Autistic People Research Articles

Brief Report: Under-Identification of Symptomatic Menopause in Publicly-Insured Autistic People.

Menopause is a normal part of aging and in the general population is associated with chronic conditions that impact health, mortality, and well-being. Menopause is experienced differently by autistic individuals, although no studies have investigated this topic in a large sample. The purpose of this study was to investigate rates of, and factors associated with symptomatic menopause among autistic individuals and to identify the prevalence of co-occurring conditions in symptomatic individuals.We included autistic females aged 35-70years enrolled for 10 + months in 2014-2016 Medicare and/or Medicaid (n = 26,904), excluding those with gender dysphoria. Those with symptomatic menopause were compared to a non-symptomatic reference group on demographic, enrollment characteristics, and co-occurring conditions through logistic regression.Approximately 4% of publicly-insured autistic females aged 46-70years had symptomatic menopause in their medical records. Intellectual disability was associated with a lower likelihood of symptomatic menopause, and being Medicare-enrolled or dual-enrolled was associated with higher likelihood of having symptomatic menopause recorded. In adjusted models, rates of ADHD, anxiety and depressive disorders, headache/migraine, altered sensory experiences, altered sexual function, and sleep disturbance were significantly higher in the symptomatic menopause sample compared to the reference group.More work to better support autistic women in discussing menopausal symptoms and co-occurring conditions with primary care providers is needed, particularly among those for whom self-report of symptoms are more challenging to ascertain. Factors associated with specific types of health care coverage warrant greater investigation to support better identification.

TikTok and YouTube Shorts by Autistic Individuals for Increasing Autism Awareness.

Autistic individuals, parents, organizations, and healthcare systems worldwide are actively sharing content aimed at increasing awareness about autism. This study aims at analyzing the type of contents presented in TikTok and YouTube Shorts videos under the hashtag #actuallyautistic and their potential to increase autism awareness. A sample of 60 videos were downloaded and analyzed (n=30 from TikTok and n=30 from YouTube Shorts). Video contents were analyzed using both thematic analysis and the AFINN sentiment analysis tool. The understandability and actionability of the videos were assessed with The Patient Education Materials Assessment Tool for Audiovisual Materials (PEMAT A/V). The contents of these videos covered five main themes: Stigmatization; Sensory difficulties; Masking; Stimming; and Communication difficulties. No statistically significant differences were found on sentiment expressed on videos from both channels. TikTok videos received significantly more views, comments, and likes than videos on YouTube Shorts. The PEMAT A/V tool showed that there is a high level of understandability, but little reference to actionability. Autistic people videos content spread valid and reliable information in hopes of normalizing difficulties and provide hope and comfort to others in similar situations. Social media videos posted by autistic individuals provide accurate portrayals about autism but lack information on actionability. These shared personal stories can help increase public literacy about autism, dispel autism stigmas and emphasize individuality.

Understanding Emotional Dynamics in Autism Social Media Communities.

We extracted a sample of X' posts related to autism and used DistilBERT to assign one out of six emotions (sadness, joy, love, anger, fear, surprise) to each post. We have analyzed a total of 414,287 posts, 98,602 (23.8%) of those included the hashtag #ActuallyAutistic. The most common expressed emotion was joy, which was expressed in 52.5% of the posts, followed by sadness, identified in 28.6% of the posts. 12% of the posts expressed fear, 4.9% reflected anger, 1.1% showed love, and 0.9% expressed surprise. Posts tagged as #ActuallyAutistic showed less joy (27.1% vs. 60.4% in posts without this hashtag, p<0.001) and more sadness (52.7% vs. 21.1% in those without the hashtag, p<0.001). The use of the hashtag #ActuallyAutistic is associated with a different emotional tone, characterized by less joy and more sadness. These results suggest the need for greater support and acceptance towards the autistic community, both online and in society in general. Insights from our study can be valuable for policy makers, health, educational or other programmes aiming at enhancing well-being, inclusiveness, improve services, and create a more compassionate and understanding atmosphere for autistic people.

A critical hit: Dungeons and Dragons as a buff for autistic people.

Tabletop role-playing games (TTRPGs) are popular hobbies that may offer specific social benefits for autistic people. This study investigated the ability of TTRPGs to provide a safe space where autistic adults could develop relationships with other autistic adults while engaging in character and world-building. A group of eight autistic adults were split into two groups and taken through a short-form online Dungeons and Dragons campaign over 6 weeks run by one of the researchers. The researcher then led a series of individual semi-structured interviews discussing how participants felt interacting in and out of the TTRPG. Several key themes were identified as important aspects of why autistic people could benefit from such an environment. Analysis showed that while real-life interactions could be challenging, in TTRPG play, they felt they experienced significantly fewer struggles. Results suggested that TTRPGs can provide a safe space environment where autistic adults can engage in productive social interactions with like-minded individuals. It also may allow autistic participants to experience 'bleed' or the ability to take on a new character that changes the way they feel about themselves outside of the game. Future directions for this work are discussed.

Enhancing autism rehabilitation: the role of expert systems in supporting therapy with intelligent robotics

Autism is a complex neurobiological disorder that affects brain development and manifests itself primarily in difficulties in communication and social interactions. Autistic people may also experience a restricted set of interests and repetitive behaviors. Among the promising tools supporting autistic people, systems supporting diagnosis, planning therapy, monitoring progress, and even conducting direct interactions with autistic children are becoming increasingly important. The article describes an expert system created to support the rehabilitation of children with autism. The presented expert system, for instance, can analyze the child's speech patterns and suggest appropriate communication strategies, or it can monitor the child's behavior and propose activities to address repetitive behaviors. The system is part of a more extensive solution consisting of three main components: the patient interface, the rehabilitator's expert system, and the machine learning module. The presented environment was used during therapeutic sessions with young patients. On the one hand, it provides promising results in patient interactions; on the other hand, it supports the work of rehabilitators. It is worth noting that the main strength of the solution is the inference and suggestions proposed by the system during a session with the patient; taking into account the dynamic development of artificial intelligence systems and the fact that each subsequent session provides new data, we can count on the beneficial impact of the presented system on both the progress in the patient's rehabilitation and also the quality and effectiveness of the rehabilitator's work.

Feasibility and Tolerability of Daily Theta Burst Stimulation in Autistic Youth with Intellectual Disabilities and Minimally Speaking Status: A Pilot Double-Blind Randomized Sham-Controlled Trial.

Scarce clinical trials involving autistic people with intellectual disability (ID) and minimally speaking (MS) status have been a substantial unmet research need in the field. Although earlier studies have demonstrated the feasibility and beneficial potentials of repetitive transcranial magnetic stimulation (rTMS) over the dorsolateral prefrontal cortex (DLPFC) in intellectually able autistic people, the feasibility and tolerability of applying rTMS in autistic people with ID/MS has never been studied. We conducted the world-first 4-week randomized, double-blind, sham-controlled pilot trial to investigate the feasibility, tolerability, and safety of intermittent theta burst stimulation (iTBS, a variant of excitatory rTMS) over the left DLPFC in autistic youth with ID/MS. 25 autistic youth with ID/MS (aged 8-30 years) were randomized to a 20-session 4-week daily iTBS (n = 13) vs. sham stimulation (n = 12) with follow-up 4 and 8 weeks, respectively, after the last stimulation. A retention rate was 100% in our study. Adverse events of local pain (38%) and dizziness (8%) were only noted in the active group. All adverse events were mild and transient. There were no seizures, new behavioral problems, or other severe/serious adverse events noted. No participants dropped out due to adverse events. With a small sample size, we did not find any beneficial signal of DLPFC iTBS. Our pilot data suggest regular daily TBS treatment for four weeks is feasible, well tolerated and safe in autistic youth with ID/MS. Future randomized controlled trials with sufficiently powered samples are needed to investigate the beneficial potential of rTMS/TBS for autistic people with ID/MS.

Barriers to and enablers of the transition from child and adolescent to adult mental health services for autistic young people and/or those with attention deficit hyperactivity disorder: protocol for a scoping review

IntroductionAutistic young people and/or those with attention deficit hyperactivity disorder (ADHD) who have co-occurring mental health conditions experience significant challenges when transitioning from child and adolescent mental health services (CAMHS)...

The process of co‐design for a new anxiety intervention for autistic children

AbstractBackgroundMental health difficulties are common for autistic people; however, almost no interventions have been co‐designed with the autistic community. Co‐design has the potential to add important insights from lived experience into intervention design, but there are currently limited examples of how rigorously to undertake this practice. This paper details a worked model of co‐design and its process, focussed on adapting an evidenced parent‐led intervention for non‐autistic child anxiety (HYC), to meet the needs of young autistic children. The aim is to provide an example of co‐design, integrating autistic, parental, academic, clinical, experience and expertise.MethodsUsing prior literature and theory, including Experience‐Based Co‐Design, we developed an iterative and collaborative process between the research team and an expert reference group (ERG). The research team comprised autistic and non‐autistic members. The ERG included parents (autistic and non‐autistic) of autistic children with anxiety problems, autistic adults with experience of anxiety problems, and clinicians with experience supporting autistic children with anxiety problems. The ERG and research team reviewed information from qualitative research interviews with autistic children with anxiety problems and their parents along with information from clinical experience and the academic literature to reach consensus on the adapted intervention design.ResultsThe creation of a truly co‐designed intervention that includes a neurodiversity‐affirmative perspective, alongside CBT techniques. With anxiety problems experienced by autistic children being framed by combining the impacts of being neurodivergent in a neurotypical world, developmental science and well known cognitive behavioural models of child‐anxiety.ConclusionCo‐design can help to integrate multiple perspectives and result in the creation of interventions that are potentially relevant and acceptable to autistic people, their family members, and clinicians.

Camouflaging, internalized stigma, and mental health in the general population.

Camouflaging, the strategies that some autistic people use to hide their differences, has been hypothesized to trigger mental health ramifications. Camouflaging might reflect ubiquitous impression management experiences that are not unique to autistic people and similarly impact the mental health of non-autistic people. We first examined whether individuals in the general population camouflage and manage impressions while experiencing mental health repercussions, and how gender and neurodivergent traits modified these associations. We then assessed how camouflaging and impression management arose from internalized stigma, and their inter-relationships in shaping mental health outcomes. Data were collected from 972 adults from a representative U.S. general population sample, with measures pertaining to camouflaging, impression management, mental health, internalized stigma, and neurodivergent traits. Multivariate hierarchical regression and moderated mediation analyses were used to address the two research aims. Both camouflaging and self-presentation (a key component of impression management) were associated with mental health presentations in the general population, which overlapped with those previously reported in autistic people. These associations were more pronounced in women compared with men and were of different directions for individuals with higher autistic traits versus higher ADHD traits. Internalized stigma might be a key stressor that could elicit camouflaging and impression management through social anxiety, which in turn might lead to adverse mental health outcomes. These findings advance the conceptual clarity and clinical relevance of camouflaging and impression management across social and neurodiverse groups in the general population. The ramifications of camouflaging and impression management underscore the need to alleviate internalized stigma for better mental health across human groups.

Barriers and facilitators to ethical co-production with Autistic people with an eating disorder

BackgroundCo-production is the collaboration between researchers and the lived experience community in designing, conducting and sharing research. The importance of co-production is increasingly advocated in both the autism and eating disorder fields. Despite this, there remains a lack of clarity at how to define, apply and conduct ethical co-production. Understanding common challenges and what we can do to overcome these challenges are integral to ensuring ethical and meaningful research with Autistic people with an eating disorder. The current study therefore explored: What are the barriers and facilitators to ethical co-production with Autistic people with an ED?MethodsFive workshops were conducted with 30 collaborators exploring barriers and facilitators to ethical co-production. Synchronous (online workshops) and asynchronous (offline discussion forum) data was analysed using thematic analysis. Themes were co-produced by a neurotypical and Autistic researcher with lived/living experience of an eating disorder.ResultsFour themes were identified that explored barriers to ethical co-production: unequal partnerships, the inaccessibility of research, excluded by diagnoses and communication differences. Three themes were identified with regards to facilitators of ethical co-production: shared power (with sub-themes relationships, not roles and creative compensation), clarity and transparency and autism-affirming approaches.DiscussionConducting ethical co-production with Autistic people with eating disorders has the potential to generate meaningful research that can be translated into improving the lives of the Autistic and eating disorder community. To achieve this, co-production teams should strive towards shared power and long-term relationships, adapting for communication differences and preferences and operating firmly within an autism-affirming framework. It is hoped that study findings will inspire collaboration, discussion and novel, translatable research.

Creating a diversity climate in the workplace: A mixed methods study into knowledge of autism and attitudes toward hiring autistic people in the United Kingdom

BACKGROUND: Autistic individuals face challenges accessing employment, particularly as a result of limited knowledge and understanding of autism. OBJECTIVE: This mixed methods study aimed to measure levels of knowledge of autism and examine hiring attitudes in the workplace. METHODS: To determine knowledge of autism, N = 101 professionals in the United Kingdom responded to a survey that included the Autism Stigma &amp; Knowledge Questionnaire (ASK-Q). Open-ended and closed-ended questions were used to examine hiring attitudes and particularly perceived barriers or drivers to employment for autistic candidates. Nine respondents took part in further semi-structured interviews. RESULTS: Findings report adequate knowledge with a lack of stigma endorsement. Data also indicate a significant relationship between self-reported autism knowledge and the overall ASK-Q total. Autism knowledge was statistically significantly higher in participants who knew an autistic individual through work and where professionals or their companies had knowingly employed an autistic person. Qualitative data provide nuanced understanding about barriers and the possibilities for more inclusive autistic employment. CONCLUSION: A strong case was made for understanding the needs and strengths of individuals in order to generate a diversity climate in the workplace.

Deep learning approaches for recognizing facial emotions on autistic patients

Autistic people need continuous assistance in order to improve their quality of life, and chatbots are one of the technologies that can provide this today. Chatbots can help with this task by providing assistance while accompanying the autist. The chatbot we plan to develop gives to autistic people an immediate personalized recommendation by determining the autist’s state, intervene with him and build a profil of the individual that will assist medical professionals in getting to know their patients better so they can provide an individualized care. We attempted to identify the emotion from the image's face in order to gain an understanding of emotions. Deep learning methods like Convolutional neural networks and Vision Transformers could be compared using the FER2013. After optimization, CNN achieved 74% accuracy, whereas the VIT achieved 69%. Given that there is not a massive dataset of autistic individuals accessible, we combined a dataset of photos of autistic people from two distinct sources and used the CNN model to identify the relevant emotion. Our accuracy rate for identifying emotions on the face is 65%. The model still has some identification limitations, such as misinterpreting some emotions, particularly "neutral," "surprised," and "angry," because these emotions and facial traits are poorly expressed by autistic people, and because the model is trained with imbalanced emotion categories.

Reduced Reporting of Social Comparison Emotions and Valuation of Group-Based Morals in Autistic People

People's moral values and social emotions play an important role in everyday interactions. We investigated moral values and social emotions in autistic people within in-person (N = 62) and online (N = 443) samples. Autistic adults and neurotypical adults rated their endorsement of “groupbinding” (versus individual-based) moral values (e.g., ingroup loyalty) and responded to vignettes designed to elicit social comparison emotions: envy and schadenfreude. Across studies, autistic participants reported reduced endorsement of binding moral values and reduced levels of social comparison emotions. These findings reveal important associations among social cognition, moral values, and social emotions.

The overlap of disordered eating, autism and ADHD: future research priorities as identified by adults with lived experience.

The focus of mental health research in emerging fields should be driven by the priorities of people with relevant lived experience. Autism and ADHD are childhood-onset neurodevelopmental conditions that are associated with a range of health inequalities, including increased risk for eating disorders. The evidence base for how best to support neurodivergent individuals who experience disordered eating is still in its infancy, but research suggests that existing clinical approaches are not currently fit for purpose. In this Personal View, through community consultation with autistic people and people with ADHD who have experienced disordered eating, we present a comprehensive ranked list of research topics that people with lived experience prioritise. These priorities could be clustered into two areas: improving outcomes and identifying causal mechanisms. Within the theme of improving disordered eating outcomes, priorities are the improvement of treatment, the need for neurodiversity training in clinical services, and the identification and minimisation of unintended adverse effects of psychological intervention. Within the theme of identifying causal mechanisms, priorities are the identification of risk factors and a better understanding of the effect of autistic or ADHD neurocognitive profiles as potential contributors to eating disorder vulnerability. The final top ten research priorities are contextualised in terms of how they compare to the existing literature on the overlap between autism or ADHD and eating disorders, and concrete suggestions are made for how to implement these research priorities as testable hypotheses. Research informed by these priorities will build necessary understanding of the reasons behind the increased risk for eating disorders in neurodivergent people, and how to best support people who are affected by disordered eating to live positive and fulfilling lives.

Recommendations for Increasing Accessibility &amp; Inclusivity of Community Spaces for Autistic LGBT+ Adults Utilizing a Community-Centered Approach

Abstract Date Presented 03/22/24 A survey of recommendations to support participation for LGBT+ autistic adults indicates the need to hire and promote LGBT+ autistic people, create sensory-friendly spaces, streamline accommodations, and require training for mental health providers. Primary Author and Speaker: Elizabeth Schmidt Additional Authors and Speakers: Jess Marie Cecília Bauza De Garcia

Approaches to improving mental healthcare for autistic people: systematic review.

Autistic people have a high likelihood of developing mental health difficulties but a low chance of receiving effective mental healthcare. Therefore, there is a need to identify and examine strategies to improve mental healthcare for autistic people. To identify strategies that have been implemented to improve access, experiences of care and mental health outcomes for autistic adults, and to examine evidence on their acceptability, feasibility and effectiveness. A co-produced systematic review was conducted. MEDLINE, PsycINFO, CINHAL, medRxiv and PsyArXiv were searched. We included all study designs reporting acceptability or feasibility outcomes and empirical quantitative study designs reporting effectiveness outcomes. Data were synthesised using a narrative approach. A total of 30 articles were identified. These included 16 studies of adapted mental health interventions, eight studies of service improvements and six studies of bespoke mental health interventions developed for autistic people. There was no conclusive evidence on effectiveness. However, most bespoke and adapted approaches appeared to be feasible and acceptable. Identified adaptations appeared to be acceptable and feasible, including increasing knowledge and detection of autism, providing environmental adjustments and communication accommodations, accommodating individual differences and modifying the structure and content of interventions. Many identified strategies are feasible and acceptable, and can be readily implemented in services with the potential to make mental healthcare more suitable for autistic people, but important research gaps remain. Future research should address these and investigate a co-produced package of service improvement measures.

Autistic traits are associated with differences in the perception of genuineness and approachability in emotional facial expressions, independently of alexithymia.

People with autism and higher levels of autistic traits often have difficulty interpreting facial emotion. Research has commonly investigated the association between autistic traits and expression labeling ability. Here, we investigated the association between two relatively understudied abilities, namely, judging whether expressions reflect genuine emotion, and using expressions to make social approach judgements, in a nonclinical sample of undergraduates at an Australian university (N = 149; data collected during 2018). Autistic traits were associated with more difficulty discriminating genuineness and less typical social approach judgements. Importantly, we also investigated whether these associations could be explained by the co-occurring personality trait alexithymia, which describes a difficulty interpreting one's own emotions. Alexithymia is hypothesized to be the source of many emotional difficulties experienced by autistic people and often accounts for expression labeling difficulties associated with autism and autistic traits. In contrast, the current results provided no evidence that alexithymia is associated with differences in genuineness discrimination and social approach judgements. Rather, differences varied as a function of individual differences in specific domains of autistic traits. More autistic-like social skills and communication predicted greater difficulty in genuineness discrimination, and more autistic-like social skills and attention to details and patterns predicted differences in approach judgements. These findings suggest that difficulties in these areas are likely to be better understood as features of the autism phenotype than of alexithymia. Finally, results highlight the importance of considering the authenticity of emotional expressions, with associations between differences in approach judgements being more pronounced for genuine emotional expressions. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Experiences of and treatment preferences for insomnia in autistic adults: An Interpretative Phenomenological Analysis

Insomnia and insomnia symptoms are frequent experiences of autistic people resulting in pronounced daytime effects and poor quality of life. This study employed an Interpretive Phenomenological Analysis approach to explore lived experiences of autistic adults with insomnia, perspectives on current available interventions and future treatment preferences. Twelve participants (aged 21–48 years old) were interviewed following screening for insomnia, using the Sleep Condition Indicator (scores ranged from 1 to 12; cut off >16). Each interview was analysed individually developing Personal Experiential Themes for each case, which were then mapped across cases based on identified patterns and connections. Results yielded rich personal accounts and identified two Group Experiential Themes: “The Night is Friendlier” and “It Doesn't Really Work for Me”. Participants described experiences with sleeplessness throughout their adult lives and often since childhood. They discussed how the night time offers them a more relaxed and safe space to freely behave as they wish. Advice and interventions were viewed by participants via the prism of underlying social issues, such as autism acceptance and trust, and how these structures can affect participants' experiences with insomnia, help seeking and effectiveness of current interventions. Our results highlight the need for inclusion of autistic people in insomnia research through co-production and co-creation as well as clinical practice and delivery. This is the first study to integrate perspectives and experiences of autistic people towards insomnia and sleep-related advice by health care professionals. Findings are discussed in relation to theoretical and practical implications, as well as directions for future research.

Perinatal and Postpartum Health Among People With Intellectual and Developmental Disabilities

Small, geographically limited studies report that people with intellectual and developmental disabilities (IDD) have increased risk for serious pregnancy-related and birth-related challenges, including preeclampsia, preterm birth, and increased anxiety and depression, than their peers. United States-based population-level data among people with IDD are lacking. To identify perinatal and postpartum outcomes among a national, longitudinal sample of people with IDD enrolled in public health insurance, compare subgroups of people with IDD, and compare outcomes among people with IDD with those of peers without IDD. This retrospective cohort study used national Medicaid claims from January 1, 2008, to December 31, 2019, for 55 440 birthing people with IDD and a random sample of 438 557 birthing people without IDD. Medicaid funds almost half of all births and is the largest behavioral health insurer in the US, covering a robust array of services for people with IDD. Statistical analysis was performed from July 2023 to June 2024. People who had a documented birth in Medicaid during the study years. Perinatal outcomes were compared across groups using univariate and multivariate logistic regression. The probability of postpartum anxiety and depression was estimated using Kaplan-Meier and Cox proportional hazards regression. The study sample included 55 440 birthing people with IDD (including 41 854 with intellectual disabilities [ID] and 13 586 with autism; mean [SD] age at first delivery, 24.9 [6.7] years) and a random sample of 438 557 birthing people without IDD (mean [SD] age at first delivery, 26.4 [6.3] years). People with IDD were younger at first observed delivery, had a lower prevalence of live births (66.6% vs 76.7%), and higher rates of obstetric conditions (gestational diabetes, 10.3% vs 9.9%; gestational hypertension, 8.7% vs 6.1%; preeclampsia, 6.1% vs 4.4%) and co-occurring physical conditions (heart failure, 1.4% vs 0.4%; hyperlipidemia, 5.3% vs 1.7%; ischemic heart disease, 1.5% vs 0.4%; obesity, 16.3% vs 7.4%) and mental health conditions (anxiety disorders, 27.9% vs 6.5%; depressive disorders, 32.1% vs 7.5%; posttraumatic stress disorder, 9.5% vs 1.2%) than people without IDD. The probability of postpartum anxiety (adjusted hazard ratio [AHR], 3.2 [95% CI, 2.9-3.4]) and postpartum depression (AHR, 2.4 [95% CI, 2.3-2.6]) was significantly higher among autistic people compared with people with ID only and people without IDD. In this retrospective cohort study, people with IDD had a younger mean age at first delivery, had lower prevalence of live births, and had poor obstetric, mental health, and medical outcomes compared with people without IDD, pointing toward a need for clinician training and timely delivery of maternal health care. Results highlight needed reproductive health education, increasing clinician knowledge, and expanding Medicaid to ensure access to care for people with IDD.

Cross-neurotype communication from an autistic point of view: Insights on autistic Theory of Mind from a focus group study.

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.