The Role of Self-Concept Clarity in the Relations Between Disordered Eating, Gender Diversity, and Autistic and ADHD Traits.

Research on autism and ADHD continues to increase, as does the research on well-being and mental health. There is a growing need to understand what factors impact mental health and well-being, and the question arises as to what factors impact mental health and well-being in autism and ADHD. The existing literature focuses on two different aspects when it comes to the well-being and mental health of autism in students. One aspect focuses on mental health and well-being in diagnosed neurodivergent individuals, and the other aspect focuses on associations between autistic and ADHD traits and mental health and well-being. In order to understand the impact on mental health in autism, an online survey using the Qualtrics platform was given to a sample of 430 university students. The survey used the well-being process questionnaire, the autism spectrum quotient, the ADHD self-report scale, and the strengths and difficulties questionnaire. The results showed significant correlations between anxiety, depression, and autistic and ADHD traits (all correlations > 0.2). These variables were also correlated with the well-being and SDQ outcomes and well-being predictors (all correlations > 0.2). The regression analyses showed significant associations between well-being outcomes and predictor variables and anxiety and depression, whereas the effects of autistic and ADHD traits were restricted to the SDQ outcomes (hyperactivity, conduct, and peer problems). Regression analyses were also conducted to determine whether a variable formed by combining autistic traits, ADHD, anxiety, and depression scores was a significant predictor of well-being and SDQ outcomes. The combined variable was associated with all outcome variables except the prosocial variable. This study provides the basis for further research for understanding the interaction between well-being, mental health, autism, and ADHD.

This study identifies the extent to which autistic students, or those with high levels of autistic traits, are pursuing higher education in the performing arts, and examined the nature of the relationship between students’ autistic traits and reported wellbeing. Performing arts students ( n = 280), along with a comparison group of students studying other subjects ( n = 144), took part in an online questionnaire about their background (diagnostic history, neurodivergent traits), and their wellbeing (perceived educational self-efficacy, quality of life, mental health). Participants also answered open-ended questions about support needed, received, or desired, in their educational institution. Similar rates of autism diagnoses and levels of autistic traits were seen in the two groups. Regression analyses indicated that higher levels of ADHD traits and depression were associated with lower levels of educational self-efficacy. Despite a significant negative correlation between autistic traits and self-efficacy, autistic traits did not uniquely predict variance in the regression model. One third of all students reported a desire for more education-based support, particularly those with ADHD traits. These findings show that, within the community of those studying in the performing arts, those who are neurodivergent or who have high levels of neurodivergent traits, may be especially vulnerable to lower wellbeing. Lay Summary Many autistic people want to have a career in the performing arts and therefore are likely to undertake performing arts degree programmes. This study looked at the experiences of autistic students, or those with high levels of autistic traits. We wanted to understand how being autistic, or having a high level of autistic traits, might relate to student wellbeing – and whether this was specific to performing arts courses. In total, 280 performing arts students and 144 students studying other subjects (a comparison group), answered an online questionnaire about their wellbeing as a student. This included questions about how good they thought they were at different parts of the course, their quality of life, their mental health, their level of autistic and ADHD traits, and their experiences of support during their studies. We found similar numbers of autistic people and levels of autistic and ADHD traits in students from the two groups (performing arts and other subjects). For both student groups, we found that a higher level of ADHD traits and mental health conditions predicted lower confidence in people's abilities. Higher levels of autistic traits were also linked with lower educational confidence, but did not predict it as much as ADHD or mental health traits did. One third of all students said they wanted more support during their course, and these students tended to have higher levels of ADHD traits. Our findings show that students who are autistic, or who have high levels of autistic traits, may be particularly at risk of lower wellbeing while studying.

Objective: ADHD and autism spectrum disorder (ASD) can be viewed as the extreme end of traits found in the general population. Clinical and genetic studies suggest that ADHD and ASD often co-occur and share genetic susceptibility. The aim of this study was to examine co-occurrence of ADHD and ASD traits in the general population. Method: In total, 334 participants were recruited from a population-based sample. Four questionnaires assessing current and retrospective ADHD and ASD traits were administered online: the Adult ADHD Self-Report Scale (ASRS) Symptom Checklist, the Wender Utah Rating Scale (WURS-25), the Broad Autism Phenotype Questionnaire (BAPQ), and the Autism Spectrum Quotient (AQ). Results: A significant correlation was found between ADHD and autistic traits. In particular, higher inattention and overall ADHD scores were associated with self-reported deficits in communication and social skills. Conclusion: Our findings are similar to results from studies on clinical populations, suggesting that ADHD and ASD might share common etiology.

Background: There has been considerable research on Autism and ADHD, which are recognized as significant special educational needs. Many studies use samples which have been diagnosed with these conditions, but there is also a growing trend to focus on these traits among community populations rather than just among the individuals diagnosed. Recent research has examined the well-being of students using the "well-being process" framework. The present study examined the association between well-being, measured by the Well-being Process Questionnaire and the Strengths and Difficulties Questionnaire, and the autistic and ADHD traits of secondary school students.
 Aims: The study first examined the associations between autistic and ADHD traits in secondary school students. The second aim was to examine the associations between well-being outcomes and these traits. Finally, analyses controlling for established predictors of well-being examined whether associations between autism and ADHD traits and well-being outcomes remained significant.
 Methodology: An online survey was carried out. The participants were 155 students from a Welsh Secondary School and represented various year groups. Correlations and regressions were conducted to examine associations between variables.
 Results: Autistic and ADHD traits were found to be significantly correlated. Both sets of traits were also significantly correlated with well-being outcomes. When autistic and ADHD traits were included in the same regression, ADHD was found to be associated with most outcomes, whereas autistic traits were only associated with hyperactivity, peer problems and reduced prosocial behaviour. When established predictors of well-being were also included in the model, ADHD traits were only associated with hyperactivity and autism with prosocial problems and hyperactivity. There were no significant effects on physical health.
 Conclusion: Autistic and ADHD traits overlap. Univariate analyses show significant associations between these traits and well-being. However, when established predictors of well-being were included in the analyses, only hyperactivity and reduced prosocial behaviour were still associated with autistic and ADHD traits. The psychosocial profiles of autism and ADHD may help design interventions to increase well-being. For example, both autism and ADHD are associated with high stress and poor coping, both of which may be improved by training.

Autistic individuals and individuals with ADHD are more likely to experience eating disorders, yet the reasons for this are not well understood. We investigated whether childhood neurodivergent (i.e. autistic and ADHD) traits are associated with patterns of emotional/restrained eating and externally driven eating behaviours in adolescence, whether these associations differed by sex and if they are mediated by anxiety. We tested the association between parent-reported childhood (age 7 years) autistic and ADHD (i.e. hyperactivity/impulsivity, inattention) traits and self-reported adolescent (age 13) eating behaviours in a large population-representative prospective cohort (N = 7,572; Avon Longitudinal Study of Parents and Children). We performed multi-group longitudinal analysis stratified by sex to understand whether sex moderates' associations between neurodevelopmental traits and adolescent eating behaviours. Mediation models tested the extent to which observed associations were driven by mid-childhood (age 10) anxiety symptoms. All analyses were adjusted for child sex, child ethnicity, maternal education levels and maternal age at birth. Individuals who had higher childhood autistic traits were more likely to report emotional/restrained (b = 0.59, 95% CI [0.29, 0.88], p < .001, B = 0.07) and externally driven (b = 0.17, 95% CI [0.05, 0.28], p < .01, B = 0.06) eating behaviours during adolescence. Additionally, individuals with higher childhood inattention traits were more likely to report externally driven eating behaviours (b = 0.10, 95% CI [0.03, 0.19], p = .02, B = 0.05). No sex differences were identified in the associations. Mediation models suggested a significant indirect effect of anxiety for the association between autistic traits and emotional/restrained eating (b = 0.08, bootstrapped 95% CIs [0.02, 0.13]). Autistic and ADHD traits in childhood may share some eating behaviour phenotypes in adolescence (externally driven eating), whereas others are specific to autism (emotional/restrained eating). We present evidence for the role of anxiety in underpinning the association between autistic traits and emotional/restrained eating behaviours, suggesting an important potential intervention target.

Autistic traits are frequently associated with depressive symptoms. However, the underlying mechanisms involved in this association still need further examination. The present study explored chain mediation pathways, examining the impact of camouflaging autistic traits on the self and its subsequent influence on depressive symptoms. According to the diathesis-stress models, the dynamic interactionist model of vulnerability, the dual vulnerability model, the disconnect theory, and the unified model of depression, the present study examined two potential chain mediation pathways (i.e. social camouflaging – self-concept clarity and social camouflaging – self-disgust) of the association between autistic traits and depressive symptoms. Four hundred sixty-three undergraduate and graduate students completed an online survey measuring autistic traits, depressive symptoms, social camouflaging, self-concept clarity, and self-disgust. Autistic traits were directly and indirectly associated with increased depressive symptoms in the general population. Specifically, autistic traits were related to depressive symptoms through the chain mediation pathways of social camouflaging to self-concept clarity and social camouflaging to self-disgust. The results demonstrate the relationship between autistic traits and depressive symptoms when individuals engage in social camouflaging, particularly focusing on self-aspects (i.e. self-concept clarity and self-disgust). These findings underscore the complexities of mental health challenges associated with camouflaging autistic traits and highlight the importance of considering self-factors as critical intervention points for depressive symptoms.

Gender clinic and single-item questionnaire-based data report increased co-occurrence of gender diversity and neurodevelopmental conditions. The nuances of these associations are under-studied. We used a transdiagnostic approach, combining categorical and dimensional characterization of neurodiversity, to further the understanding of its associations with gender diversity in identity and expression in children. Data from 291 children (Autism N = 104, ADHD N = 104, Autism + ADHD N = 17, neurotypical N = 66) aged 4-12 years enrolled in the Province of Ontario Neurodevelopmental Network were analyzed. Gender diversity was measured multi-dimensionally using a well-validated parent-report instrument, the Gender Identity Questionnaire for Children (GIQC). We used gamma regression models to determine the significant correlates of gender diversity among age, puberty, sex-assigned-at-birth, categorical neurodevelopmental diagnoses, and dimensional neurodivergent traits (using the Social Communication Questionnaire and the Strengths and Weaknesses of ADHD Symptoms and Normal Behavior Rating Scales). Internalizing and externalizing problems were included as covariates. Neither a categorical diagnosis of autism nor ADHD significantly correlated with current GIQC-derived scores. Instead, higher early-childhood dimensional autistic social-communication traits correlated with higher current overall gender incongruence (as defined by GIQC-14 score). This correlation was potentially moderated by sex-assigned-at-birth: greater early-childhood autistic social-communication traits were associated with higher current overall gender incongruence in assigned-males-at-birth, but not assigned-females-at-birth. For fine-grained gender diversity domains, greater autistic restricted-repetitive behavior traits were associated with greater diversity in gender identity across sexes-assigned-at-birth; greater autistic social-communication traits were associated with lower stereotypical male expression across sexes-assigned-at-birth. Dimensional autistic traits, rather than ADHD traits or categorical neurodevelopmental diagnoses, were associated with gender diversity domains across neurodivergent and neurotypical children. The association between early-childhood autistic social-communication traits and overall current gender diversity was most evident in assigned-males-at-birth. Nuanced interrelationships between neurodivergence and gender diversity should be better understood to clarify developmental links and to offer tailored support for neurodivergent and gender-diverse populations.

BackgroundAttention‐Deficit/Hyperactivity Disorder (ADHD) is linked to strengths in creative problem‐solving amongst school‐aged children and adults. In contrast, autism (which frequently co‐occurs with ADHD) is associated with lower generativity, and perseverative responses during problem‐solving. Little is known about how ADHD and autism traits—or broader heritable autism and ADHD phenotypes—associate with problem‐solving skills in early childhood.Methods129 UK 2‐ and 3‐year‐olds (exploratory dataset) and 74 Swedish 3‐year‐olds (confirmatory dataset) with and without a family history (FH) of ADHD and autism, completed a problem‐solving task. Parents reported on their 3‐year‐olds’ ADHD and autism traits using the Child Behaviour Checklist and Social Responsiveness Scale‐2. FH group differences in problem‐solving performance were tested using ANOVA (exploratory dataset, FH‐autism and FH‐ADHD as fixed factors) and t‐test (confirmatory and combined datasets split by FH‐ADHD). Linear regressions of problem‐solving success on autism/ADHD traits were run in both samples.ResultsCompared with peers with no FH‐ADHD, children with FH‐ADHD showed higher problem‐solving success at 2 (partial ω2 = 0.106) and 3 years (partial ω2 = 0.045) in the exploratory dataset. In the confirmatory dataset, a FH‐ADHD‐and‐autism group trended towards higher success scores compared with a no‐FH‐ADHD group (comprising FH‐autism‐only and no‐FH ADHD‐or‐autism sub‐groups) but scores were only significantly higher for children with FH‐ADHD‐and‐autism when compared with children with no FH‐ADHD‐or‐autism (gs = 0.977). ADHD (but not autism) traits were positively associated with problem‐solving performance in the exploratory (β = 0.212, p = 0.031) and combined samples (β = 0.173, p = 0.024). Effects were a consistent direction and magnitude, but not significant, in the confirmatory sample alone (β = 0.201, p = 0.103).ConclusionsConsidering a child's family history alongside their neurodivergent traits may help to identify their likely strengths, and how to access them: Children with ADHD traits and/or a family history of ADHD are likely to have an aptitude for generative problem‐solving when presented with highly motivating, ecologically valid challenges.

BackgroundChildren with Neurofibromatosis 1 (NF1) show cognitive, behavioural and social differences compared to their peers. However, the age and sequence at which these differences begin to emerge is not fully understood. This prospective cohort study examines the cognitive, behavioural, ADHD trait and autism symptom development in infant and pre-school children with NF1 compared with typically developing (TD) children without a family history of neurodevelopmental conditions.MethodsData from standardised tests was gathered at 5, 10, 14, 24 and 36 months of age (NF1 n = 35, TD n = 29). Developmental trajectories of cognitive (Mullen Scales of Early Learning, MSEL) and adaptive behavioural (Vineland Adaptive Behavior Scales, VABS) development from 5 to 36 months were analysed using linear mixed modelling. Measures of ADHD (Child Behavior Checklist) and autism traits (ADOS-2, BOSA-MV and ADI-R) were assessed at 24 and 36 months.ResultsThe developmental trajectory of cognitive skills (all domains of the MSEL) and behavioural skills (four domains of the VABS) differed significantly between NF1 and TD groups. Post-hoc tests demonstrated that the NF1 participants scored significantly lower than TD participants at 24 months on all MSEL and VABS domains. The NF1 cohort demonstrated higher mean autism and ADHD traits at 24 months and 14% of the NF1 cohort met a research diagnostic classification for autism at 36 months.LimitationsThe study has a relatively small sample size due to variable retention and rolling recruitment. Due to limitations imposed by the COVID-19 pandemic, we utilised the Brief Observation of Symptoms of Autism for Minimally Verbal children (BOSA-MV) for some participants, which was administered online and may not gather as accurate a picture of traits as ADOS-2. The BOSA-MV was utilised for 41% of participants with NF1 at 36 months compared to 11% at 24 months. This may explain the reduction in the percentage of children with NF1 that met autism criteria at 36 months.ConclusionsBy 24 months of age, the NF1 cohort show lower cognitive skills and adaptive behaviour and higher levels of autism and ADHD traits as compared to TD children. This has implications for developmental monitoring and referral for early interventions.Trial registrationNot applicable.

The ability to attend to social stimuli is fundamental for processing social cues and shaping social behavior, yet cultural variability in this capacity remains relatively unexplored. Social attention is typically tested using preferential-looking paradigms in labs, which have demonstrated that autistic individuals attend less to social stimuli. Such studies are limited, by the fact that they have almost all been conducted in Western Europe and the USA. To address this gap, our objective was to test the cultural generalizability of these results by investigating whether autistic symptoms are negatively associated with social attention in a traditionally understudied sample: Indian adults. Additionally, we tested the specificity of this relation by investigating whether a similar association exists with the traits of attention-deficit/hyperactivity disorder (ADHD). Our study involved 121 young adults from Kerala, India. Autistic and ADHD traits were evaluated using the Autism Spectrum Quotient (AQ) and Adult ADHD Self-Report Scale (ASRS), respectively. The participants’ gaze behavior was recorded during a preferential-looking task, where pairs of social and non-social images were presented simultaneously. Individuals with higher autistic traits exhibited a reduced preference for social stimuli. No such association of social attention was noted with ADHD traits. Follow-up analysis of AQ subscales indicated that the association between gaze duration and autistic traits was driven by the social, and not the attention to detail factor of autistic traits. Our results provide new evidence for the cultural generalizability of the social attention task and offer the potential for culture-agnostic phenotypic assessments for adults with autism.Supplementary InformationThe online version contains supplementary material available at 10.1038/s41598-025-23676-7.

Background: Recent research has examined the associations between autistic traits and the well-being of students. This research has also included measures of ADHD and mental health. Methods: To understand the association and interaction of well-being and mental health with autistic traits (AQ) and attention deficit hyperactivity disorder (ADHD) traits, a survey was given to 578 secondary school students. The survey used the well-being process questionnaire (WPQ), the autism spectrum quotient, the ADHD self-report scale, and the Strengths and Difficulties questionnaire (SDQ). Results: The analysis conducted using SPSS showed that there was a significant correlation between anxiety, depression, AQ, and ADHD. Anxiety and depression were also significantly correlated with all well-being and SDQ variables. The regression analysis, including psychosocial predictors of well-being, anxiety, depression, ADHD, and AQ, showed that anxiety and depression were strongly associated with well-being outcomes. In contrast, AQ and ADHD were associated with hyperactivity, peer problems, and reduced prosocial behaviour. The associations between anxiety, depression, and well-being outcomes were stronger than with either AQ or ADHD. Conclusions: This study extends previous research from university samples to a secondary school sample. This shows the importance of investigating associations between subclinical traits and psychological symptoms in early adolescence, as this will lead to better-informed prevention and early intervention strategies.

There has been no study in the literature evaluating autistic traits (ATs) in men with substance use disorders (SUDs). Therefore, we performed the current study to evaluate whether there is a relation between the ATs among men with SUDs and normal controls. A total of 142 men with SUDs and 109 age and sex-matched healthy controls were included in the current study. Present attention deficit hyperactivity disorder (ADHD) symptoms of the participants were evaluated using the Adult ADHD Self-Report Scale. The autism spectrum quotient (AQ) was used to evaluate ATs. The current study found that higher AQ imagination and lower AQ attention to detail scores predicted SUDs after controlling for AQ subscales and present ADHD symptoms. This study shows that ATs may be engaged in the development of SUDs. To explore the connection between ATs and SUDs, more research is needed.

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 nonautistic 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.

Mindfulness is positively associated with self-esteem, yet little is known about possible mediators underlying this relation. In this study, the role of self-concept clarity and cognitive flexibility is examined as potential mediators. A predominantly female (78.9%) sample (N = 204) with a mean age of 31 years participated in a cross-sectional survey. They completed the Five Facet Mindfulness Questionnaire, the Rosenberg Self-Esteem Scale, the Self-Concept Clarity Scale, and the Cognitive Flexibility Scale. To examine relations between study variables, a multiple linear regression analysis was conducted, and a parallel mediation model was performed using the Hayes’ process macro. The regression analysis explained 56% of variance in self-esteem, and all study variables were significant predictors, with self-concept clarity as the strongest predictor. The results found support for partial mediation, with self-concept clarity exhibiting a strong association with self-esteem (β = 0.47). The effect of cognitive flexibility was weaker but significant (β = 0.16). Self-concept clarity and cognitive flexibility partially explained the path from dispositional mindfulness to self-esteem. This could indicate an explanatory role of these two factors, and suggests possible processes by which mindfulness may enhance self-esteem.

Neurodivergent and gender diverse people are overrepresented among individuals with eating disorders. There also appears to be an epidemiological overlap between autism, ADHD, and gender diversity, making it difficult to disentangle their possible contributions to eating behaviours and body image, including restrictive eating and muscle-building behaviours. We examined the unique associations between neurodivergent traits, dimensional gender diversity, disordered eating (DE), and drive for muscularity in a UK general population sample ( N = 492; 324 assigned female at birth; 98.6% cisgender; M age = 41.44 years), using correlations and hierarchical multiple regressions. We found higher levels of autistic traits, ADHD traits, and gender diversity were associated with elevated DE. Nonbinary gender diversity, when one's gender identity exists between or outside of the gender binary, was associated with higher levels of drive for muscularity in people assigned female at birth, but with elevated DE in people assigned male at birth. Notably, ADHD traits were the only independent predictor of DE and drive for muscularity when controlling for co-occurring internalising symptoms. The study highlights an association between ADHD traits and both DE and drive for muscularity, even after controlling for internalising symptoms. Additionally, it demonstrates the crucial role of internalising symptoms when examining the associations between autistic traits, gender diversity, and DE.