Language interventions for autistic people: An online survey of community member views and priorities

Non-autistic individuals find it difficult to read the behaviour of autistic people in comparison to non-autistic others. We investigated whether non-autistic people's ability to read autistic individuals is improved by providing diagnostic information, and whether this ability is associated with a person's knowledge about autism, prior contact with autistic people, and autism stigma. Participants (N = 128) viewed videos that were taken from a previous study. These showed autistic and non-autistic individuals reacting to events enacted by the researcher, and participants were asked to infer what event had taken place. Videos were presented either with no diagnostic information, a correct diagnostic label, or an incorrect label (autistic individuals labelled as non-autistic and vice versa). Autism knowledge, contact with autistic people, and autism stigma were measured by questionnaires. Participants performed less well for videos of autistic than non-autistic others. Diagnostic information had little impact on performance, although labelling non-autistic individuals as autistic reduced accuracy. Autism knowledge, contact with autistic people, and autism stigma were not associated with relative strength in interpreting the behaviour of autistic individuals. We conclude it might be difficult to train people to read autistic people's non-verbal behaviour more effectively; instead, intervention might focus on raising awareness of this issue.Lay AbstractRecent research has shown that non-autistic people are prone to misinterpreting the behaviour of autistic individuals, which may contribute to the difficulties autistic people often experience during social interactions. This suggests that interventions should identify ways to improve other people's ability to interpret autistic people's behaviour. However, little is known about what circumstances may improve non-autistic people's ability to read autistic others. This study investigated whether telling people that someone is autistic would improve their ability to interpret the behaviour of that person. We also investigated whether having more knowledge about autism, having previous contact with autistic people, or holding stigmatic attitudes about autism relates to this ability. The researchers used video clips that were recorded for a previous study. They showed autistic and non-autistic people reacting to aspects of the researchers' behaviour, such as being told a joke or paid a compliment. Participants' task was to watch the video clips and infer what the person in each video was reacting to and accuracy in doing so was recorded. The videos were presented with either no diagnostic information or with a diagnostic label alongside the video, which was either correct or inaccurate (labelling autistic individuals as non-autistic and vice versa). We used questionnaires to assess participants' autism knowledge, previous contact with autistic people, and autism stigma. We found that participants had more difficulty judging the reactions of autistic individuals than the non-autistic individuals. Telling participants that a person was autistic did not make people better at interpreting their behaviour, although labelling non-autistic participants as autistic reduced accuracy. Knowledge about autism, previous contact with autistic people, and autism stigma did not relate to a person's ability to interpret autistic people's behaviour. This suggests that it may not be easy to create interventions to improve people's ability to interpret the behaviour of autistic others. Intervention might focus on raising awareness of the need to avoid making assumptions based on the non-verbal behaviour of autistic people.

Autistic masking is an emerging research area, and so far, research has suggested that masking has a negative effect on autistic people. Masking relates to general social practices (such as identity management) and is often driven by stigma avoidance. Many nonautistic people also experience stigma that might drive them to suppress aspects of their identity. In this study, we investigate similarities and differences in experiences of masking in autistic and nonautistic people. We conducted an online survey about experiences and views of masking in autistic people (n = 144), neurodivergent people without an autism diagnosis (n = 49), and neurotypical people (n = 45) recruited via social media. We used thematic analysis to analyze responses to open-ended items about masking, using an inductive approach, at a semantic level, with a critical realist paradigm. Thematic analysis revealed that some aspects of masking are shared across autistic and nonautistic people, such as utilizing mimicry of others as a social strategy or feeling exhausted from masking. All groups reported that masking made them feel disconnected from their true sense of identity and had a negative effect on them. Other aspects of masking seemed more specific to autistic people, such as sensory suppression, and masking leading to suicidal ideation. Our findings suggest that many aspects of masking are experienced across different neurotypes and are likely related to outside perceptions of difference and stigma. It is likely that what we call "autistic masking" is similar to other forms of stigma management previously theorized. Some aspects of masking do seem more specific to the autistic neurotype (e.g., suppression of stimming) and should be explored further to provide support for autistic people recovering from the negative impact of masking. Why was this study done?: Masking is the process of intentionally, or unintentionally, hiding aspects of yourself to avoid harm. Recent research has suggested that autistic people might mask a lot and that this can lead to long-term problems in mental health. At the moment, we do not know which parts of masking are specific to autistic people, and which parts might be experienced by others, especially other neurodivergent people who are not autistic, for example, people with attention-deficit hyperactivity disorder (ADHD).What was the purpose of this study?: The purpose of this study was to find out about masking in autistic and nonautistic people, to find out whether some parts of masking are specific to autistic people, or experienced by others.What did the researchers do?: We conducted an online survey about masking with three groups of people: autistic people, nonautistic people who have another neurodevelopmental or mental health diagnosis, such as dyslexia, ADHD, or depression, and nonautistic people who do not have any neurodevelopmental or mental health diagnoses. The survey included an open text box for people to write about their experiences of masking and their opinions about masking. We analyzed these responses using a method called "thematic analysis." This method helps us look for ideas that people commonly talk about in their answers.What were the results of this study?: We found out that autistic and nonautistic people think masking is very complicated and has a negative effect on them. Both autistic and nonautistic people said that masking made them exhausted and really unhappy and that it made them feel like people did not know the "real them." Only autistic people mentioned that masking sometimes makes them feel suicidal and that masking includes things that other groups did not mention (such as trying to hide being upset by sensory things such as loud noise).What do these findings add to what was already known?: Our findings suggest that some aspects of masking do not just affect autistic people (such as feeling like people do not know the real you), but other parts might be more unique to autistic people (such as hiding stims from other people).What are potential weaknesses in this study?: More women than men and nonbinary people took part, which means that we know more about women than other people. We also do not really know whether everyone in the nonautistic groups were really "not autistic." They could be autistic people who do not have a diagnosis, which might affect our results.How will these findings help autistic people now or in the future?: We hope our findings will help people to understand how masking affects autistic and nonautistic people. We also hope that people designing new studies will look at important things such as whether someone is autistic and nonbinary, or autistic and ADHD as these things might affect their experiences.

Introduction: Autistic people often encounter barriers to social connectedness, leading to feelings of loneliness and isolation. Tabletop role play games (TTRPG) groups have shown potential as a neurodiversity-affirming way to enhance the social connectedness of autistic adolescents and young adults. TTRPGs involve interactive collaborative storytelling through player constructed characters, often with involvement of a Game Master, and include games such as Dungeons and Dragons. Our study aimed to explore the experiences of autistic adolescents and young adults participating in socially led TTRPG groups. Method: We employed a qualitative phenomenological design. Thirteen participants (10 males, 1 female, 2 non-binary/diverse gender) with ages ranging between 14 and 29 years from Australia took part in semi-structured interviews, which we analyzed using thematic analysis. Results: We identified four key themes. Theme 1: Safe space that encouraged happiness, self-expression, and escapism; explored how TTRPGs created a safe environment that encouraged participants to unmask and express themselves through escapism and creativity. Theme 2: Learning to manage group dynamics and resolve conflict; included how TTRPGs provided opportunities to learn through conflict. Theme 3: Connection and belonging through friendships; described how social confidence was facilitated through a sense of belonging in TTRPGs. Theme 4: Personal growth and learning; explored how TTRPGs facilitated development of social and emotional awareness, cognitive flexibility, and problem-solving abilities. Conclusion: Socially-led TTRPG supported autistic adolescents and young adults to explore their authentic selves, feel more socially connected and happier, develop genuine and long-lasting friendships, social confidence, and cognitive skills. Participants experienced conflict in TTRPG groups but described that this enabled development of conflict resolution skills. It is important to note that no therapists were involved in these groups. Future research could explore TTRPGs with mixed neurotype participants to further understand the roles of shared interests in communication between mixed neurotype participants. Community Brief Why is this an important issue? Autistic people are more likely to feel lonely due to negative social experiences and feelings of being excluded. This can lead to difficulties with mental and physical health, including masking, depression, anxiety, burnout, and suicidality. Tabletop role play games (TTRPGs) are games in which a group of people work together to create and experience a story, often guided by a Game Master. The most well-known TTRPG is Dungeons and Dragons. Each player can decide on their unique character. TTRPGs may help autistic teenagers and young adults feel less lonely and more connected. What was the purpose of this study? We wanted to understand how TTRPGs led by people in the community may impact the loneliness and friendships of autistic teenagers and young adults. What did the researchers do? We interviewed 13 autistic adolescents and young adults aged between 14 and 29 years who lived in Australia and had a range of TTRPG experiences. They participated mainly in socially-led TTRPGs, which had no therapists involved. We developed interview questions with input from an autistic advisor. The interview questions asked about positive and negative experiences of TTRPGs. We then found the common themes that autistic young people talked about. What were the results and conclusions of the study? The autistic people in our study said that TTRPG groups created safe spaces where they could connect with others without masking, due to being able to explore through their characters. TTRPGs brought mainly positive experiences, with long-term friendships being formed or consolidated. Autistic young people felt more socially confident, more flexible, and learnt life skills that helped outside of the TTRPGs. Most people said they experienced hard times in TTRPGs; however, these situations helped them to learn how to manage conflict, negative experiences and emotions. These findings suggest that TTRPGs can be a neurodiversity-affirming, strengths-based way to help autistic adolescents and young adults feel more connected and to develop friendships. What is new or controversial about these findings? Most research in the past has focused on how therapists can develop the social skills of autistic people. Our study found that social confidence, friendships, and connections can be developed through being in safe spaces related to the person’s interests that allow personal growth and exploration, without therapists present. What are the potential weaknesses in the study? We interviewed people in Australia and mostly male participants. Therefore, our study may not reflect the thoughts of everyone, particularly related to masking, which is more common in autistic females. How will these findings help autistic adults now or in the future? These findings suggest that autistic people can enhance their happiness and unmask by engaging in a socially led interest-based group, such as TTRPGs. Autistic adults may feel empowered to know that by finding a safe space with a group of people who have similar interests, they can develop strong friendships and life skills that can be helpful in other areas of their life.

The formation of autism advocacy organisations led by family members of autistic individuals led to intense criticism from some parts of the autistic community. In response to what was perceived as a misrepresentation of their interests, autistic individuals formed autistic self-advocacy groups, adopting the philosophy that autism advocacy should be led ‘by’ autistic people ‘for’ autistic people. However, recent claims that self-advocacy organisations represent only a narrow subset of the autistic community have prompted renewed debate surrounding the role of organisations in autism advocacy. While many individuals and groups have outlined their views, the debate has yet to be studied through computational means. In this study, we apply machine learning and natural language processing techniques to a large-scale collection of Tweets from organisations and individuals in autism advocacy. We conduct a specification curve analysis on the similarity of language across organisations and individuals, and find evidence to support claims of partial representation relevant to both self-advocacy groups and organisations led by non-autistic people. In introducing a novel approach to studying the long-standing conflict between different groups in the autism advocacy community, we hope to provide both organisations and individuals with new tools to help ground discussions of representation in empirical insight.Lay Some autism advocacy organisations are run by family members of autistic people, and claim to speak on behalf of autistic people. These organisations have been criticised by autistic people, who feel like autism charities do not adequately represent their true interests. In response to these organisations, autistic people have come together to form autistic self-advocacy organisations, or groups in which activists can spread awareness of autism from an autistic point-of-view. However, some people say that autistic self-advocacy organisations do not sufficiently represent the needs of all autistic people. These tensions between organisations and individuals have made it difficult to determine which organisations can make the claim that they represent all autism advocates individuals equally, instead of showing preference to a sub-group within the autism community. In this study, we try to approach this issue using computational tools to see if, in their Twitter posts, both kinds of organisations show a preference for the interests of autistic people or parents of autistic children. We do so by comparing a large body of Tweets by organisations to Tweets by autistic people and parents of autistic children. We find that both kinds of organisations match the interests of one group of autism advocates better than the other. The insight we provide has the potential to inspire new conversations and solutions to a long-standing conflict in autism advocacy.

The conceptualisation of autism as a disorder where Theory of Mind (ToM) and pragmatics are fundamentally impaired has prompted a wealth of research on autistic deficits, most of which is characterised by two main assumptions: first, that autistic people would display said deficits, if present, with any conversation partner and in any situation; second, that neurotypical people do not present these deficits, regardless of the conversation partner. However, this is not necessarily reflected in autistic accounts of the way they experience social cognition and pragmatics. The present paper aims to investigate the autistic experience of communication with both autistic and neurotypical people, with a particular focus on their perception of the ability of autistic and neurotypical people to understand their communicative intentions. Participants, 23 adult Italian autistic people without intellectual disability or language disorders, were recruited online. Two virtual focus groups of 2 hours each were conducted, transcribed and analysed through thematic analysis with a descriptive phenomenological approach by two independent researchers. Six themes were developed from the analysis, the most relevant being Autistic-Autistic communication and Autistic ToM. The results, in line with the Double Empathy theory, suggest there seem to be important differences between neurotypical and autistic people's ToM. These appear to make it easier for autistic people to communicate with one another, as well as to create difficulties for neurotypical people to understand autistic people, not just the other way around. These results seem to confirm that challenges in cross-neurotype communication are better interpreted as mutual miscomprehension and reciprocal differences in ToM rather than deficits on the autistic part. This calls for a reframing of ToM and/or the need for autistic ToM as a construct, of which neurotypical people seem to be lacking. Moreover, these insights should be taken into account for speech and language therapy and clinical practice in general, advocating for a neurodiversity-informed view of co-constructed communication as well as for a broader societal change in which therapists can play a crucial role, through participatory approaches or raising awareness in their daily practice. What is already known on the subject Autism is conceived as characterised by social cognition and communication difficulties, often linked to Theory of Mind (ToM) deficits. However, recent research suggested variations in ToM abilities within the autistic population and proposed alternative theories like the Double Empathy theory. Nevertheless, only a few studies examined how autistic individuals perceive communication across neurotypes. What this study adds Autistic individuals seem to find it easier to communicate with other autistic people, and they identify specific characteristics of neurotypical communication that hinder successful communication. Moreover, neurotypical people are perceived as having difficulties in autistic ToM, which seems to emerge as a relevant and needed construct in light of the Double Empathy problem. What are the clinical implications of this work? These findings can inform speech and language therapy and clinical practice about the potential gains of raising awareness on the Double Empathy problem and the higher communication ease inside the autistic community, alongside individualised support. Participatory approaches and closer collaboration with the autistic community also seem to be crucial for therapists to help improve communication experiences for autistic individuals.

Focused interests are characterised by high attention and focus, and are commonly experienced by autistic people. While some research frames these interests as inflexible and non-social, other research has highlighted many positive impacts for autistic people. Research also shows that cultural activities, such as museum and art gallery visits, can facilitate and promote health, including mental health, in the general population. This study used an online mixed-methods survey to explore relationships between focused interests, motivation, museum/gallery attendance, and wellbeing for 45 autistic and 44 non-autistic participants. Findings include (a) both autistic and non-autistic participants reported having focused interests, which had a similar nature and served similar purposes for both groups; (b) exploring focused interests in museums/galleries related to more positive emotions during visits for both groups, but autistic individuals more frequently raised sensory and accessibility concerns; and (c) autistic participants reported significantly lower wellbeing, but focused interests, motivation, and museum/gallery attendance did not significantly impact wellbeing. Our findings highlight the deep meaning and positive impact of focused interests on autistic lives, the potential of galleries and museums to provide opportunities for the meaningful exploration of focused interests, and the importance of minimising accessibility barriers for autistic people in these spaces. Lay Abstract Some research says that focused interests – meaning interests to which people dedicate a lot of attention, time, and focus – are bad for autistic people, but other research indicates that focused they can be good in many ways, like helping in careers or education. Visiting galleries and museums can be good for human wellbeing, but we do not know if that works in the same way for autistic people specifically. This study looked at whether focused interests, motivation, and museum/gallery attendance contributed to better wellbeing for autistic adults. We also checked if non-autistic people had focused interests, and if there were any differences in autistic and non-autistic people's interests. We looked at the different experiences and needs of autistic and non-autistic people when visiting museums/galleries. To do this, we asked 45 autistic and 44 non-autistic adults to complete an online survey including ratings on scales and open text boxes. We analysed participants’ scale ratings using statistics, and their open answers using content analysis, which helps researchers find the most frequent categories in text. Autistic people's focused interests, motivation, and museum/gallery attendance did not impact their wellbeing in the statistical analysis, but some participants wrote that they used their focused interests to help their wellbeing and mental health. Autistic people reported focused interests more frequently than non-autistic people, but the content and purpose of their interests were similar. Both groups talked about good experiences in visiting museums/galleries and exploring their focused interests there, but autistic people specifically complained about environments that were not accessible. Our findings show that being able to explore focused interests in galleries and museums can lead to positive feelings, while barriers in the environment and accessibility issues can stop autistic people from enjoying their visits and exploring their interests.

The Autism Intervention Research Network on Physical Health Autistic Researcher Review Board.

Sensory processing differences (SPDs) and mental health symptoms are not limited to young autistic people but continue to occur into adulthood. However, existing quantitative research has predominantly focused on younger autistic people. Less work has been done to investigate SPDs and relationships with mental health conditions in older autistic adults (i.e., aged 40 and older) across their midlife and older adulthood. A total of 432 participants (autistic n = 265; non-autistic n = 167) aged 40-93 years completed online questionnaires related to SPDs and mental health (i.e., anxiety and depression symptoms). Neurotype and gender differences, age associations, and associations between SPDs and mental health were examined. Participants' contextualization of their lived experiences of SPDs was analyzed qualitatively. Overall, SPDs and mental health symptoms were more apparent in the autistic group than the non-autistic group, with autistic women showing higher levels of SPDs and poorer mental health than autistic men. SPDs were more often reported to worsen across adulthood by those in the autistic group than those in the non-autistic group, with older autistic people more often reporting worse coping abilities. Furthermore, positive associations between SPDs and anxiety/depression symptoms were observed in the autistic group, with the strength of associations increasing with age. From the qualitative data, we developed six topics reflecting participants' lived experience of SPDs. Quantitative and qualitative evidence suggest that autistic adults in older age may be more likely to have a heightened risk of SPDs and associated poorer mental health. This study extends previous understanding of SPDs with mainly younger autism populations and highlights the necessity of exploring sensory difficulties in autistic adults in midlife and older adulthood. Why is this an important issue?: Autistic people often experience sensory processing differences (SPDs), for example, difficulties with sound/noise, textures, tastes, smells, and temperatures. In addition, these SPDs often impact their mental health. Although these SPDs are not unique to autistic people, they experience SPDs at higher rates than the general population.What was the purpose of this study?: People of all ages can experience SPDs and mental health conditions. Despite this, much of the existing research on sensory and mental health experiences has focused on young autistic people. This study aimed to explore these experiences in middle-aged (age 40-59) and older (age 60+) autistic people.What did the researchers do?: Using an online survey, we asked middle-aged and older autistic and non-autistic adults questions about their experiences of SPDs and their mental health. A total of 265 autistic and 167 non-autistic adults aged 40-93 took part in our survey. About half of our sample were women.What were the results of the study?: Compared with the non-autistic participants, the autistic people in our study reported more SPDs, a higher frequency of overwhelming sensory experiences, and lower abilities to cope with their sensory experiences as they aged. SPDs and mental health conditions were found to co-occur, and this was reported more often by older autistic participants. In the open-text responses, autistic and non-autistic people reported that noise was a particular issue, but autistic people were more likely to stress the impacts on their mental health than non-autistic people. Several autistic people mentioned that they had developed coping strategies for managing their sensory experiences, for example, wearing noise-canceling headphones.What do these findings add to what was already known?: These findings further our understanding of the experience of SPD in autistic populations. Much of the existing research has focused on younger people, and these findings highlight that middle-aged and older autistic people may need additional support for managing their sensory environments as they get older. It also highlights that sensory experiences should be considered when supporting autistic people with their mental health, and this may be particularly important for older autistic people.What are potential weaknesses in the study?: First, our findings are based on cross-sectional data, and thus, we are unable to generate predictive relationships between SPDs and mental health conditions. Second, the subscale used to measure the presence of SPDs included only three items. Third, most current participants are from the United Kingdom, and very few non-binary/trans/gender-fluid individuals took part in this study. Last, there may also be other factors that are influencing the SPDs of middle-aged and older autistic adults that are not taken into consideration in this study, for example, their physical health or their living situation.How will these findings help autistic adults now or in the future?: These findings highlight that autistic people in midlife and older age may be particularly susceptible to SPDs, which may impact their mental health. This emphasizes the need for evidence-based interventions to address SPDs and support autistic people with their sensory environments as they age.

The double empathy problem proposes a lack of shared understanding between autistic and non-autistic people leads to interaction difficulties between them. Social self-efficacy (confidence in one’s social abilities) makes an important contribution to social interactions. Research has shown that autistic people show a social identity (one’s sense of self based on membership of social groups) with other autistic people, and this impacts positively on well-being. In addition, research shows that autistic people have a number of social identities. This study aims to understand whether social self-efficacy relates to mental well-being in autistic adults, and whether social identity plays a role in this relationship. A total of 512 autistic adults completed measures of social self-efficacy, social identity, mental well-being and autistic traits. In-group social self-efficacy was found to be higher than out-group social self-efficacy. Second, in-group social self-efficacy was positively associated with well-being. Finally, social identity did not mediate the relationships between social self-efficacy and mental well-being. These findings suggest social self-efficacy may relate to the nature of the group one interacts with. The findings support further research into the relationship between social self-efficacy and well-being, as well as using the double empathy problem as a framework for further investigations in other social groups.Lay abstractIn the past, research has suggested that autistic people are not able to communicate well with non-autistic people because of autistic people’s communication difficulties. However, newer theories question this conclusion. It is now thought that the communication difficulties may be because autistic and non-autistic people both struggle to understand each other. This study explores how these differences in shared understanding relate to autistic people’s mental well-being, confidence in social situations and social identities (groups that we belong to and that influence how we see ourselves). We created an online survey taken by 512 autistic adults, which included questions about their confidence being social with people from different groups (such as other autistic people or people they share a hobby with), about the social groups they felt they belong to and about their mental well-being. First, participants reported higher social confidence when interacting with members of a social group they belonged to. Second, being confident during these interactions was linked to higher mental well-being. Finally, the groups participants belonged to did not influence the link between social confidence and mental well-being. These findings are important as they help us better understand autistic people’s experiences of social interactions and what contributes to good and poor mental well-being in autistic people. They also help us to think further about how to improve autistic people’s well-being.

Background: Autistic people experience worse mental health outcomes than non-autistic people. Masking (concealing autistic traits) is found to relate to poor mental health. Research shows that autistic people indicate relationships between masking and difficulties creating or maintaining a sense of identity. Personal identity is rarely studied within autism research. This study aims to bridge this gap by exploring the connection between identity formation difficulties (both social and personal) and its impact on poor mental health in autistic people. It examines levels of identity conflict and distress in autistic and non-autistic people and whether identity distress mediates and identity conflict moderates the relationship between masking and psychological distress. Method: Data were collected for autistic ( n = 139) and non-autistic people ( n = 133) using an online survey. Results: Autistic people were found to experience higher levels of identity distress, conflict, and psychological distress. Identity distress represents a full mediation of the relationship between masking and psychological distress in the autistic cohort, but a partial mediation in the non-autistic cohort. Identity conflict did not moderate any relationships within the model for either cohort. However, it did have a significant direct relationship with masking identity distress and psychological distress. Conclusions: These findings suggest that autistic people may experience worse mental health outcomes due to difficulties with cohesive identity formation. Additional research into the role of autism in identity development may identify other areas in which identity difficulties negatively impact autistic people, such as long-term planning and suicidality.

This study aimed to identify guiding principles to underpin assessment and diagnosis of autism to improve the quality, consistency and accuracy of services provided to individuals and their families. An online survey and focus groups were used to capture community perspectives of members of the Australian autistic and autism communities. A total of 871 individuals participated across the research activities, including autistic individuals (n = 253), parents of autistic individuals (n = 344), practitioners (n = 325) and members of organisations with an interest in the assessment and/or diagnosis of autism (n = 115). Three overarching themes, encompassing 15 codes, representing the principles that should underpin practice across the assessment and diagnostic process were developed (a) placing the person at the centre of the process; (b) understanding and valuing the whole person and (c) improving quality and access. Assessment and diagnosis for autism should go beyond diagnostic decision-making to include understanding of individual needs and identifying support pathways. The principles identified serve as a first step to guiding practitioners in their approach, ensuring they work in ways that promote best practice, reflect the perspectives of autistic people and engender meaningful outcomes for individuals and families that are independent of receiving a diagnostic label.Lay AbstractThis study looked to identify principles of practice that could help make autism assessments and diagnoses better for autistic people and their families. To do this, the researchers asked people from the autism community in Australia to share their thoughts through an online survey and focus groups. A total of 871 people took part. This included autistic adults, parents of autistic children, professionals like psychologists and speech pathologists and people from autism-related organisations. From what people said, three main ideas stood out: (a) putting people at the centre of the process, (b) looking at the whole person and (c) improving quality and access to services. The study found that getting a diagnosis is just one part of the process. It is also important to use the assessment to help people understand themselves better and find the right support. The principles highlighted in this study can help guide professionals to do a better job when assessing autism. They encourage practices that are respectful, person-focused and based on what autistic people and their families say is important. This can lead to better outcomes for everyone, no matter whether a diagnosis is given or not.

Background: There is a general belief in the scientific community that autistic people have emotion recognition (ER) difficulties. Despite this, the research is inconclusive, with roughly half of the studies showing that autistic people have similar ER ability to non-autistic people. The alexithymia hypothesis posits that ER differences found in some autistic individuals might be due to concurrent alexithymia, with some incipient research backing this claim. One limitation of past literature is the focus on facial expressions, with ER from body language remaining understudied, especially in relation to autism and alexithymia. Methods: Adults ( N = 364) completed a face and body ER task containing video expressions of all basic emotions, during which we measured their accuracy, confidence, and intensity ratings. Participants also completed Alexithymia (PAQ) and autism traits (AQ-10) questionnaires. After data cleaning, we split participants into an autistic group ( n = 71) and non-autistic group ( n = 279). We used alexithymia scores to further split the two autism groups into high and low alexithymia categories. We investigated the effects of autism and alexithymia on body and face ER accuracy (unbiased hit rates), confidence ratings, and intensity ratings. Results: Autistic individuals had slightly lower accuracy and confidence than non-autistic individuals. When alexithymia was modeled with autism, autistic people were no different than non-autistic people on accuracy and confidence. Alexithymia was a better predictor of confidence than autism and interacted with modality. Bodies were harder to recognize than faces, but we found no interaction between modality and autism or alexithymia. Our results did not find differences in intensity ratings. Conclusion: Alexithymia may account for differences in ER accuracy and confidence between autistic and non-autistic people. Our findings support the alexithymia hypothesis of autism. This is the first study comparing facial and bodily ER in autistic and non-autistic people and in low- and high-alexithymia-score individuals.

Autistic individuals often experience difficulties in social settings. Although autistic individuals may not intuitively know the "typical" way to behave in social settings, many autistic individuals have a desire to fit in so they develop techniques to "camouflage" their autistic traits. Although camouflaging may help individuals to navigate social environments, camouflaging has also been shown to produce negative psychological outcomes. This study aims to explore whether this "camouflaging" strategy is associated with poor social competence, an aspect of the autism diagnosis. In this study, 247 nonautistic adults completed the Multidimensional Social Competence Scale (MSCS) to assess their social competence, and the Camouflaging Autistic Traits Questionnaire (CAT-Q) to assess the extent to which they used strategies to compensate or mask behaviors characteristic of autism in social settings. We found that over and above IQ, gender, and executive functioning scores, social competence (MSCS) scores reliably predicted the extent to which nonautistic individuals camouflaged, accounting for 25% of the variance in CAT-Q scores. Importantly, even when autistic traits were controlled for, social competence was still able to account for additional variance in CAT-Q scores. These results suggest that low social competency in nonautistic adults predicts camouflaging as a strategy in social situations. Given these camouflaging behaviors are being performed in an attempt to comply with an environmental demand to behave in a particular manner, these results also highlight the importance of conceptualizing the social challenges that autistic and nonautistic individuals face in a bidirectional manner, where the onus is not solely on the individual to comply with social conventions but also on society to accommodate diverse behavioral traits. Why was this study done?: Some autistic individuals try to hide their autistic traits to "fit in" with others, referred to as "camouflaging." Nonautistic adults also report camouflaging, but it is unclear whether this camouflaging is related to social difficulties that are not specific to autism. No research has been conducted to examine the relationship between social competence and camouflaging in nonautistic adults.What was the purpose of this study?: To further understand the factors that are related to camouflaging behaviors. More specifically, whether social abilities, and/or autism characteristics, are related to whether nonautistic adults camouflage.What did the researchers do?: We had 257 nonautistic adults complete various questionnaires, including ones that asked them about their camouflaging behaviors and social abilities. We examined the relationships between the scores from these questionnaires and the influence of other factors such as gender, intelligence, and executive functioning.What were the results of the study?: We found that both social abilities and autistic traits were related to camouflaging behaviors. Indeed, nonautistic adults who had poor social skills, and more autistic traits, engaged in more camouflaging. Social skills were associated with camouflaging even after we considered factors such as gender, intelligence, and executive functioning.What do these findings add to what was already known?: These findings help us understand camouflaging by demonstrating that it may be a common response to social difficulties in nonautistic, as well as autistic, adults. These results also indicate that camouflaging is related to low social competency, not just autism characteristics.What are the potential weaknesses in the study?: The participants in our study completed questionnaires through which they were required to pick from set answers, rather than describe their experiences. We may be missing important qualitative differences in the way nonautistic adults camouflage compared with autistic adults.How will these findings help autistic adults now or in the future?: By comparing what is shared and what is unique with nonautistic people who share traits with autistic people, a more precise definition and study of camouflaging behavior are possible. Rather than see camouflaging as a phenomenon that occurs exclusively in autistic people because of their disability, it may be that both autistic and nonautistic people use camouflaging when they perceive themselves to lack the necessary social competencies that are expected within their social contexts. Because both autistic traits and social competency are related to camouflaging behavior, we can begin to think about how to tease apart which characteristics are more likely to evoke camouflaging in autistic individuals and how this may be similar or different in nonautistic individuals. This knowledge will ultimately contribute to the development of more tailored approaches to prevent and/or reduce the negative impact of camouflaging behaviors for autistic adults.

Background Autistic children and their families access services, such as occupational therapy (OT), speech language pathology (SLP) services, applied behaviour analysis (ABA)-based therapies and physiotherapy (PT). There are varying levels of evidence supporting the efficacy of these therapies, and some autistic-led advocacy is critical of the methods and aims of certain services. Exploring stakeholder perspectives is critical to ensure services are appropriate and informed by lived experiences. This work is part of a larger survey that explored the perspectives of autistic individuals, parents of autistic children, and clinicians on these services. Objectives This study explored how autistic people perceive the acceptability of OT, SLP services, ABA-based therapies, and PT. Design/Methods Using the Theoretical Framework of Acceptability (TFA), a survey was built with input from autistic people, parents of autistic children, and clinicians and shared online through social media and autism organizations. Demographic data and perspectives were captured. An acceptability sub-score was produced for each therapy, ranging from 0 (least accepting) to 64 (most accepting). The sub-scores were combined into an overall acceptability score. Open-ended questions were qualitatively analyzed using deductive content analysis following the TFA, and categories within constructs of ethicality are presented. Results 21 autistic people completed the survey, and their median (range) sub-scores were OT 40 (16 – 56), SLP 43.5 (28 – 57), ABA 19.5 (8 – 48), PT 39.5 (28 – 57). Qualitative categories within the TFA construct of ethicality included: 1) concerns about harms and negative experiences that can potentially occur because of therapies; 2) a lack of support for what respondents identified as behavioural techniques or methods. Conclusion Findings are similar to existing perspectives that some autistic people have towards ABA-based therapies. However, these findings highlight that some autistic people may view any therapy as unacceptable if it incorporates behavioural methods. Further work is needed to better understand aspects of behavioral methods that are viewed as unacceptable, given that some strategies, such as positive reinforcement, are used in different therapies and with the general population. Future work should explore perspectives from larger samples. Potential competing interests Melanie Penner has received consulting fees from the province of Nova Scotia and Addis & Associates / Roche, and research grant funding from Autism Speaks.

Controversy regarding the neurodiversity movement (NDM), the social and medical models of disability, autism intervention goals, and causal attributions of disability contributes to divides in the autistic and autism communities. The present study investigates the views of autistic and non-autistic autistic and autism community members on these topics. We explored whether these views are shaped by having close relationships to autistic people with intellectual disabilities (ID) and nonspeaking autistic (NSA) people. A total of 504 autistic and autism community members (278 autistic, 226 non-autistic) completed an online survey about theoretical models and intervention goals. Participants reported whether they had one or more close relationships with NSA people, autistic people with ID, neither, or both. Overall, there was considerable consensus regarding desired intervention goals: normalization goals were generally opposed, while participants generally supported well-being, societal reform, supportive environment, and adaptive skill goals. While autistic participants reported less support for normalization and adaptive skills goals than non-autistic participants, they expressed somewhat more enthusiasm for societal reform and supportive environments than non-autistic people. Autistic people supported the NDM more and the medical model less than non-autistic people. Those close to autistic people with ID gave higher ratings to adaptive skill goals. On average, participants not close to autistic people with ID saw the challenges of those without ID as being slightly more due to environmental/social factors than the challenges of those with ID; there was no such statistical difference among those close to autistic people with ID. Further research investigating community views, with the inclusion of more autistic people with ID and NSA people themselves, is needed, but the results of this study suggest that the broader autistic and autism communities see NDM-consistent intervention goals as appropriate for all autistic people, including NSA people and those with ID. As autism interventions have often pursued unpopular normalization goals, this suggests directions for reform.