Eating difficulties are highly prevalent among autistic children and are linked to negative health consequences. While many mechanisms are thought to underly these behaviors, we know less about how internalizing and externalizing behaviors relate to eating difficulties in autism. The purpose of this study was to examine how internalizing and externalizing behaviors differ between autistic children (3-6 years of age) with parent-reported picky eating (n = 80) and without picky eating (n = 30). Data was drawn from intake paperwork and assessments completed as part of an autism diagnostic evaluation at a large medical center. Results suggested that picky eaters, when compared to non-picky eaters, had significantly more difficulties with aggression and withdrawal. Our study findings suggest that understanding the behavioral profiles associated with picky eating may be particularly useful when devising treatment plans. Furthermore, diagnosticians who may be the first to gather both eating and behavioral symptom data can initiate referrals to feeding specialists to help prevent some of the negative health consequences associated with these eating behaviors.Lay AbstractMany autistic children have trouble with eating (e.g. not eating a wide variety of foods) which can lead to later health issues. While there are many factors that are thought to relate to these eating issues, one factor we know less about are internalizing behaviors, or being worried, anxious, or sad, and externalizing behaviors, or issues with attending to a task or aggressive behaviors. In this study, we looked at differences in externalizing and internalizing behaviors in autistic children, who were 3-6 years of age, with picky eating (80 children with picky eating) and without picky eating (30 children without picky eating). Our results suggested that autistic children with picky eating had more issues with an externalizing and an internalizing behavior than autistic children without picky eating. Our findings are important because both externalizing and internalizing behaviors are likely important factors to consider when supporting an autistic child with eating difficulties and their family. Practitioners who diagnose autism may also be the first to gather both eating and behavioral information and may help to refer the child to a feeding specialist to prevent later issues.

Making visible the lived experience of Autistic children and their parents attending emergency departments in Australia: A Qualitative study.

Parents of autistic children support their children through additional challenges, often experiencing adversity as a result. Such parents report high support needs, yet service provision is often limited. Services often support children through providing various psychological interventions to parents. Quantitative evidence for such interventions is mixed and qualitative evidence is sparse. This review therefore aimed to synthesise the perspectives of UK parents regarding interventions for their autistic child. The databases Scopus, Embase, Medline, PubMed, PsycInfo, CINAHL, Web of Science and ASSIA were searched in February 2025. Inclusion criteria constituted qualitative articles published in English from 2004 onwards exploring UK parents' perspectives of interventions aimed at supporting autistic children. Articles were evaluated using Standard Quality Assessment Criteria. Thematic meta-synthesis was conducted. Fourteen papers were identified: eight high-quality, one medium-quality, and four low-quality. Interventions were psychoeducational behavioural, communication-based, sensory-related or mental-health based in nature. Themes included change, relationship with help, parents' need to process and solidarity. Facilitators of positive change included learning, empowerment, structure and rigour, while barriers included delivery issues and unhelpful information. Parents reported finding solidarity amongst similar parents helpful. Reflective space was deemed useful in facilitating new understanding of autistic lives. Methodological quality varied, with more reflexive and theoretically grounded research encouraged. Future research should also consider implementing embedding processes into qualitative designs.

"You can't whoop autism": Intersectional stigma in the Black community.

Our understanding of autistic socialization using social network analysis has focused on autistic children and understanding support systems. The purpose of this study is to examine autistic friendship networks in adulthood without focusing on support systems. We broadly recruited autistic and nonautistic college students (n = 592 students). Students provided ego-network information, including demographics, satisfaction with their social relationships, and perceptions of their friends (e.g. perceived neurotype and demographics). Autistic college students reported similar network structure metrics (e.g. density, number of friends) as nonautistic college students. Participants of all neurotypes reported similar friendship closeness, social satisfaction, and close mixed-neurotype friendships. However, on average, autistic college students had a higher proportion of autistic and neurodivergent friends than nonautistic college students. To a lesser extent, nonautistic students reported a greater preference for neurotypical friendships. These quantitative results suggest that autistic college students prefer building friendships with other autistic or neurodivergent peers (i.e. autistic or neurodivergent homophily). This preference suggests that authentically autistic (social) spaces and the availability of neurodivergent peers would be beneficial for autistic college students. Overall, these findings contradict the pathologizing "lack of interest in friendships" narrative surrounding autism.Lay AbstractPast research on autistic friendships has either recruited children or has focused on support services. We were interested in autistic adults who might not be enrolled in support services. So, we asked college students to fill out an interview form that included information about their traits and the traits of their friends. Based on answers to questions, participants were considered not autistic (n = 325), not sure but possibly autistic (n = 166), autistic-self-identified but not diagnosed (n = 67), or autistic-diagnosed (n = 34). Overall, all the groups reported similar degrees of social satisfaction (e.g. quality of friendships). On average, the two autistic groups had the most autistic friends and the fewest neurotypical friends. The "not-autistic" group had fewer autistic friends but the most neurotypical friends. However, all groups reported close "cross-neurotype" friendships (e.g. "not-autistic" people being close friends with autistic people). We concluded that autistic college students probably like friendships with other autistic or neurodivergent people, though college students build friendships with all neurotypes.These findings contradict stereotypes about autistic people preferring to be isolated. This study shows that autistic college students do build close friendships with others. It is important to note that we focused on autistic college students rather than all autistic people. We do not know if these findings apply to other groups of autistic individuals. We also relied on what people told us. It is possible that what people are reporting about their friends is not the same thing their friends would say.

Qualitative approaches to developmental psychology: negotiating power, ethics, and geographies when researching in South African schools for autistic children

Home-based interventions for autistic children in Saudi Arabia: Carers’ training programme

ABSTRACT Background Parents of autistic children and young people have higher levels of anxiety, depression, stress and burnout, PTSD, suicidality and lower quality of life. Current research focuses on interventions with outcomes directed at the child including parent training and psychoeducation. There is a paucity of research into psychological support for the parents, and little is known about the perceptions of, and barriers to, counselling for this population. Aim This qualitative study aimed to answer the following question: What are the perceptions of parents of autistic children and young people about accessing counselling for their own mental health and well‐being? Method Parents of autistic children and young people were recruited via social media, schools, charities and counselling services, and nine parents attended online semi‐structured interviews. Transcripts were analysed using reflexive thematic analysis. Findings Four themes were identified: The system is broken; A need for belonging and connection; We are all different; and Counselling experience and exposure. Barriers and facilitators were identified across all four themes. Conclusion The research highlights a need for improvement in diagnostic and support services, training for counsellors, and concludes that further research is needed into psychological interventions directly targeting parent well‐being and mental health, including counselling.

ABSTRACT Background Challenges with executive functions are well documented in autism and can lead to negative outcomes for autistic children. Moreover, mental health therapists report a need for clinical strategies to address executive functioning, particularly for their autistic clients. Executive functioning interventions show promise in improving these abilities, making them valuable for mental health services. Unstuck and On Target (Unstuck) is a cognitive–behavioral, school-based executive functioning intervention with preliminary data supporting its effectiveness when adapted for outpatient mental health services. Further evaluation of therapist training and implementation outcomes is needed to better understand the potential of interventions such as adapted Unstuck in mental health services. Objective The current mixed-methods study reports therapist training and implementation outcomes from a randomized feasibility pilot test of an adapted version of Unstuck in outpatient children’s mental health services. Method Mental health therapists (n = 16) received training in and delivered Unstuck with participating autistic youth. Through a sequential quantitative → qualitative mixed-methods approach, we assessed therapist training outcomes and perceptions regarding the acceptability, appropriateness, feasibility, and potential for sustainability and generalization of the adapted Unstuck intervention. Qualitative themes analyzed using rapid qualitative assessment method expanded on quantitative findings regarding training and implementation outcomes of interest. Results Therapists demonstrated strong Unstuck training and delivery completion and reported significant changes in their knowledge and confidence addressing executive functioning following participation. Therapists similarly reported high acceptability, appropriateness, feasibility, and potential sustainability of Unstuck, and generalized use with autistic and non-autistic children. Conclusions Overall, results indicated the feasibility of training therapists in Unstuck, with good training completion and impacts on knowledge regarding addressing executive function challenges. Additionally, therapists found Unstuck feasible, appropriate, and acceptable for clients and families they commonly work with. Results also suggest the utility and impact of Unstuck beyond autism to other mental health conditions.

Autism research depends on the participation of autistic children and adults as well as their families, but researchers have not routinely involved autistic people in the planning or execution of research. Community-engaged research practices, standard in other fields such as areas of public health, are gaining acceptance in autism research, although some researchers and other stakeholders remain concerned about their appropriateness, feasibility, or utility. This study, part of a larger project on stakeholder views on the ethics of community engagement practices in autism research, examines researchers' ethical beliefs about community engagement. We find that the researchers with whom we spoke cite multiple specific ethical and epistemological benefits of these practices and relatively few risks. Barriers to community engagement are, in their view, often institutional and practical, including the longer timelines of community-engaged research, resistance or lack of comprehension on the part of funding organizations and grant reviewers, the need for additional resources to support appropriate compensation, and ensuring that community stakeholders and researchers have a shared understanding of terminology.

Auditory mismatch responses-mismatch negativity (MMN) and mismatch fields (MMF)-are well established electrophysiological markers of automatic auditory discrimination supported by short-term sensory memory. These responses, typically elicited using passive oddball paradigms, are increasingly used to investigate sensory and language processing in autism. This systematic review synthesizes findings from 55 studies comparing MMN and MMF responses in autistic and typically developing (TD) individuals across childhood, adolescence, and adulthood. Using the Synthesis Without Meta-analysis (SWiM) framework, we identified consistent evidence for smaller MMN amplitudes and reduced MMF power in autistic children and adolescents relative to TD peers, particularly in response to frequency, duration, and speech-based deviants. Studies also frequently reported longer mismatch latencies in autistic participants and associated these delays with language difficulties and heightened auditory sensitivity. Although some studies reported age-related convergence in MMN and MMF measures between autistic and TD groups in later childhood or adolescence, greater right-hemisphere lateralization in autistic individuals emerged as a consistent finding across both speech and non-speech paradigms, suggesting differences in hemispheric weighting for auditory processing of linguistic and non-linguistic cues. To explain interindividual and developmental variability in mismatch responses, we propose a precision-weighted predictive coding account, in which divergent assignment of confidence to sensory prediction errors may contribute to autism-related differences. While study quality was generally fair, methodological heterogeneity, underrepresentation of females, and limited cross-cultural sampling constrain generalizability. Future research should prioritize longitudinal, sex-stratified, and culturally diverse designs, using standardized protocols and collaborative data practices. MMN and MMF responses hold promise as non-invasive translational biomarkers of early-stage sensory prediction and neurodevelopmental variation in autism.

Autistic monolingual children show heterogeneity in their language abilities in the school-age years. School-age bilingual neurotypical children also show heterogeneity in their second-language (L2) abilities as these are modulated by many factors including cumulative L2 input. This study compared school-age neurotypical and autistic children's L2 vocabulary development, as modulated by cumulative L2 input, to determine the extent to which the autistic children formed a distinct group from the neurotypical children. Participants were autistic (n = 23) and neurotypical (n = 26) bilingual children with English as their L2 and diverse first-language backgrounds, aged 4;7-9;6 (years;months). Children were matched groupwise for age. Children were administered a receptive vocabulary test, and conversational language samples yielded expressive lexical measures: word tokens and types and internal state term tokens and types. Linear regression modeling revealed that the autistic group had lower scores for all but one vocabulary measure and that higher scores were associated with more L2 input for children in both groups. A hierarchical cluster analysis revealed more nuanced results: One cluster, consisting of all but one of the neurotypical and the majority of the autistic children, overlapped in vocabulary abilities, with the autistic group having somewhat more L2 input. A second cluster consisted of all autistic children except for one neurotypical child and had extensive L2 input and very low vocabulary abilities. The autistic bilinguals in this study were not a homogeneous group separate from their neurotypical peers. Instead, only some autistic bilinguals showed distinct L2 profiles from their neurotypical peers.

Many neuropsychiatric conditions share overlapping features underpinned by shared genetics. In this study, we examined the co-aggregation of sub-threshold variation in neuropsychiatric phenotypes in biological parents of autistic children to provide insights into the intergenerational transmission of genetic liability for autism. Autistic, neuropsychiatric (i.e., anxiety, depression, ADHD), and cognitive traits were characterized in biological parents of children enrolled in a longitudinal developmental study: 189 families of autistic children and 100 families with no autistic children were included. Families were further characterized as having only one (simplex) or more than one (multiplex) autistic child. Maternal and paternal traits were compared across groups using analysis of variance. Between-parent and within-parent correlations across trait domains examined patterns of familial trait aggregation and assessed shared versus unique contributions to the inheritance of autism. Logistic regression assessed the predictive utility of parental traits for simplex vs. multiplex group membership. Mean levels of paternal autistic traits (F(2, 224) = 5.67, FDR-adjusted p-value (q) = 0.013) and maternal anxious (F(2, 262) = 11.14, q < 0.001) and depressive (F(2, 262) = 7.08, q = 0.005) traits differed between groups. Post-hoc tests revealed elevated autistic traits in multiplex fathers (q = 0.009) and elevated anxious (q < 0.001) and depressive (q = 0.004) traits in multiplex mothers compared to parents of non-autistic children; simplex parents did not differ from either of the other groups. Parental traits jointly accounted for 7.9% of autism recurrence liability in multiplex families. Elevations in autistic traits co-occur with elevations in neuropsychiatric traits in simplex parents (0.35 ≤ r ≤ 0.43) but were uncorrelated in multiplex parents. Findings from this study may not generalize to more heterogeneous samples with differing racial, ethnic, and socioeconomic demographics. Exclusionary criteria for the original study may result in families with a lower trait burden for psychiatric disorders than the broader population of parents of autistic children. Results highlight unique patterns of autistic, anxious, and depressive trait presentation and aggregation in multiplex parents. Findings call for a transdiagnostic approach to quantifying genetic liability in families with autistic children.

ABSTRACT Reflecting the recognition of children’s right to have their views heard and acted upon in matters affecting them (UNCRC, 1989), Physical Education (PE) research has increasingly acknowledged the importance of listening to and valuing students’ voices. While autistic students’ voices have started gaining greater visibility in PE research, most of the existing studies rely primarily on verbal methods, excluding autistic children who use different forms of communication. Moreover, no research has yet involved autistic students in decisions shaping opportunities of being physically active within school. Drawing on a study with autistic students (n = 33) across three specialist provisions within three mainstream primary schools in Scotland, this paper describes and critically reflects on the methodological approach employed for including ‘voices’ that are traditionally unheard in PE research. Specifically, it describes how the Mosaic Approach and Lundy's model of children’s participation were brought together into a flexible multimodal methodological framework, involving observations, walking interviews, LEGO®, and sticky notes, to enable autistic children to share their PE experiences and play an active role in shaping their learning by designing a Physical Activity (PA) programme reflecting their interests, strengths, and needs. In doing so, the paper offers a reflective account that illuminates how methodological decisions and their implementation shape not only which voices and experiences are heard, but also whether we are ready to listen to what children wish to communicate.

BackgroundEducators endorse challenging behavior as a concern for autistic students, which is compounded by the lack of adequate resources for behavioral intervention use at school. The RUBI program is an evidence-based intervention, initially developed for clinicians to implement with parents of autistic children ages 3–14 with co-occurring challenging behavior in outpatient settings. Using the Discover, Design/Build, Test framework, which combines human-centered design and implementation science, implementation usability issues of RUBI were identified for redesign to ensure intervention-setting fit when used in schools.MethodRUBI content was collaboratively and iteratively redesigned with elementary school partners, including 41 staff members from 28 schools. During the Discover Phase, the research team conducted in-class behavioral observations (N = 8) and cognitive walkthroughs (N = 15) with educators to identify implementation usability issues in the original RUBI intervention. In the Design/Build Phase, collaborative redesign sessions (N = 6) and demonstration studies (N = 12) were conducted to develop potential solutions to these issues. Implementation usability issues were systematically rated for importance and feasibility prior to redesign to guide the adaptation process.ResultsConventional content analysis was used to code qualitative data and identify implementation usability issues. Two implementation usability issues were identified: (1) integration with other school-based systems of support and (2) data collection in schools.ConclusionIdentifying and addressing usability issues may promote greater utility and successful implementation of RUBI in schools. Using partner-engaged methods allowed for the identification of critical implementation usability issues prior to the implementation of the redesigned intervention, RUBI in Educational Settings, or RUBIES. Implications to implementation in school settings are discussed, including potential ways to integrate RUBIES within existing school frameworks (i.e., MTSS) and streamline data collection with the use of technology.

Disruptive behaviors (non-compliance, aggression) are common in autistic children. Parent-Child Interaction Therapy (PCIT) is a caregiver-mediated intervention utilizing invivo caregiver coaching that reduces disruptive behaviors and has been shown to be effective for young autistic children. This study sought to identify child and caregiver factors that relate to session-level progress among autistic children and their caregivers. Participants included 98 autistic children aged 2-8 years (91% male) who received PCIT in a university-affiliated clinic. Session-level change was examined using iterative multilevel modeling to examine change in child disruptive behaviors, as measured on the Eyberg Child Behavior Inventory (ECBI), caregiver positive attending skills (Do-skills), and caregiver negative statements (Avoid-skills). Optimal fitting trajectories revealed quadratic change in ECBI scores, Do-skills, and Avoid-skills. The effectiveness of PCIT did not differ based on participants' level of autistic traits or caregiver demographics. Improvements in child disruptive behavior were associated with child adaptability and parenting stress pre-treatment; higher adaptability and lower stress were related to faster declines in child disruptive behavior. Caregivers exhibited slower rates of change in Do-skills when they had lower rates of homework completion, and when their child had lower social responsiveness, and challenges with adaptability and externalizing problems. These findings may help clinicians tailor what factors to emphasize and monitor over the course of PCIT.

Eye tracking has emerged as a powerful tool for advancing autism research, including diagnostics and interventions. However, studies on joint attention (JA) in autistic children have predominantly concentrated on the responding to joint attention (RJA) construct, with limited focus on the initiating joint attention (IJA) construct. Moreover, despite the interactive nature of JA, researchers have often relied on passive paradigms to study JA in this population. To address these gaps, we developed a gaze-contingent eye-tracking battery targeting three developmentally appropriate JA skills for young children: RJA, IJA to request, and IJA to comment or reference. The development process was multifaceted and iterative, involving a series of collaborative steps and the allocation of various resources. These steps included determining the motion format and stimulus type, designing and prototyping the stimuli, recruiting an actor to serve as a communication partner in the stimuli, recording and editing videos for the stimuli, and building and test-running the battery. We developed the Interactive Eye Tracking for Joint Attention (IET-JA) battery, which consists of 32 JA stimuli: 16 RJA, 8 IJA-Request, and 8 IJA-Comment/Reference. The stimuli are dynamic (i.e., videos) and feature a preprogrammed interactive human communication partner who is responsive to the participant's gaze. The IET-JA takes approximately 8 minutes to complete, and its duration is expected to vary based on the participant's level of engagement. Implications for advancing methodologies, fostering team science, and enhancing iterative processes are discussed.

The study examines how bilinguals' languages of higher proficiency (LHP) and lower proficiency (LLP) correlate with daily-life Theory of Mind (ToM) in 137 White, bilingual typically developing (TD; 45% boys) and 107 White, bilingual autistic children (78% boys) aged 6 to 12. A subset of participants (28 TD, 43% boys; 21 autistic children, 76% boys) was reassessed approximately 1 year later. Age positively correlated with ToM in TD and autistic children, although the former outperformed the latter. In autistic children, but not TD peers, LHP and LLP were both positively associated with greater ToM skills. Longitudinal findings 1 year later confirmed this pattern, suggesting that bilingual autistic children continue to capitalize on both languages over time to support ToM development.

Questions are an important component of social communication. Autistic children experience difficulties in social communication, and question asking is a common target of services. We know little about how context shapes question asking in autistic children. The current study quantifies the frequency (rate per minute), form (wh-, yes/no, intonation), and function (information-seeking, directive, initiation/maintenance) of questions produced by autistic children (n = 15; mean age = 5.6 years) in two social contexts: a semi-structured activity (the "tablet task") and unstructured play (a naturalistic play session). Autistic children asked slightly more questions in the play session (M =1.35 questions/minute) than in the tablet task (M = 0.81 questions/minute), but there was no significant difference between conditions (effect size = 0.36). For question form, children asked wh-questions at similar rates across contexts, but they asked significantly more yes/no and intonation questions in the play session (effect sizes = 0.01, 0.62, 0.85, respectively). Finally, in function, children's use of information-seeking questions was similar across contexts, but they used significantly more directive and initiation/maintenance questions in the play session (effect sizes = 0.008, 0.82, 0.80, respectively). These findings offer important considerations for the assessment of question asking in autistic children.

Elevated medial prefrontal GABA/Glx ratio in preschool autistic children: A 1H-MRS study of cognitive and behavioral correlates.