significantly predicted Sleep Problems ([beta] = .101, p = .048) and Eating Problems ([beta] = .102, p = .045). Both hierarchical regressions showed a significant R2 change as well, but should also be interpreted with caution, as both increases were small (0.9% increases). An ASD diagnosis was significantly predictive of only the Negative Emotionality Subscale of the Dysregulation domain ([beta] = .151, p = .047). Results from the "segmented" package of R estimate a break point of 10.27 (p = .04171) for predicting Externalizing problems, but not Internalizing or Dysregulation problems. Toddlers ages 12-60 months with ASD are more likely to experience comorbid internalizing problems, which can have numerous clinical implications in the detection and prevention of internalizing problems early in life. Cumulative risk in early developmental periods overall does not explain socioemotional deficits in toddlers with ASD, DD, or with typical development. However, cumulative risk does predict dysregulation problems across children, regardless of diagnosis. A model depicting the relationship between cumulative risk in early developmental periods, dysregulation or non-disorder-specific socioemotional problems, and later psychopathology was proposed and should be investigated further in future research. A significant threshold of 10 risk factors was identified in predicting externalizing problems but may be possible in predicting internalizing and dysregulation problems as well. A more sensitive measure of cumulative biomedical risk early in life may also improve assessment of cumulative risk.

Autism spectrum disorder (ASD) and gender dysphoria (GD) frequently cooccur. However, existing research has primarily used smaller samples, limiting generalizability and the ability to assess further demographic variation. The purpose of this study was to (1) examine the prevalence of cooccurring ASD and GD diagnoses among US adolescents aged 9 to 18 and (2) identify demographic differences in the prevalence of cooccurring ASD and GD diagnoses. This secondary analysis used data from the PEDSnet learning health system network of 8 pediatric hospital institutions. Analyses included descriptive statistics and adjusted mixed logistic regression testing for associations between ASD and GD diagnoses and interactions between ASD diagnosis and demographic characteristics in the association with GD diagnosis. Among 919 898 patients, GD diagnosis was more prevalent among youth with an ASD diagnosis compared with youth without an ASD diagnosis (1.1% vs 0.6%), and adjusted regression revealed significantly greater odds of GD diagnosis among youth with an ASD diagnosis (adjusted odds ratio = 3.00, 95% confidence interval: 2.72-3.31). Cooccurring ASD/GD diagnoses were more prevalent among youth whose electronic medical record-reported sex was female and those using private insurance, and less prevalent among youth of color, particularly Black and Asian youth. Results indicate that youth whose electronic medical record-reported sex was female and those using private insurance are more likely, and youth of color are less likely, to have cooccurring ASD/GD diagnoses. This represents an important step toward building services and supports that reduce disparities in access to care and improve outcomes for youth with cooccurring ASD/GD and their families.

Previous social-pragmatic and narrative research involving autistic individuals has mostly focused on children. Little is known about how autistic adults and adults who have autistic traits but do not have a diagnosis of an autism spectrum disorder (ASD) interpret complex social situations and tell narratives about these situations. We asked 32 autistic young adults, 18 adults with autistic traits but no ASD diagnosis, and 34 non-autistic young adults to watch socially complex situations and freely tell narratives about what they thought was occurring in each situation. These narratives were analysed for how the participants had interpreted the situations and for the type of narratives they produced. We found that the groups had both similarities and differences. Regarding the differences, we found that the autistic adults and adults with autistic traits interpreted the situations differently from the non-autistic adults. The autistic adults found different aspects of the situations relevant, had different foci and placed greater importance on details than the non-autistic adults. The autistic adults and adults with autistic traits also differed from the non-autistic adults by having more detail- and event-focused narratives whereas the non-autistic adults were more likely to base their narratives on their own broad interpretations of the situations. Perceptual processing styles appeared to play a bigger role in interpreting the situations for the autistic adults and adults with autistic traits than the non-autistic adults. Our findings suggest that autistic adults and adults with autistic traits focus on different aspects in their social world than non-autistic adults.

BackgroundAn increasing number of autistic adults have entered their later life, but little is known about the disease trajectory in mid- and later adulthood. We aimed to examine the patterns of comorbidity progression in adults with autism spectrum disorder (ASD) that may affect their mortality.MethodsParticipants were identified from the UK Biobank study. We first identified individuals with ASD diagnosis, each of whom was randomly matched to up to 10 participants without ASD diagnosis. Cox regression was used to estimate the hazard ratio (HR) of mortality. Disease trajectory analysis was performed to investigate temporal sequencing of medical conditions and mortality associated with ASD. A multistate model was used to investigate the association patterns between ASD and three common chronic conditions: cardiovascular disease/hypertension, type 2 diabetes and disorders of lipoprotein metabolism, and depression/anxiety.ResultsThe study included 659 ASD cases (66.8% male; mean age 52.0 [SD, 8.1]) and 6590 matched non-autistic individuals. ASD were associated with a 90% higher all-cause mortality (HR, 1.90, 95% CI, 1.41–2.55) and also higher risks of 45 medical conditions across almost all body systems (all Bonferroni-adjusted P < 0.05). Trajectory analyses exhibited three clusters of medical conditions that predisposed autistic adults to excess mortality: cardiometabolic diseases, external conditions, and infectious diseases. Autistic adults showed not only an overall increased risk of progression of multimorbidity but also distinctive association patterns across different disease transitions.ConclusionsOur findings show patterns of comorbidities among autistic adults in their mid- and later adulthood, which could provide information to their caregivers to implement appropriate disease management and prevention strategies.

Effectively serving students with autism spectrum disorders (ASDs) requires professionals to possess specialized knowledge, skills, and understanding. When students with ASDs are from culturally or linguistically diverse (CLD) families, the professionals assessing and providing services to the students need the additional dimension of how cultural and linguistic differences may affect identification, assessment, and treatment strategies.

Children with Autism Spectrum Disorders: Three Case Studies

Autism spectrum disorder (ASD) refers to a heterogeneous condition characterized by deficits in social communication and the presence of restricted, repetitive, and stereotypic behaviors, interests, or activities. While some neurodevelopmental disorders have a well-established correlation with ASD, people continue to believe that because individuals with Down syndrome are characteristically perceived as affectionate and engaging, a diagnosis of ASD is contradictory. However, some people with Down syndrome indeed do meet diagnostic criteria for ASD and this chapter examines the research literature regarding Down syndrome and ASD, presenting information regarding the establishment of a diagnosis of ASD in individuals with Down syndrome and research techniques to understand the dual diagnosis of ASD and Down syndrome. Behavioral manifestations of ASD in Down syndrome are presented and research methodologies which address possible underlying mechanisms in Down syndrome and ASD are surveyed. Finally, the need for specification of behavioral profiles for individuals with a dual diagnosis of Down syndrome and ASD, in order to design and implement appropriate therapeutic interventions, is highlighted. Once a person with Down syndrome is diagnosed with ASD, he or she should automatically receive a combined treatment approach incorporating direct instruction, natural environment teaching, and incidental teaching. The manifestation of ASD in individuals with Down syndrome can shed light on our understanding of how ASD and intellectual disability are associated and what impact these diagnoses have on individuals and their families. This knowledge can help shape public policy and our research agenda in the areas of ASD, intellectual impairment, and Down syndrome.

Family socioeconomic status has been associated with autism spectrum disorder (ASD) diagnoses. Less is known regarding the role of neighborhood disadvantage in the United States, particularly when children have similar access to health insurance. To evaluate the association between neighborhood disadvantage and the diagnosis of ASD and potential effect modification by maternal and child demographic characteristics. This cohort study examined a retrospective birth cohort from Kaiser Permanente Southern California (KPSC), an integrated health care system. Children born in 2001 to 2014 at KPSC were followed up through KPSC membership records. Electronic medical records were used to obtain an ASD diagnosis up to December 31, 2019, or the last follow-up. Data were analyzed from February 2022 to September 2023. Socioeconomic disadvantage at the neighborhood level, an index derived from 7 US census tract characteristics using principal component analysis. Clinical ASD diagnosis based on electronic medical records. Associations between neighborhood disadvantage and ASD diagnosis were determined by hazard ratios (HRs) from Cox regression models adjusted for birth year, child sex, maternal age at delivery, parity, severe prepregnancy health conditions, maternal race and ethnicity, and maternal education. Effect modification by maternal race and ethnicity, maternal education, and child sex was assessed. Among 318 372 mothers with singleton deliveries during the study period, 6357 children had ASD diagnoses during follow-up; their median age at diagnosis was 3.53 years (IQR, 2.57-5.34 years). Neighborhood disadvantage was associated with a higher likelihood of ASD diagnosis (HR, 1.07; 95% CI, 1.02-1.11, per IQR = 2.70 increase). Children of mothers from minoritized racial and ethnic groups (African American or Black, Asian or Pacific Islander, Hispanic or Latinx groups) had increased likelihood of ASD diagnosis compared with children of White mothers. There was an interaction between maternal race and ethnicity and neighborhood disadvantage (difference in log-likelihood = 21.88; P < .001 for interaction under χ24); neighborhood disadvantage was only associated with ASD among children of White mothers (HR, 1.17; 95% CI, 1.09-1.26, per IQR = 2.00 increase). Maternal education and child sex did not significantly modify the neighborhood-ASD association. In this study, children residing in more disadvantaged neighborhoods at birth had higher likelihood of ASD diagnosis among a population with health insurance. Future research is warranted to investigate the mechanisms behind the neighborhood-related disparities in ASD diagnosis, alongside efforts to provide resources for early intervention and family support in communities with a higher likelihood of ASD.

Autistic individuals are at an increased risk for both sleep disturbances and depression. While studies in the general population and in autistic adults have drawn general links between sleep disturbances and mental health, few studies have examined the extent to which specific sleep problems may be implicated in the extremely high rates of depression among autistic adults. This study aimed to describe the patterns of sleep disturbances in autistic young adults, and their associations with depressive symptoms while controlling for relevant demographic factors. A sample of 304 legally independent adults (age 18-35 years old) with a childhood diagnosis of autism spectrum disorder self-reported on their average sleep behaviors during the past week and depressive symptoms on the Beck Depressive Inventory-II. A significant proportion (86.01%) of autistic young adults experienced at least one of the primary sleep disturbances of interest, including short total sleep time (39.59%), poor sleep efficiency (60.07%), and delayed sleep phase (36.18%). Additionally, lower sleep efficiency and delayed sleep phase were both associated with higher depressive symptoms. The associations between sleep and depressive symptoms identified in our study suggest that sleep treatments may hold potential for ameliorating depressive symptoms in autistic adults who also experience sleep problems. Further research using daily sleep diaries and objective measures of sleep behaviors, as well as longitudinal studies, are needed to understand how changes in sleep may relate to changes in depressive symptoms in autistic adults.

Examining the relationship between measures of autistic traits and neural synchrony during movies in children with and without autism

To determine the effect the COVID-19 pandemic had on autism spectrum disorder (ASD) diagnosis in the Military Health System (MHS). Repeated cross-sectional study utilized MHS Data Repository from JAN2018 to FEB2023. ASD encounters identified by ICD-10 diagnosis codes. Incident ASD encounters and overall visits were evaluated. Study included periods: Pre-COVID (PCo) (1/18 -2/20), COVID-19 Year (CoY) CoY1(3/20 -2/21), CoY2(3/21 -2/22) and CoY3(3/22 -2/23). Incident rates and overall visits were compared across time periods using Poisson regression, adjusting for sex, age group, region, and parent rank. Median age at first diagnosis across time periods were compared using generalized linear modeling. 2million dependents ages 1-17 years were eligible for care over the study, with 44,508 incident ASD diagnoses (Table1). ASD diagnosis incident rate decreased 10% in CoY1 vs. PCo (RR 0.90, 95% CI 0.87-0.93) and increased during CoY2 and CoY3 [RR2 1.21, 95% CI (1.18-1.24), RR3 1.50, 95% CI (1.46-1.54)]. CoY1-CoY3 vs. PCo all had statistically significant increased ASD visit rates (RR1 1.20, RR2 1.44, RR3 1.67). ASD diagnosis median age was 6 years (Table1). The incidence of ASD and related encounters decreased at the COVID-19 pandemic onset, highlighting the impact COVID-19 had on a delayed process within the MHS. The ASD incidence and encounters following the pandemic onset improved and continued to increase through CoY3. This uptrend suggests adaptation by providers during COVID-19 restrictions to use telehealth for developmental screening and ASD diagnosis.

This study explores whether providing information about a juvenile defendant's autism spectrum disorder (ASD) diagnosis, the type of offense (violent/nonviolent), and their race influences laypersons' credibility evaluations and legal decisions (verdicts/sentencing). We expected participants to render more not guilty verdicts and show leniency in sentencing when the defendant is White, has an ASD diagnosis, and is charged with a nonviolent offense. We anticipated credibility evaluations would mediate the relationships between ASD diagnosis and race, type of offense and sentencing views. Using a mock-juror paradigm, 466 participants read a vignette in which the juvenile defendant's diagnosis (ASD + information vs. no diagnosis), race (White vs. Black), and the charged offense (violent vs. nonviolent) were experimentally manipulated. Participants were highly unlikely to render guilty verdicts (p < .001, OR = 0.33) and harsh sentences (p < .001, ηp² = .11) when the defendant had an ASD diagnosis, even less so for violent offenses (p = .005, ηp² = .02). The defendant's likability (p < .001, ηp² = .04), honesty (p < .001, ηp² = .11), and believability (p < .001, ηp² = .09) were rated higher when the defendant had an ASD diagnosis, and these considerations led to significantly more lenient sentences compared to the no diagnosis condition. Participants were also twice as likely to find the White defendant guilty (p = .003, OR = 1.95) and reported being significantly more certain in their verdicts for the White defendant (p = .017, ηp² = .02). These results highlight the complex interplay between defendant characteristics and public perceptions of ASD in criminal legal proceedings. Findings highlight the need for judicial education, clearer guidelines on presenting ASD information in court, and further research on how race and neurodevelopmental diagnoses influence legal decisions. (PsycInfo Database Record (c) 2025 APA, all rights reserved).