Autistic Population Research Articles

Quality-of-Life Discrepancies Among Autistic Adolescents and Adults: A Rapid Review.

Quality of life (QoL) is a core outcome of occupational therapy, but it is decreased among autistic adolescents and adults. This is the first review of QoL from an occupational therapy standpoint. To identify self-reported QoL differences between autistic and nonautistic samples; investigate sex differences in QoL among autistic people; examine consistency in QoL among autistic people across age, intellectual disability (ID), and self- versus proxy-report method; and appraise occupational therapy-related interventions addressing QoL among autistic people. Articles published in peer-reviewed journals between 2010 and 2020, located through Academic Search Ultimate, PubMed, and OTseeker, along with the American Journal of Occupational Therapy, British Journal of Occupational Therapy, Canadian Journal of Occupational Therapy, and Australian Occupational Therapy Journal. Study Selection and Data Collection: Article samples consisted of at least 20% autistic females and used self-reported QoL measures. Qualitative research was excluded, as well as studies with participants younger than age 13 yr. Twenty-seven articles qualified (3 Level 1B, 13 Level 3B, and 11 Level 4). Autistic adolescents and adults demonstrated decreased self-reported QoL compared with nonautistic peers across age and ID presence. One article compared sex differences in QoL among autistic people. Interventions improved QoL among autistic people. Autistic adolescents and adults demonstrate decreased QoL in comparison with nonautistic peers. Questions remain related to sex differences in QoL among autistic people, an area for future research. Multiple evidence-based approaches to improve QoL in the autistic population are relevant to occupational therapy practice. What This Article Adds: Self-reported QoL among autistic adolescents and adults is clearly lower than among their nonautistic counterparts. This article provides information on multiple interventions related to occupational therapy to improve QoL among autistic people.

Delayed cortical processing of auditory stimuli in children with autism spectrum disorder: A meta-analysis of electrophysiological studies

Several researchers have hypothesised that individuals with Autism Spectrum Disorder (ASD) show encoding delays in their obligatory event-related potentials (ERPs)/ event-related fields (ERFs) for low-level auditory information compared to neurotypical (NT) samples. However, empirical research has yielded varied findings, such as low-level auditory processing in ASD samples being unimpaired, superior, or impaired compared to NT samples. Diverse outcomes have also been reported for studies investigating ASD-NT differences in functional lateralisation of delays. The lack of consistency across studies has prevented a comprehensive understanding of the overall effects in the autistic population. Therefore, this meta-analysis compared long-latency ERPs and ERFs produced by autistic and NT individuals to non-linguistic auditory stimuli to test, firstly, the robustness of auditory processing differences and, secondly, whether these differences are observed in one or both hemispheres. Nine articles meeting the inclusion criteria were included in the meta-analysis. Meta-analytic results indicated that autistic individuals demonstrate bilaterally delayed P1/ M50 peaks and lateralised delays in the right but not left hemisphere N1/ M100 peak. These results further inform our understanding of auditory processing and lateralisation across the autism spectrum.

Camouflaging in Autistic and Non-autistic Adolescents in the Modern Context of Social Media.

Camouflaging is described as a set of strategies used to prevent others from noticing one's social difficulties. Research indicates heightened levels of camouflaging behaviours in the adult autistic population. To extend understanding of camouflaging in adolescents, this mixed-methods study explored camouflaging behaviours in offline and online contexts with 40 autistic and 158 non-autistic adolescents. At the quantitative phase, participants completed measures of camouflaging behaviours (online vs offline) and measures of social media use. Following this, six autistic adolescents participated in semi-structured interviews. Findings indicate that in the offline context, autistic adolescents camouflage more than non-autistic adolescents. Online, autistic participants camouflage less than they do offline, and females camouflage more than males. Implications for research and theory are discussed.

Factor structure and psychometric properties of the Brief COPE in autistic older adolescents and adults

BackgroundAutistic adults experience high levels of stress, which may negatively affect their mental health. However, research into coping with stress in this population is limited, with no coping measures specifically validated for use in the autistic population. MethodUtilising data from two Australian longitudinal adult studies, exploratory factor analysis was conducted to determine the factor structure that best represented the use of coping strategies in a sample of autistic adults (N = 255) using the Brief COPE. Mental health and well-being measures were used to provide information on psychometric properties. To explore potential intricacies in factor structure that may be unique to autistic adults, a preliminary subjective comparison with a non-autistic adult sample (N = 165) was also conducted. ResultsA six-factor solution, with high internal reliabilities, best represented the use of coping strategies in the autistic adult sample. Good convergent and divergent validities for the conceptually relevant coping factors were also reported. Subjective comparisons raise the possibility of some similarities (e.g., support-seeking coping strategies) and differences (e.g., the use of self-distraction coping strategies) in factor structures between the autistic and non-autistic samples. ConclusionsThis study provides an initial validation of the Brief COPE in autistic adults and supports its usefulness in assessing coping strategies in response to stress in this population. Findings also have potential implications for informing intervention services for autistic individuals, given the known relationships between the coping of stress and broader outcomes, such as mental health.

RETRACTED ARTICLE: Improving the measurement of alexithymia in autistic adults: a psychometric investigation and refinement of the twenty-item Toronto Alexithymia Scale

BackgroundAlexithymia, a personality trait characterized by difficulties interpreting one’s own emotional states, is commonly elevated in autistic adults, and a growing body of literature suggests that this trait underlies a number of cognitive and emotional differences previously attributed to autism, such as difficulties in facial emotion recognition and reduced empathy. Although questionnaires such as the twenty-item Toronto Alexithymia Scale (TAS-20) are frequently used to measure alexithymia in the autistic population, few studies have attempted to determine the psychometric properties of these questionnaires in autistic adults, including whether differential item functioning (I-DIF) exists between autistic and general population adults.MethodsWe conducted an in-depth psychometric analysis of the TAS-20 in a large sample of 743 verbal autistic adults recruited from the Simons Foundation SPARK participant pool and 721 general population controls enrolled in a large international psychological study (the Human Penguin Project). The factor structure of the TAS-20 was examined using confirmatory factor analysis, and item response theory was used to further refine the scale based on local model misfit and I-DIF between the groups. Correlations between alexithymia and other clinical outcomes such as autistic traits, anxiety, and quality-of-life were used to assess the nomological validity of the revised alexithymia scale in the SPARK sample.ResultsThe TAS-20 did not exhibit adequate global model fit in either the autistic or general population samples. Empirically driven item reduction was undertaken, resulting in an eight-item unidimensional scale (TAS-8) with sound psychometric properties and practically ignorable I-DIF between diagnostic groups. Correlational analyses indicated that TAS-8 scores meaningfully predict autistic trait levels, anxiety and depression symptoms, and quality of life, even after controlling for trait neuroticism.LimitationsLimitations of the current study include a sample of autistic adults that was overwhelmingly female, later-diagnosed, and well-educated; clinical and control groups drawn from different studies with variable measures; and an inability to test several other important psychometric characteristics of the TAS-8, including sensitivity to change and I-DIF across multiple administrations.ConclusionsThese results indicate the potential of the TAS-8 as a psychometrically robust tool to measure alexithymia in both autistic and non-autistic adults. A free online score calculator has been created to facilitate the use of norm-referenced TAS-8 latent trait scores in research applications (available at http://asdmeasures.shinyapps.io/TAS8_Score).

A Critical Review of Academic Literature Constructing Well-Being in Autistic Adults.

Why was this study done?: More autistic people and researchers have advocated to study autism in critical and positive ways. While it is important to promote better well-being for autistic people, little is known about what well-being actually means to them.What was the purpose of this study?: The purpose of our critical review was to identify how the concept of well-being in autistic people is understood and described in academic literature. We also critiqued how well-being research considers the input and perspectives of autistic adults.What did we do?: We systematically searched for research articles published between 2013 and 2020. We identified 63 articles that involved direct data collection with autistic adults and focused on well-being and related concepts such as quality of life, life satisfaction, and happiness. We analyzed the articles by focusing on how they used language to describe well-being in autistic adults and how they valued the data collected from these adults.What did we find?: We identified several ways that article authors described their understanding of autistic well-being: (1) well-being as an objective and uncontested object, (2) well-being is personal and can vary in nature, (3) well-being warrants a measure that considers opinions of autistic people, and (4) well-being as very specific to autistic people's subjective perspectives. We critically analyzed how these different understandings limit or open life possibilities for autistic people's well-being.How will this work help autistic people?: We recommend that researchers critically reflect on how they engage autistic adults and use their input in research. Promoting well-being needs to be meaningful and ethical to autistic adults. Research also needs to advocate for social justice to challenge how the majority in society understands or misunderstands autistic people.

Differential diagnosis on the autism spectrum: Theorizing an “Ordinary Autism”

ObjectivesData on the prevalence of Autism Spectrum Disorder (ASD) reveal several clinical evolutions inducing new psychiatric definitions and diagnostic practices. Thus, autism has shifted from being a rare syndrome with severe clinical forms to a new paradigm: the paradigm of “ordinary” or “invisible” autism, in terms of the frequency and the intensity of the disorders. These changes incorporate new populations into our conception of autism, with new phenotypes that pose theoretical and clinical challenges to clinicians. In response, we propose the hypothesis — based on psychoanalytic theories of psychic structures — of an “ordinary autism” as a definition of a non-prototypical autistic psychic functioning that falls outside the DSM diagnostic framework. This idea seems to provide us new theoretical references that nourish our practices as well as fundamental research. MethodFirst, we will review the nosographic mutations of the DSM-5 and their implications for non-prototypical psychic modes of functioning of autistic people that may not be contained within the autism spectrum's blurry boundaries — especially for the adult population without intellectual delay and in the case of complicated differential diagnosis for clinical and societal reasons. Next, we will discuss the definition of “ordinary” or “invisible” autism in a psychoanalytic structural model, as a possible epistemological orientation for identifying and designing practice with the clinical heterogeneity of autism outside the boundaries of psychiatric ASD. ResultsThe autistic population targeted by the DSM-5 criteria is different from that previously defined by DSM-IV. This leads to two consequences: on the one hand, autistic modes of functioning are not limited to individuals who have been diagnosed with Autism Spectrum Disorders as defined by the DSM-5; thus individuals with autism do not have access to the diagnosis of ASD or are given other diagnoses. The alternative diagnoses proposed by the DSM-5 that attempt to correct this diagnostic exclusion — such as Social (Pragmatic) Communication Disorder — are unsatisfactory. Therefore, there is an entire segment of the autistic population that has subclinical, non-prototypic autistic manifestations or more subtle phenomena discernible in the broader autistic phenotype or sub-threshold autism spectrum that does not have access to the ASD diagnosis and raises differential diagnostic issues. On the other hand, it appears that the autism spectrum brings together extremely different entities and false positives such as schizophrenia and schizophrenic spectrum personality disorders under one diagnostic rubric. Then, the differential problem appears central: both at the theoretical level and in diagnostic practices. The recognition of these limits should encourage us to promote research and clinical applications on this subject. One solution that we envisage is to be found in an extension of Maleval's structural psychoanalytical model: we propose the notion of “ordinary autism” — an echo of ordinary psychosis — to define attenuated or compensated non-prototypical autistic phenotypes, increasingly frequent and with fewer “extraordinary” phenomenological expressions than the classic cases of autism which now call into question the relationship between the normal and the pathological. Discussion“Ordinary autism” seems to offer clinicians the opportunity to formalize the new contemporary and extensive clinical reality of autism. This term situates itself within a theoretical model whose current and future developments might help us respond to clinical and diagnostic issues, but also to therapeutic and societal ones. We propose to continue on the path of the operationalization of these theoretical models in order to identify autistic structural constants that could be found throughout the “ordinary” clinic of autism and could serve as differentiating tools for diagnosis as well as a support in developing and refining therapeutic practices. ConclusionWe conclude that there is an urgent need to conceive of “ordinary autism” to provide us with reference points to respond to new clinical issues, but also to reintroduce respect for the autistic person in his or her subjectivity to the center of our therapeutic practices.

The Effectiveness of Mirroring- and Rhythm-Based Interventions for Children with Autism Spectrum Disorder: a Systematic Review

Autism Spectrum Disorder (ASD) is characterised as a neurodevelopmental disorder that has continuing deficits in communication skills and social development. Utilising techniques known as mirroring and rhythm, Dance and Movement Therapy (DMT) has shown beneficial effects in the autistic population reducing such deficits. However, no review to date has investigated these individual techniques outside the practice of DMT. This systematic review of studies published between 1975 and 2020 aims to evaluate the effectiveness of both mirroring and rhythm as interventions that target communication skills and social development in children diagnosed with ASD. Out of 1369 relevant articles, 11 met the inclusion criteria. All studies showed beneficial effects of mirroring and rhythm for communication skills and social development in children diagnosed with ASD. Therefore, incorporating these techniques into new interventions and practice may offer substantial therapeutic benefits for autistic children.

Leveling Up Regulatory Support Through Community Collaboration

Purpose No group has more stake in the game than the community that researchers, educators, and practitioners aim to serve. In our field, we must recognize not only that autistic people are those most affected by decisions around programming and policies, but that they are key informants in decisions around the conceptualization, implementation, and evaluation of educational programming for autistic learners. Too often, they are left out of these discussions altogether. To illustrate the process of community collaboration, we discuss emotional and energy regulation (ER), a top priority among autistic people based upon their viewpoints. Method In this clinical focus article, we outline what emotional regulation is, why it is relevant and often challenging for the autistic population, the shortcomings of current practice, as well as practical strategies and ways of thinking about supporting ER for autistic learners. We provide theoretical insights as well as firsthand accounts from a diverse group of autistic people. Each autistic person contributing their perspective in this clinical focus article provided written consent for their participation, as well as direction as to how they wanted to be cited and acknowledged. Quotes were gathered from personal communications, social media posts, and online sources. The clinical viewpoint and materials and tools presented throughout the clinical focus article are the works of the authors that have been informed by the autistic community. Results Based upon the qualitative data presented in this clinical focus article, incorporating the autistic community voice when devising tools and strategies is validating of their experiences and generates useful supports. Conclusions Using a framework similar to the one presented here for engaging the autistic community will help to facilitate the conceptualization of more reliable, valid, and effective supports, goal-setting, and programming overall. Future directions related to the value of empirical study of the tools and strategies developed through such a process are offered.

“People Might Understand Me Better”: Diagnostic Disclosure Experiences of Autistic Individuals in the Workplace

Background: Autistic individuals face challenges in the workplace, particularly related to social communication. Diagnostic disclosure may mitigate these challenges, but it also exposes individuals to potential discrimination. This study aimed to share the diagnostic disclosure experiences of autistic adults in the workplace to help employers better understand the process, and help other autistic individuals make an informed decision about disclosure. Methods: The participants in this study were 238 clinically diagnosed, U.K.-based autistic adults with employment experience. Participants completed an online survey, comprising both open-ended and closed-ended questions, that asked about their experiences of disclosure in the workplace. Specifically, questions focused on when in the employment process participants disclosed, to whom the disclosure was made, what factors were involved in the decision to disclose, and what the impacts were of this decision. Results: Our findings suggest that when deciding to disclose, the participants were most concerned about how this might affect the attitudes of others in the workplace. Participants most often only disclosed selectively, while over a third disclosed to everyone. Many participants chose to disclose when completing the application materials or after starting the job, but rarely in the interview process. Many also disclosed after encountering issues at work (i.e., retrospective disclosure). Just over a third of participants rated the impact of disclosing to supervisors and coworkers positively. Subsequent adjustments made were even less positively endorsed. Conclusions: Autistic individuals must weigh the potential benefits of disclosure against the costs. This study highlights the need for organizations, rather than autistic individuals, to take more responsibility for facilitating disclosure and improving outcomes to it. Specific recommendations include the creation of clear pathways for disclosure in workplaces, and an ongoing commitment to organization-wide autism training to reduce stigma and discrimination for autistic employees. Lay summary Why was this study done? Autistic individuals face challenges in the workplace. Telling someone that you have an autism diagnosis (disclosure) might be one way of addressing these challenges (e.g., by increasing the understanding of others). However, the literature on disclosure shows mixed outcomes and rarely gives voice to autistic people. What was the purpose of this study? The purpose of this study was to explore the disclosure experiences of autistic job seekers and employees and gain insight into their decision-making. What did the researchers do? We conducted an online survey with 238 clinically diagnosed autistic adults with employment experience. Our participants answered some questions about their personal information (e.g., age) and their past work experience before completing survey questions about disclosure. We read through everyone's answers to open-ended questions and put the answers into groups, such as “Reasons to disclose” and “Reasons not to disclose.” What were the results of the study? When deciding whether or not to disclose, our participants were most concerned about what other people they worked with would think. Most of our participants only told some people at work about their diagnosis, and many only disclosed after issues arose in the workplace. Over a third, however, disclosed to everyone. Participants said they were most likely to disclose on the application materials or after starting a job, not during a job interview. Just over one-third said that telling their supervisors or coworkers they were autistic had a positive impact, and that the changes made by their supervisors afterward were positive. Over a third said the changes made by their coworkers were neither positive nor negative. What do these findings add to what was already known? This is the first large-scale U.K.-based study on the disclosure experiences of autistic adults in the workplace. Our findings suggest that autistic people focus most on what other people will think and how others will treat them if they disclose. We found that disclosure during interviews is unlikely—contrary to what previous studies focused on—and that we need to conduct research looking at disclosure in more likely scenarios. What are potential weaknesses in the study? Most of our participants were white and female, but in the wider autistic population that isn't the case. We had many more participants who had told people at work about their autism diagnosis than those who had not. We also could not ask any follow-up questions about our participants' experiences because the survey was online. How will these findings help autistic adults now or in the future? Knowing more about the experiences of autistic people can help individuals to make an informed choice about disclosing their diagnosis. This study highlights that we need to involve nonautistic employers, colleagues, and organization leaders in the disclosure process to improve autism knowledge and acceptance, and hopefully improve outcomes for autistic people.

Relational mentalizing after any representation.

Autistic, developmental, and nonhuman primate populations fail tasks that are thought to involve attributing beliefs, but not those thought to reflect the representation of knowledge. Instead of knowledge representations being more basic than belief representations, relational mentalizing may explain these observations: The tasks referred to as reflecting "belief" representation, but not the "knowledge" representation tasks, are social conflict designs. They involve mental conflict monitoring after another's mental state is represented - with effects that need to be accounted for.

The broader autism phenotype constellations–disability matrix paradigm: Theoretical model for autism and the broader autism phenotype

The prevalence of autism has increased dramatically over the last 60 years, and the cause of this increase is unclear. In this paradigm-shift paper, I propose an explanatory paradigm for the cause of autism and its increased prevalence in the general population. I also discuss how social and historical contexts may have influenced the evolution and manifestation of specific traits in the autism population. These traits expand the characterization of the broader autism phenotype to include a constellation of socially valued traits, termed Broader Autism Phenotype Constellations (BAPCO). The frequency of these traits may have increased due to assortative mating opportunities that occurred alongside social changes in education and occupational opportunities over the last 100 years. I propose that assortative mating can lead to both positive and negative developmental consequences affecting social and language development. I also propose that BAPCO traits, which are not intrinsically disabilities, could interact with co-occurring conditions in a new model called the BAPCO-Disability Matrix Paradigm (BAPCO-DMAP). In this paradigm, autism is located at the intersection of BAPCO traits and at least one co-occurring condition. These proposed models support the need to create a more comprehensive definition of autism that includes constellations of BAPCO traits. The BAPCO-DMAP paves the way to testable predictions of autism prevalence and provides a framework to better understand the foundational traits of autism. Finally, this paradigm radically redefines the broader autism phenotype with characteristics that can inform therapy and child development.

Coproduction with Autistic Adults: Reflections from the Authentistic Research Collective.

Why is coproduction important?: Coproduction means creating things jointly with others. Ideally, autistic people should be involved in research that is about them so that their thoughts and opinions are included. Coproduction allows this to happen.What is the purpose of this article?: There is little advice for how autistic and nonautistic people can work together to coproduce useful research. This article hopes to encourage discussion by sharing our reflections on how we used coproduction in our project.What did we do?: Our group was made up of autistic and nonautistic people. One of our goals was to gain experience in using coproduction. We created this article containing our reflections-what we found worked well, and what we felt could be done differently in the future.What did we learn?: We learnt the importance of five key areas: (1) group rules, and a "traffic light" system to help group members show how they like to communicate; (2) adapting the environment to suit people's needs; (3) inclusion of digital communication tools; (4) encouraging group members to feel they are authentic (be fully themselves); and (5) supporting autistic strengths. We hope that the discussion of these themes will be helpful for future coproduction projects.

Emotional self-awareness in autism: A meta-analysis of group differences and developmental effects.

Emotional self-awareness is increasingly suggested to be an area of difficulty in autism that may predict socioemotional outcomes for this population. However, whether emotional self-awareness is consistently diminished in autism across age and methodology remains unclear. We systematically reviewed 47 papers measuring emotional self-awareness in autistic (n = 1387) and non-autistic (n = 1433) participants. Most studies relied on self-report. Of studies testing for group differences, the majority (32/41) found significantly poorer emotional self-awareness in autism. Meta-analyses of self-report measures found that emotional self-awareness was significantly poorer in autism (d = 1.16). However, when examining age groups individually, autistic children of age 12 years and under were not significantly different from their peers (d = 0.03). Instead, difficulties emerged during adolescence (d = 0.63) and increased with age (d = 1.16 – 1.58). The pattern of emotional self-awareness difficulties being more common in autism, and worsening with age is similar to the development of mental health difficulties in autism. However, findings rely on self-perception and so may reflect poor self-beliefs of socioemotional competence. We propose that negative self-beliefs in autistic populations may account for findings of low emotional self-awareness.Lay abstractAutistic people are thought to have difficulties with identifying and understanding their own emotions. This is referred to as emotional self-awareness. It is important to study emotional self-awareness as people who are more able to understand their own emotions, whether they are autistic or not, are more able to respond to them appropriately, as well as to identify them in other people. It has not yet been confirmed whether autistic people have difficulties with emotional self-awareness, or if any reported difficulties are actually due to the way in which emotional self-awareness is measured in autistic people. If these difficulties do exist, it is also not known when these difficulties emerge. In this research, we reviewed 47 existing studies that measured emotional self-awareness in autistic and non-autistic adults and children. We also compared studies that measured emotional self-awareness in different ways. We found that autistic adults did seem to have poorer emotional self-awareness compared to their neurotypical peers. However, this was not the case with autistic children of age 12 years and below. Instead, differences in emotional self-awareness only seemed to emerge during adolescence. Moreover, these difficulties seemed to increase with age. These results suggest that difficulties with emotional self-awareness may not be inherent in autism. Instead, they may emerge alongside the greater social and mental health difficulties that are experienced by many autistic people during adolescence. We therefore suggest that it is important to find out more about, and subsequently support, the emotional self-awareness difficulties that autistic adolescents may encounter.

Avaliações de distúrbios gastrointestinais nutricionais no transtorno do espectro autista: uma revisão integrativa

Este estudo tem como finalidade compreender as relações sintomatológicas gastrointestinais e nutricionais suas possíveis relações de pessoas com transtorno do espectro autista. O objetivo desse estudo foi realizar uma revisão integrativa sobre autismo e distúrbios gastrointestinais de maneira abrangente, analisando dieta e nutrição, e diferença funcional de trato gastrointestinal em pacientes com TEA. Para a seleção da amostra definiu-se critérios de artigos indexados de 2010 a 2020, publicados em periódicos nacionais e internacionais, disponibilizados na íntegra em língua portuguesa e inglesa. A coleta de dados foi realizada na base Biblioteca Virtual de Saúde (BVS), LILACS, SCIELO, PubMed, e GOOGLE ACADÊMICO, utilizando os seguintes descritores “Autismo”, “Distúrbios Gastrointestinais”, “Distúrbio Nutricional”. A busca resultou em 138 artigos após utilização dos critérios de inclusão e exclusão, restaram 15 artigos para análise, interpretação e discussão. Os resultados evidenciam que existe relação entre a alimentação com distúrbios gastrointestinais causando problemas nutricionais e dificultando a execução de medidas adequadas no tempo necessário para melhor abordagem em intervenções dietética. Conclui-se que seria importante uma abordagem de mudança em relação ao alimento na dieta de pessoas com TEA, além de considerar a heterogeneidade da população autista. Não há evidências cientificas suficientes nos estudos exploratórios e de revisão que comprovem que uma dieta restritiva melhore os sintomas de distúrbios gastrointestinais, funcionalidades da microbiota e aspectos nutricionais no TEA.

Autism, autistic traits and creativity: a systematic review and meta-analysis.

Psychometric, historiometric and psychiatric studies are controversial on a hypothetical link between psychopathology and creativity. In this study, we will try to contribute to this debate by analysing the case of autism. Is there a relationship between autism and creativity? If so, can we find the same relationship in a watered-down form in subjects with autistic traits? In order to answer these questions, we carried out a systematic literature review of the studies on this topic published in the last 10years. We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. We also conducted a meta-analysis of data. We found that in the clinical population there are fewer creative performances than in control groups; nonetheless, it is possible to delineate a medium creative profile of subjects with autism. The average creative profile of people with autism shows that they are inhibited in fluency and flexibility, but that they display a high level of detail and a particularly high level of originality in works either generated during tests or created in private time. In particular, the level of detail reached in the latter condition seems to be higher in the autistic population than in the control groups. Better linguistic skills appear to be linked to better creative performances. Linguistic tests, if compared with visual and performative tests, seem to favour the expression of originality in subjects with autism. Although our data on autistic traits are compatible with the hypothesis that a high level of autistic traits is a watered-down replica of the cognitive profile of subjects with autism, we have no sufficient data to support this hypothesis.

Reliability and Validity of the Simplified Chinese Version of the Aberrant Behavior Checklist in Chinese Autism Population.

Background: The Aberrant Behavior Checklist (ABC) is a widely used scale in autism clinical intervention research for the assessment of core symptoms and comorbid emotional and behavioral problems among people with autism. The aim of this study was to examine the psychometric properties of the Simplified Chinese version of the Aberrant Behavior Checklist (SC-ABC) using a sample of people with autism in a Chinese population.Methods: In total, we enrolled 799 patients aged 1.5–33 years old. We collected data using the SC-ABC (n = 799), Autism Behavior Checklist (n = 743), Attention Deficit Hyperactivity Disorder Rating Scale-IV (ADHD-RS-IV) (n = 433) and Achenbach Child Behavior Checklist (CBCL) (n = 319). Eighty-four patients were separately assessed with the SC-ABC by two caregivers simultaneously. Forty-four patients were assessed with the SC-ABC again by same caregiver 2 weeks after the first assessment. SC-ABC data from the whole sample were used for confirmatory factor analysis. We evaluated criterion validity using Spearman's correlation coefficient between scores of the SC-ABC and scores of the Autism Behavior Checklist, ADHD-RS-IV and CBCL separately in the whole sample and different age groups. We calculated the intragroup correlation coefficients and Spearman's correlation coefficient for interrater reliability in 84 samples and test-retest reliability in 44 samples. We conducted Cronbach's α for internal consistency.Results: For the SC-ABC, the intragroup correlation coefficients of five subscales and the total score in interrater and test-retest reliability ranged from 0.87 to 0.92 and from 0.93 to 0.97 (all P < 0.01). The Spearman's correlation coefficient of five subscales and the total score in interrater and test-retest reliability ranged from 0.78 to 0.85 and 0.86 to 0.94, respectively (all P < 0.01). Cronbach's α of five subscales and the total score ranged from 0.75 to 0.96 (all P < 0.01). The Spearman's correlation coefficient for criterion validity for the whole sample and different age groups ranged from 0.39 to 0.76 (all P < 0.01). The model fit for the original five factor model was acceptable, with fit indices of SMR = 0.062 and RMSEA = 0.052.Conclusions: The SC-ABC has satisfactory psychometric properties and can be used in the assessment of core symptoms and comorbid emotional and behavioral problems in patients with autism.

Cortical Auditory Processing of Simple Stimuli Is Altered in Autism: A Meta-analysis of Auditory Evoked Responses

BackgroundAuditory perceptual abnormalities are common in persons on the autism spectrum. The neurophysiologic underpinnings of these differences have frequently been studied using auditory event-related potentials (ERPs) and event-related magnetic fields (ERFs). However, no study to date has quantitatively synthesized this literature to determine whether early auditory ERP/ERF latencies or amplitudes in autistic persons differ from those of typically developing control subjects. MethodsWe searched PubMed and ProQuest for studies comparing 1) latencies/amplitudes of P1/M50, N1b, N1c, M100, P2/M200, and/or N2 ERP/ERF components evoked by pure tones and 2) paired-click sensory gating (P1/N1b amplitude suppression) in autistic individuals and typically developing control subjects. Effects were synthesized using Bayesian 3-level meta-analysis. ResultsIn response to pure tones, autistic individuals exhibited prolonged P1/M50 latencies (g = 0.341 [95% credible interval = 0.166, 0.546]), prolonged M100 latencies (g = 0.319 [0.093, 0.550]), reduced N1c amplitudes (g = −0.812 [−1.278, −0.187]), and reduced N2 amplitudes (g = −0.374 [−0.633, −0.179]). There were no practically significant group differences in P2/M200 latencies, N2 latencies, P1/M50 amplitudes, N1b amplitudes, M100 amplitudes, or P2/M200 amplitudes. Paired-click sensory gating was also reduced in autistic individuals (g = −0.389 [−0.619, −0.112]), although this effect was primarily driven by smaller responses to the first click stimulus. ConclusionsRelative to typically developing control subjects, autistic individuals demonstrate multiple alterations in early cortical auditory processing of simple stimuli. However, most group differences were modest in size and based on small numbers of heterogeneous studies with variable quality. Future work is necessary to understand whether these neurophysiologic measures can predict clinically meaningful outcomes or serve as stratification biomarkers for the autistic population.

Effect Sizes of Deletions and Duplications on Autism Risk Across the Genome.

Deleterious copy number variants (CNVs) are identified in up to 20% of individuals with autism. However, levels of autism risk conferred by most rare CNVs remain unknown. The authors recently developed statistical models to estimate the effect size on IQ of all CNVs, including undocumented ones. In this study, the authors extended this model to autism susceptibility. The authors identified CNVs in two autism populations (Simons Simplex Collection and MSSNG) and two unselected populations (IMAGEN and Saguenay Youth Study). Statistical models were used to test nine quantitative variables associated with genes encompassed in CNVs to explain their effects on IQ, autism susceptibility, and behavioral domains. The "probability of being loss-of-function intolerant" (pLI) best explains the effect of CNVs on IQ and autism risk. Deleting 1 point of pLI decreases IQ by 2.6 points in autism and unselected populations. The effect of duplications on IQ is threefold smaller. Autism susceptibility increases when deleting or duplicating any point of pLI. This is true for individuals with high or low IQ and after removing de novo and known recurrent neuropsychiatric CNVs. When CNV effects on IQ are accounted for, autism susceptibility remains mostly unchanged for duplications but decreases for deletions. Model estimates for autism risk overlap with previously published observations. Deletions and duplications differentially affect social communication, behavior, and phonological memory, whereas both equally affect motor skills. Autism risk conferred by duplications is less influenced by IQ compared with deletions. The model applied in this study, trained on CNVs encompassing >4,500 genes, suggests highly polygenic properties of gene dosage with respect to autism risk and IQ loss. These models will help to interpret CNVs identified in the clinic.

Health status of Medicare-enrolled autistic older adults with and without co-occurring intellectual disability: An analysis of inpatient and institutional outpatient medical claims.

Little is known about the extent to which the healthcare needs of autistic older adults with intellectual disability differ from autistic older adults without intellectual disability. Our study is the first, to our knowledge, to use US national data to compare physical and mental health conditions among autistic older adults with and without intellectual disability. The data analyzed in this study consisted of records from inpatient hospitalizations as well as "institutional outpatient" healthcare visits, which include visits to hospital outpatient departments, rural health clinics, renal dialysis facilities, outpatient rehabilitation facilities, Federally Qualified Health Centers, and community mental health centers. Autistic older adults with intellectual disability were significantly more likely to have thyroid disorders, epilepsy, respiratory infections, gastrointestinal conditions, osteoporosis, cognitive disorders, and schizophrenia/psychotic disorders. In contrast, autistic older adults without intellectual disability were significantly more likely to have obesity, diabetes, high blood pressure, cerebrovascular disease, chronic obstructive pulmonary disease, arthritis, back conditions, attention deficit disorders, substance use disorders, and suicidal ideation or intentional self-injury. These findings highlight the importance of developing distinct, tailored health management strategies for the autistic older adults with and without intellectual disability.