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

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

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

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.

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

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

The present study explored the relationship between camouflaging, autistic burnout, and cultural factors in Latino young adults with autism spectrum disorder (ASD). While autistic burnout and camouflaging have been widely studied in general ASD populations, limited research has focused on Latino individuals, who may experience unique pressures due to cultural values such as collectivism, familism, and traditional gender roles. Participants (N = 56) from the ¡Iniciando! la Adultez therapy program completed measures assessing burnout, camouflaging, acculturation, and cultural values. Results indicate that participants reported moderate to high levels of autistic burnout, with the highest levels observed in heightened self-awareness and cognitive disruption. Camouflaging behaviors were prevalent, with compensation being the most frequently used strategy. Cultural values, especially Mexican American values related to independence and familism, were positively correlated with burnout severity. In addition, camouflaging behaviors were significantly associated with higher adaptive functioning, particularly in conceptual, social, and practical domains, and were predictive of increased anxiety and depression. Acculturation stress and traditional gender role values were found to influence camouflaging strategies. These findings highlight the complex interplay between cultural expectations, camouflaging, and burnout in Latino autistic young adults, underscoring the need for culturally responsive interventions to better support their well-being and autonomy.Lay Autism spectrum disorder (ASD) affects individuals in unique ways, and many people with ASD feel pressured to “mask” or hide certain aspects of themselves to fit societal expectations. This study explored the relationship between camouflaging, burnout, and cultural factors in Latino young adults with ASD. While burnout and camouflaging have been studied in general ASD populations, there is limited research on how Latino cultural values, such as family importance and traditional gender roles, influence these experiences. In this study, 56 participants from the ¡Iniciando! la Adultez therapy program completed surveys about their burnout, camouflaging, cultural values, and stress related to adapting to a new culture. The results showed that many participants experienced significant burnout, particularly in areas like self-awareness and cognitive challenges. Camouflaging, such as pretending to act “neurotypical,” was common and linked to difficulties in social interactions and daily tasks, as well as higher levels of anxiety and depression. Cultural values, such as a strong focus on family, were related to higher burnout, and traditional gender roles influenced how participants camouflaged their autism. These findings highlight the need for societal change and culturally sensitive interventions that support Latino young adults with autism, helping them manage burnout and camouflaging while embracing their true identities.

Recognising speech in noise involves focusing on a target speaker while filtering out competing voices and sounds. Acoustic cues, such as vocal characteristics and spatial location, help differentiate between speakers. However, autistic individuals may process these cues differently, making it more challenging for them to perceive speech in such conditions. This study investigated how autistic individuals use acoustic cues to follow a target speaker and whether background music increases processing demands. Thirty-six autistic and 36 non-autistic participants, recruited in the United Kingdom, identified information from a target speaker while ignoring a competing speaker and background music. The competing speaker’s gender and location either matched or differed from the target. The autistic group exhibited lower mean accuracy across cue conditions, indicating general challenges in recognising speech in noise. Trial-level analyses revealed that while both groups showed accuracy improvements over time without acoustic cues, the autistic group demonstrated smaller gains, suggesting greater difficulty in tracking the target speaker without distinct acoustic features. Background music did not disproportionately affect autistic participants but had a greater impact on those with stronger local processing tendencies. Using a naturalistic paradigm mimicking real-life scenarios, this study provides insights into speech-in-noise processing in autism, informing strategies to support speech perception in complex environments.Lay abstractThis study examined how autistic and non-autistic adults understand speech when other voices or music were playing in the background. Participants focused on one main speaker while another voice played simultaneously. Sometimes, the second voice differed from the main one in gender or where the sound was coming from. These differences made it easier to tell the voices apart and understand what the main speaker was saying. Both autistic and non-autistic participants did better when these differences were present. But autistic individuals struggled more when the two voices were the same gender and came from the same location. Background music also made it harder to understand speech for everyone, but it especially affected autistic participants who tended to focus more on small details. These findings help us understand how autistic individuals process speech in noisy environments and could lead to better ways to support communication.

This study examines disparities in autism identification rates and support needs between Māori and non-Māori populations in Aotearoa New Zealand. The research was conducted through a collaborative approach with autistic Māori. Population-level administrative data were analysed for all individuals aged 0–24 years (N = 1,565,505) as of 30 June 2018. Autism identification was determined through health service records from July 2010 to June 2018. Comparative analyses examined autism rates, intellectual disability (ID) co-occurrence, and Ongoing Resourcing Scheme (ORS; high-need education funding support) allocation between Māori and non-Māori populations. Autism identification rates were lower among Māori (70.9/10,000) compared to non-Māori (78.3/10,000). Autistic Māori had higher rates of ID diagnosis (OR = 1.12; 95% CI = 1.02, 1.24) and ORS funding allocation (OR = 1.35; 95% CI = 1.22, 1.48). The observed disparities in autism identification rates and diagnostic patterns suggest potential systemic barriers to autism identification among Māori, particularly for those with lower formal support needs. Future Kaupapa Māori, autistic-led research is warranted to better understand these disparities and inform culturally responsive diagnostic and support services.Lay In this study, autistic Māori collaborated with researchers to analyse autism identification in Aotearoa New Zealand using population-level administrative data. The research examined all children and young people (0–24 years) in the Aotearoa New Zealand population as of 30 June 2018, identifying autism through health service records between July 2010 and June 2018. The findings showed lower autism identification rates among Māori (70.9 per 10,000) compared to non-Māori (78.3 per 10,000). This difference in rates is likely to reflect ongoing inequities and systemic racism, not true prevalence differences. Autistic Māori were also more frequently diagnosed with intellectual disability (ID) and more likely to receive high-need education funding support than autistic non-Māori. While these patterns might suggest higher formal support needs among autistic Māori, it’s crucial to recognise that support requirements are highly individual and context-dependent, making them difficult to measure using broad indicators. The lower overall autism identification rate among Māori, combined with these findings, suggests that autistic Māori with lower formal support needs may be missing opportunities for diagnosis and not accessing the supports and services they are entitled to. Future Kaupapa Māori, autistic-led research is needed to gain a more nuanced understanding of autism identification and support needs among Māori.

There is an increasing need to measure caregiver implementation of strategies from Naturalistic Developmental Behavioral Interventions (NDBIs) as a possible key mediator of outcomes in a child. The NDBI Fidelity (NDBI-Fi) rating scheme is a macro-code to estimate the implementation of core strategies. Yet, there is a need to understand the dependability of this measure to ensure intervention study findings are generalizable to everyday interactions and comparable across studies. We addressed this by evaluating the dependability or consistency of NDBI-Fi scores for 20 caregivers, averaged across observations of two occasions of two routines that were each scored by two raters. Our findings indicated that a single score (i.e. from a single occasion, single routine, and single rater) from the measure has low dependability (g = 0.43). When scores were averaged across two observations each of two routines scored by two raters (i.e. eight scores total), the score was more dependable (g = 0.77). The majority (81.6%) of absolute error variance was attributable to occasions of observation and its interaction with other facets (routine or rater). Therefore, we recommend the NDBI-Fi be applied to more than one observation of more than one routine to strengthen confidence that scores are generalizable to everyday parent-child interactions.Lay abstractOutcomes from caregiver-mediated interventions typically include measuring the caregiver’s use of key techniques. The Naturalistic Developmental Behavioral Intervention-Fidelity (NDBI-Fi) tool is a valid measurement strategy for estimating caregiver use. In this study, we sought to understand how to improve data collection from natural observations of caregivers with their children to ensure the scores are representative of how the caregiver and child typically interact. We observed 20 caregiver-child pairs via telehealth in snack and play routines over two different days. Each video was rated using the NDBI-Fi by two observers. We learned that increasing the number of observations may be the best way to improve the dependability of scores from natural caregiver-child observations. This study adds to recent research seeking to understand how to best measure caregiver strategy use. These findings may guide future researchers and clinicians to consider increasing the number of observations used to evaluate caregiver use of intervention techniques in research studies or clinical practice.