Autistic Population Research Articles

The Economic Impacts of COVID-19 on Autistic Children and Their Families.

We used data from the National Survey of Children's Health to (1) examine differences in economic hardship and safety net program use after the implementation of federal relief efforts, and (2) assess whether the COVID-19 pandemic exacerbated autism-based disparities in hardship and program use. We examined five dimensions of economic hardship (poverty, food insecurity, medical hardship, medical costs, and foregone work) and four safety net programs (cash assistance, Supplemental Nutrition Assistance Program (SNAP), Special Supplemental Nutrition Program for Women, Infants and Children (WIC), and free or reduced-cost meals). First, we calculated adjusted prevalence and odds ratios to compare pre-COVID (2018-2019) and during COVID (2021) outcomes by autism status. Next, we calculated the adjusted odds of each outcome among autistic children compared to those of children with and without other special healthcare needs at both time points. COVID-19 exacerbated autism-based disparities in food insecurity, SNAP, and public health insurance, but alleviated inequities in medical hardship, foregone work, and cash assistance. Autistic children did not experience declines in food insecurity or increases in SNAP like other children; medical hardship and foregone work decreased more for autistic children; and the magnitude of autism-based differences in public coverage significantly increased during the pandemic. Federal relief efforts likely improved economic outcomes of children; however, these effects varied according to type of hardship and by disability group. Efforts to promote economic well-being among autistic populations should be tailored to the financial challenges most salient to low-income autistic children, like food insecurity.

The use of psychotropic medications in autistic individuals (21 years and younger) in Western Australia: A preliminary investigation.

Prescriptions and use of medications to treat mental health conditions in young autistic populations are inconsistent worldwide. This makes it hard to compare findings from international studies to the Australian autistic population, where there are limited relevant studies. Apart from risperidone, there are no other medications specified for direct use in autistic persons. This study aims to gain initial broad understanding of the use of medications, commonly prescribed for mental health conditions, specifically by autistics under the age of 21 years. We analysed data that were previously collected as part of the Western Australian Autism Biological Registry between 2011 and 2015 which amounted to 239 surveys completed on young persons with diagnosed autism. The questionnaires included information on co-occurring conditions, current or previous use of medications and reasons for use of the medications. Only one-quarter of the participants in this study reported using at least one mental health-related medication in their lifetime. The most reported medications were stimulants, antidepressants and antiepileptics. The reasons for using medication included managing attention deficit hyperactivity disorder, challenging behaviours, seizures, sleep difficulties and symptoms of anxiety and depression. The number of individuals reporting medication use in this study was lower compared to other developed countries. Nevertheless, these medications should be monitored due to limited understanding of their use to manage co-occurring symptoms in young autistic persons. The findings highlight the importance of ongoing research to better understand mental health-related medications and inform best practice.

The Assessment and Treatment of Post-traumatic Stress Disorder in Autistic People: A Systematic Review

AbstractAdverse life events and mental health conditions are unfortunately common amongst autistic adults and children; this may present a vulnerability to developing post-traumatic stress disorder (PTSD). This systematic review provides an update of Rumball’s (Review Journal of Autism and Developmental Disorders, 6, 294–324, 2019) systematic review of PTSD in autistic individuals and identifies 18 new studies published from 2017 to 2022, reflecting increased research interest in PTSD in autistic populations. Included literature suggests that autistic adults and children experience more severe PTSD symptoms compared to their non-autistic peers, with at least comparable rates of occurrence. We provide a comprehensive overview of this emerging field and identify the need for future research to validate PTSD symptom assessment tools and treatment strategies and investigate unique manifestations of trauma-related symptoms in autistic individuals.

No association between alexithymia and emotion recognition or theory of mind in a sample of adolescents enhanced for autistic traits.

Alexithymia is a sub-clinical condition characterised by difficulties identifying and describing one's own emotions, which is found in many, but not all autistic people. The alexithymia hypothesis suggests that certain aspects of socio-cognitive functioning typically attributed to autism, namely difficulties in emotion recognition, might be better explained by often co-occurring alexithymia. It is important to understand what is specific to autism and what is due to other co-occurring characteristics to develop appropriate support for autistic people. However, most research on this topic has been conducted in adults, which limits our knowledge about the relevance of this theory to younger autistic populations. This study tested whether difficulties in emotion recognition and theory of mind traditionally associated with autism might be better explained by alexithymia in a sample of adolescents with and without a diagnosis of autism. Results found that difficulties in emotion recognition and theory of mind were both associated with autistic traits, and this was not accounted for by individual differences in levels of alexithymia. This research suggests that more work is needed to understand the applicability of the alexithymia hypothesis in younger populations, but that at least in adolescents and when using parent-report measures, alexithymia may not account for emotion recognition or theory of mind difficulties associated with autistic traits.

A qualitative study of physical activity drivers in autistic individuals using COM-B. Autistic and non-autistic perspectives

BackgroundDespite evidence of the health benefits of physical activity in non-autistic populations and the additional benefits for autistic populations, physical activity levels remain stubbornly low in autistic individuals. Understanding the determinants of physical activity is essential in order to support intervention development. MethodsThe current research applied the Theoretical Domains Framework (TDF) and Capability Opportunity Motivation, Behaviour (COM-B) model of behaviour to identify determinants of physical activity behaviour, mechanisms of action, and potentially efficacious behaviour change techniques. Fifteen semi-structured interviews were conducted with autistic adults (N = 4) and children (N = 2), parents of autistic children (N = 4), and stakeholders in autism care and support (N = 5). A deductive approach was taken to map themes onto TDF and COM-B. ResultsParticipants identified three overarching themes: Discordance between autistic and non-autistic perspectives; physically active environments; and autonomy and choice. Eight subthemes were identified and mapped onto COM-B and TDF. Recommendations for intervention development are made and potential behaviour change techniques are identified. ConclusionsGiven the important role of care providers, future research should focus on the attitudes and behaviours of individuals who care for and support autistic individuals to identify barriers and drivers of physical activity promotion, particularly for individuals with high support needs. An argument is made for co-design in future intervention development.

The search for gastrointestinal inflammation in autism: a systematic review and meta-analysis of non-invasive gastrointestinal markers

BackgroundGastrointestinal symptoms and inflammatory gastrointestinal diseases exist at higher rates in the autistic population. It is not clear however whether autism is associated with elevated gastrointestinal inflammation as studies examining non-invasive faecal biomarkers report conflicting findings. To understand the research landscape and identify gaps, we performed a systematic review and meta-analysis of studies measuring non-invasive markers of gastrointestinal inflammation in autistic and non-autistic samples. Our examination focused on faecal biomarkers as sampling is non-invasive and these markers are a direct reflection of inflammatory processes in the gastrointestinal tract.MethodsWe extracted data from case–control studies examining faecal markers of gastrointestinal inflammation. We searched PubMed, Embase, Cochrane CENTRAL, CINAHL, PsycINFO, Web of Science Core Collection and Epistemonikos and forward and backwards citations of included studies published up to April 14, 2023 (PROSPERO CRD42022369279).ResultsThere were few studies examining faecal markers of gastrointestinal inflammation in the autistic population, and many established markers have not been studied. Meta-analyses of studies examining calprotectin (n = 9) and lactoferrin (n = 3) were carried out. A total of 508 autistic children and adolescents and 397 non-autistic children and adolescents were included in the meta-analysis of calprotectin studies which found no significant group differences (ROM: 1.30 [0.91, 1.86]). Estimated differences in calprotectin were lower in studies with siblings and studies which did not exclude non-autistic controls with gastrointestinal symptoms. A total of 139 autistic participants and 75 non-autistic controls were included in the meta-analysis of lactoferrin studies which found no significant group differences (ROM: 1.27 [0.79, 2.04]).LimitationsAll studies included in this systematic review and meta-analysis examined children and adolescents. Many studies included non-autistic controls with gastrointestinal symptoms which limit the validity of their findings. The majority of studies of gastrointestinal inflammation focused on children under 12 with few studies including adolescent participants. Most studies that included participants aged four or under did not account for the impact of age on calprotectin levels. Future studies should screen for relevant confounders, include larger samples and explore gastrointestinal inflammation in autistic adolescents and adults.ConclusionsThere is no evidence to suggest higher levels of gastrointestinal inflammation as measured by calprotectin and lactoferrin are present in autistic children and adolescents at the population level. Preliminary evidence suggests however that higher calprotectin levels may be present in a subset of autistic participants, who may be clinically characterised by more severe gastrointestinal symptoms and higher levels of autistic traits.

Sertraline for anxiety in adults with a diagnosis of autism (STRATA): study protocol for a pragmatic, multicentre, double-blind, placebo-controlled randomised controlled trial

BackgroundSelective serotonin reuptake inhibitors (SSRIs) are commonly prescribed to manage anxiety in adults with an autism diagnosis. However, their effectiveness and adverse effect profile in the autistic population are not well known. This trial aims to determine the effectiveness and cost-effectiveness of the SSRI sertraline in reducing symptoms of anxiety and improving quality of life in adults with a diagnosis of autism compared with placebo and to quantify any adverse effects.MethodsSTRATA is a two-parallel group, multi-centre, pragmatic, double-blind, randomised placebo-controlled trial with allocation at the level of the individual. It will be delivered through recruiting sites with autism services in 4 regional centres in the United Kingdom (UK) and 1 in Australia. Adults with an autism diagnosis and a Generalised Anxiety Disorder Assessment (GAD-7) score ≥ 10 at screening will be randomised 1:1 to either 25 mg sertraline or placebo, with subsequent flexible dose titration up to 200 mg. The primary outcome is GAD-7 scores at 16 weeks post-randomisation. Secondary outcomes include adverse effects, proportionate change in GAD-7 scores including 50% reduction, social anxiety, obsessive-compulsive symptoms, panic attacks, repetitive behaviours, meltdowns, depressive symptoms, composite depression and anxiety, functioning and disability and quality of life. Carer burden will be assessed in a linked carer sub-study. Outcome data will be collected using online/paper methods via video call, face-to-face or telephone according to participant preference at 16, 24 and 52 weeks post-randomisation, with brief safety checks and data collection at 1–2, 4, 8, 12 and 36 weeks. An economic evaluation to study the cost-effectiveness of sertraline vs placebo and a QuinteT Recruitment Intervention (QRI) to optimise recruitment and informed consent are embedded within the trial. Qualitative interviews at various times during the study will explore experiences of participating and taking the trial medication.DiscussionResults from this study should help autistic adults and their clinicians make evidence-based decisions on the use of sertraline for managing anxiety in this population.Trial registrationISRCTN, ISRCTN15984604. Registered on 08 February 2021. EudraCT 2019-004312-66. ANZCTR ACTRN12621000801819. Registered on 07 April 2021.

Outcomes in PEERS® for Adolescents Across Neurodevelopmental Disorders: ADHD, Autism, and Their Co-occurrence

ObjectivesAutistic individuals and those diagnosed with ADHD are at greater risk for social difficulties, with evidence suggesting that the co-occurrence of these neurodevelopmental disorders may further exacerbate social challenges. Though social skill interventions have strong empirical support in autistic populations, fewer evidence-based social skill interventions for adolescents with ADHD exist. Further, the impact of co-occurring autism and ADHD diagnoses on social skill treatment response is unknown. This study aimed to investigate the comparative efficacy of the evidence-based PEERS® for Adolescents social skills intervention in adolescents with ADHD, autistic adolescents, and adolescents with co-occurring ADHD and autism.MethodsAdolescents (N = 144; ADHD, n = 43; Autism, n = 60; ADHD + Autism, n = 41) and their parents participated in PEERS® for Adolescents and completed questionnaires on social functioning at pre- and post-intervention. PEERS® for Adolescents is a 16-week, parent-assisted social skills intervention that teaches ecologically valid skills related to making and keeping friends as well as handling conflict and rejection in peer relationships.ResultsAt baseline, a MANCOVA revealed significant differences in social behavior by diagnostic group (ADHD, Autism, ADHD + Autism), F(10,218) = 3.60, p < .001. However, in a repeated measures MANCOVA, no significant differences in treatment response following PEERS® for Adolescents across diagnostic groups emerged, F(10,214) = 1.34, p = .209. As a whole, participants significantly improved across all assessed outcomes.ConclusionResults suggest that adolescents with ADHD, with or without a co-occurring autism diagnosis, benefit from the novel extension of PEERS® for Adolescents, showing improved social skill proficiency and decreased problem behaviors.

Large increase in ASD prevalence in Israel between 2017 and 2021.

Accurate estimation of annual changes in autism spectrum disorders (ASD) prevalence is critical for planning the expansion of diagnostic, education, and intervention services at an adequate rate. Previous studies from Israel have reported that ASD prevalence among 8-year-old children has increased from estimates of 0.3% in 2008 to 0.65% in 2015 and 1.3% in 2018. Here, we analyzed data acquired from the National Insurance Institute of Israeli (NII), a governmental organization that approves and monitors all ASD children who receive welfare services in Israel, and Clalit Health Services (CHS), the largest Health Maintenance Organization in Israel that provides health services to ~52% of the population. Data from both sources included annual data files from 2017 to 2021 containing the number of ASD cases per year of birth for 1-17-year-old children. This allowed us to estimate annual ASD prevalence among 3.5 million children born between 2000 and 2020 in Israel. Both data sources revealed a nearly two-fold increase in ASD prevalence among 1-17-year-old children from 2017 to 2021. Estimated prevalence rates differed across age groups with 2-3-year-old (day-care) children increasing from 0.27% to 1.19% (>4 fold change), 4-6-year-old (pre-school) children increasing from 0.8% to 1.83%, and 8-year-old children increasing from 0.82% to 1.56% in NII data. These results demonstrate that autism prevalence continues to increase in Israel with a shift towards diagnosis at earlier ages. These findings highlight the challenge facing health and education service providers in meeting the needs of a rapidly growing autism population.

Analysis of Media Image of Autism Patients in Social Media

Autism is a neurodevelopmental disorder with unclear pathogenesis, characterized mainly by social disorders and repetitive stereotypical behaviors, often accompanied by ADHD, sleep disorders, or gastrointestinal problems. In recent years, the incidence rate of autism worldwide has increased at an alarming rate. The general public lacks a comprehensive understanding of the autism population, resulting in biases, discrimination, and stigmatization. Social media has played an important role in accurately presenting and shaping the image of autism for the public, greatly affecting the social situation of patients. In the study, content analysis is used in the study to get the data. 32 previous papers are selected from CNKI and foreign websites to analyse in this study. The time span for selecting samples is from 2009 to 2022 and the samples are mainly about stigmatization, stereotypes, and media image of autism. Through the analyse, media images on autism generally exhibit negatively and are generally one-sided, mostly drifting between the polarization of "genius" and "idiot".

Cortical morphological networks for profiling autism spectrum disorder using tensor component analysis.

Atypical neurodevelopmental disorders such as Autism Spectrum Disorder (ASD) can alter the cortex morphology at different levels: (i) a low-order level where cortical regions are examined individually, (ii) a high-order level where the relationship between two cortical regions is considered, and (iii) a multi-view high-order level where the relationship between regions is examined across multiple brain views. In this study, we propose to use the emerging multi-view cortical morphological network (CMN), which is derived from T1-w magnetic resonance imaging (MRI), to profile autistic and typical brains and pursue new ways of fingerprinting 'cortical morphology' at the intersection of 'network neuroscience'. Each CMN view models the pairwise morphological dissimilarity at the connection level using a specific cortical attribute (e.g., thickness). Specifically, we set out to identify the inherently most representative morphological connectivities shared across different views of the cortex in both autistic and normal control (NC) populations using tensor component analysis. We thus discover the connectional profiles of both populations shared across different CMNs of the left and right hemispheres, respectively. One of the most representative morphological cortical attributes for assessing the abnormal brain structures in patients with ASD is cortical thickness. The most representative morphological connectivities in multi-view CMN population of normal control and ASD subjects, respectively, and in both left and right hemispheres within the temporal, frontal, and insular lobes of individuals with ASD. These representative connectivities are corresponded to specific clinical features observed in individuals with ASD.

“There’s No Separating My View of My Body from My Autism”: A qualitative study of positive body image in autistic individuals

While scholars have investigated positive body image across diverse populations, extant theory largely excludes those with differing socio-cognitive experiences, such as autistic individuals. Using constructivist grounded theory, this study sought to develop a grounded theory of positive body image in autistic individuals. One-to-one interviews with photo-elicitation were conducted with 20 autistic adults (7 women, 8 men, 5 non-binary/agender; aged 18–53 years) from the United Kingdom. Through a process of open, axial, and focused coding, a grounded theory was developed around a core category of positive body image in autistic adults and was found to comprise six themes: body connection, body acceptance, appreciating body functionality and neurodivergent strengths, having a body-positive protective filter, taking care of the body, and body and appearance neutrality. Our findings suggest that some aspects of positive body image in autistic individuals are consistent with those found in neurotypical adults. However, positive body image in autistic individuals further encompasses both the sensory (i.e., how the body is felt) and aesthetic (i.e., how the body is seen) body. These findings may stimulate research aimed at improving positive body image in autistic populations.

Autism impairs face perception? Opposite associations between different subclusters of autistic traits and illusory face detection

ABSTRACT Despite common beliefs about facial processing deficits in autism, many studies have failed to confirm qualitative impairments. Individual differences within the autistic population are likely key confounding factors. The dichotomy of the Autism Spectrum Quotient (AQ) has been recognized in psychometric literature among subclinical and clinical population, enabling large-sample research on how heterogeneous autistic traits affect face perception. Here we innovatively used face pareidolia, the illusion of seeing faces in non-face objects, to investigate how different autistic traits affect face perception. Our results showed that higher AQ-social scores (social and communication aspects) were linked to a lower likelihood of seeing illusory faces, while higher AQ-attention-to-detail scores (rigidity and pattern aspects) increased susceptibility to face pareidolia. A mediation model revealed that imagination mediates the relationship between autistic traits and face perception, suggesting diverse mechanisms in autism's impact on face-related processes.

Estimating life expectancy and years of life lost for autistic people in the UK: a matched cohort study

Previous research has shown that people who have been diagnosed autistic are more likely to die prematurely than the general population. However, statistics on premature mortality in autistic people have often been misinterpreted. In this study we aimed to estimate the life expectancy and years of life lost experienced by autistic people living in the UK. We studied people in the IQVIA Medical Research Database with an autism diagnosis between January 1, 1989 and January 16, 2019. For each participant diagnosed autistic, we included ten comparison participants without an autism diagnosis, matched by age, sex, and primary care practice. We calculated age- and sex-standardised mortality ratios comparing people diagnosed autistic to the reference group. We used Poisson regression to estimate age-specific mortality rates, and life tables to estimate life expectancy at age 18 and years of life lost. We analysed the data separately by sex, and for people with and without a record of intellectual disability. We discuss the findings in the light of the prevalence of recorded diagnosis of autism in primary care compared to community estimates. From a cohort of nearly 10 million people, we identified 17,130 participants diagnosed autistic without an intellectual disability (matched with 171,300 comparison participants), and 6450 participants diagnosed autistic with an intellectual disability (matched with 64,500 comparison participants). The apparent estimates indicated that people diagnosed with autism but not intellectual disability had 1.71 (95% CI: 1.39-2.11) times the mortality rate of people without these diagnoses. People diagnosed with autism and intellectual disability had 2.83 (95% CI: 2.33-3.43) times the mortality rate of people without these diagnoses. Likewise, the apparent reduction in life expectancy for people diagnosed with autism but not intellectual disability was 6.14 years (95% CI: 2.84-9.07) for men and 6.45 years (95% CI: 1.37-11.58 years) for women. The apparent reduction in life expectancy for people diagnosed with autism and intellectual disability was 7.28 years (95% CI: 3.78-10.27) for men and 14.59 years (95% CI: 9.45-19.02 years) for women. However, these findings are likely to be subject to exposure misclassification biases: very few autistic adults and older-adults have been diagnosed, meaning that we could only study a fraction of the total autistic population. Those who have been diagnosed may well be those with greater support needs and more co-occurring health conditions than autistic people on average. The findings indicate that there is a group of autistic people who experience premature mortality, which is of significant concern. There is an urgent need for investigation into the reasons behind this. However, our estimates suggest that the widely reported statistic that autistic people live 16-years less on average is likely incorrect. Nine out of 10 autistic people may have been undiagnosed across the time-period studied. Hence, the results of our study do not generalise to all autistic people. Diagnosed autistic adults, and particularly older adults, are likely those with greater-than-average support needs. Therefore, we may have over-estimated the reduction in life expectancy experienced by autistic people on average. The larger reduction in life expectancy for women diagnosed with autism and intellectual disability vs. men may in part reflect disproportionate underdiagnosis of autism and/or intellectual disability in women. Dunhill Medical Trust, Medical Research Council, National Institute for Health and Care Research, and the Royal College of Psychiatrists.

Effectiveness of primary care psychological therapy services for treating depression and anxiety in autistic adults in England: a retrospective, matched, observational cohort study of national health-care records

Autistic adults report a higher prevalence of anxiety and depression than adults without identified autism but have poorer access to appropriate mental health care. Evidence-based psychological therapies are recommended in treatment guidelines for autistic adults, but no study has investigated their effectiveness in large samples representative of the autistic population accessing routine care. This study aimed to examine therapy outcomes for autistic adults in a primary care service. In this retrospective, matched, observational cohort study of national health-care records, we used the MODIFY dataset that used linked electronic health-care records, including national data, for individuals who accessed psychological therapy in primary care in Improving Access to Psychological Therapies (IAPT) services in 211 clinical commissioning group areas in England, UK. All adults aged 18 years or older who had completed a course of IAPT in 2012-19 were eligible, and were propensity score matched (1:1) with a comparison group without identified autism. Exact matching was used, when possible, for a range of sociodemographic factors. Primary outcomes were routine metrics that have been nationally defined and used to evaluate IAPT treatments: reliable improvement, reliable recovery, and reliable deterioration. Secondary outcomes were calculated pre-post treatment changes in scores for Patient Health Questionnaire-9, Generalised Anxiety Disorder Assessment-7, and Work and Social Adjustment Scale measures. Subgroup analyses investigated differential effects across a range of sociodemographic factors. Of 2 515 402 adults who completed at least two sessions of IAPT in 2012-19, 8761 had an autism diagnosis (5054 [57·7%] male and 3707 [42·3%] female) and 1 918 504 did not (631 606 [32·9%] male and 1 286 898 [67·0%] female). After propensity score matching, 8593 autistic individuals were matched with an individual in the comparison group. During IAPT treatment, symptoms of depression and generalised anxiety disorder decreased for most autistic adults, but symptoms were less likely to improve in the autism group than in the comparison group (4820 [56·1%] of 8593 autistic adults had reliable improvement vs 5304 [61·7%] of 8593 adults in the matched group; adjusted odds ratio [ORadj] 0·75, 95% CI 0·70-0·80; p<0·0001) and symptoms were more likely to deteriorate (792 [9·2%] vs 619 [7·2%]; ORadj 1·34, 1·18-1·48; p<0·0001). In the comparison group, improved outcomes were associated with employment and belonging to a higher socioeconomic deprivation category, but this was not the case for autistic adults. Evidence-based psychological therapy for depression or anxiety might be effective for autistic adults but less so than for adults without identified autism. Treatment moderators appear different for autistic individuals, so more research is needed to allow for better targeted and personalised care. Alzheimer's Society.

Toward a strengths-based model for designing virtual reality learning experiences for autistic users.

Virtual reality has been studied for its potential in supporting individuals with autism, but existing research often focuses on deficits and lacks consideration of individual preferences and strengths. This article introduces a framework that emphasizes the strengths and abilities of autistic individuals when designing virtual reality interventions. It builds upon an existing taxonomy of educational technology affordances and extends it to align with the unique needs of autistic individuals. The framework provides guidance for incorporating virtual reality technology that supports and amplifies autistic strengths, such as visual perception and response to positive feedback. The framework has implications for practice, research, and policy. For practitioners, it offers a tool for designing virtual reality experiences that cater to the strengths of autistic individuals, enhancing engagement and educational outcomes. Researchers can utilize the framework to guide the development of user-centered virtual reality interventions and expand our understanding of the potential benefits of virtual reality for autistic populations. Policymakers and educators can consider this framework when incorporating virtual reality into educational settings, ensuring that virtual reality technology is used in a way that aligns with the strengths and needs of autistic learners. Overall, the framework promotes a strengths-based approach in utilizing virtual reality technology for individuals with autism, fostering inclusivity and maximizing the benefits of immersive experiences.

Short report: Initial pilot of a brief career development program for autistic young adults

BackgroundMany autistic young adults may struggle to progress to further education or employment after high school, highlighting the need for tailored career development programs. If provided with the proper resources and support, the obstacles faced by autistic youth in pursuing post-secondary activities may decrease. AimsThis pilot study aimed to examine the feasibility and preliminary efficacy of a brief career development program consisting of a strengths and challenges intervention paired with a 12-week workshop intervention. Methods and proceduresWe studied the participants' changes in confidence and participation in pursuing post-secondary activities using a series of questionnaires in 20 participants, ages 16–23. The Myers-Briggs Type Indicator (MBTI) and Strong Interest Inventory (SII) helped the participants choose a post-secondary path. The 1–9 Vocational Index Scale measured post-secondary participation and hours working in a normed fashion. The Confidence Index Interval: Entering Workforce measured the participants’ perceived confidence related to career transition. Outcomes and resultsOur results suggested that a brief career development program paired with a strengths and challenges intervention significantly increased post-secondary involvement in autistic young adults (N = 20, p = 0.014). There were no significant changes in confidence. Conclusions and implicationsThese findings provide proof of concept of a brief career development program using the MBTI and SII in young adults with ASD. What this paper addsResearch in career development and transition for autistic young adults reveals that career interventions specific to the autistic population are lacking. Our pilot study explores a new type of intervention that incorporates the analysis of personal strengths and challenges with a 12-week transition workshop. Our project is the first to utilize the MBTI and SII as a tool to guide autistic youth in choosing a post-secondary path. The results of our study suggest that our program significantly improves post-secondary participation in autistic young adults. The findings provide proof of concept of using the MTBI and SII with a 12-week workshop for autistic young adults. At the end of our program, several participants began pursuing post-secondary education on track to obtain associate’s (N = 8) or bachelor’s (N = 3) degrees. Some began trade school (N = 3) and internships (N = 2), and others began employment or onboarding to employment (N = 4). Given the need for more evidence-based career interventions for autistic adults, our pilot study contributes significantly to autism research to better serve the autistic population.

Longitudinal Associations Between Autistic Traits, Self-compassion, Anxiety and Depression in Autistic and Non-autistic Adults Without Intellectual Disability

PurposePrevious cross-sectional research suggests self-compassion may mediate associations between autistic traits and mental health in autistic and non-autistic adults. However, no research to date has examined these relationships longitudinally. In this study, we used a cross-lagged panel analysis to examine correlations over time between autistic traits, self-compassion, and anxiety/depression.MethodsParticipants were from the UK and included autistic (n = 228 at T1, n = 156 at T2, and n = 165 at T3) and non-autistic adults (n = 228 at T1, n = 122 at T2, and n = 124 at T3) without intellectual disability. Participants were recruited through an online participation platform and completed demographics, the Autism Spectrum Quotient (AQ), the Self-Compassion Scale (SCS), and the Hospital Anxiety and Depression Scale (HADS) at baseline (T1), 6 months (T2), and 12 months (T3).ResultsIn the autistic sample, negative correlations were observed between self-compassion and subsequent anxiety/depression across all models and timepoints, and these relationships were not reciprocal (i.e., earlier depression and anxiety did not predict future self-compassion). In the non-autistic sample, the findings generally suggested bi-directional relationships between self-compassion and anxiety/depression. In both groups, an indirect pathway between T1 autistic traits and T3 anxiety/depression via T2 self-compassion was confirmed.ConclusionConsidering the high prevalence of anxiety and depression among autistic people, and that self-compassion can be cultivated through practice, these findings suggest that self-compassion could be a useful therapeutic target to promote mental health in the autistic population.

Challenges and opportunities for conceptualizing intuitive eating in autistic people.

Although intuitive eating (IE) has become an increasingly adopted intervention target, current conceptualisations of IE have yet to pivot away from (neuro)normative physiology and phenomenology. Autistic individuals commonly report disordered eating behaviours and/or poorer well-being but appear to benefit from adaptive interventions using an affirmative approach. This article uses autism as a case example to summarise challenges related to IE's prevailing conceptualisation, before proposing how future research and current practice can be extended to the autistic population. Scholars are encouraged to evaluate the full 10-principal IE framework while utilising a participatory-led approach. We argue that research using a mixed methods design is urgently needed to comprehensively explore the (re)conceptualisation of IE in autistic people. While IE shows promise for producing positive outcomes in the autistic population, we discuss the potential challenges for research and practice due to its current emphasis on accurate interoception, emotional awareness and processing, and executive functioning. This suggests the need for research and practice to integrate autistic needs and experiences into future developments with an affirmative approach. Public Significance: IE is an effective intervention for reducing disordered eating behaviours. Autistic individuals commonly present disordered eating behaviours and have unique nutritional needs which often require intervention. However, there is limited understanding of IE among the autistic population. Research-informed definitions involving autistic perspectives will support translating the IE framework to this underrepresented population.

Metabolomic biomarkers in autism: identification of complex dysregulations of cellular bioenergetics.

Autism Spectrum Disorder (ASD or autism) is a phenotypically and etiologically heterogeneous condition. Identifying biomarkers of clinically significant metabolic subtypes of autism could improve understanding of its underlying pathophysiology and potentially lead to more targeted interventions. We hypothesized that the application of metabolite-based biomarker techniques using decision thresholds derived from quantitative measurements could identify autism-associated subpopulations. Metabolomic profiling was carried out in a case-control study of 499 autistic and 209 typically developing (TYP) children, ages 18-48 months, enrolled in the Children's Autism Metabolome Project (CAMP; ClinicalTrials.gov Identifier: NCT02548442). Fifty-four metabolites, associated with amino acid, organic acid, acylcarnitine and purine metabolism as well as microbiome-associated metabolites, were quantified using liquid chromatography-tandem mass spectrometry. Using quantitative thresholds, the concentrations of 4 metabolites and 149 ratios of metabolites were identified as biomarkers, each identifying subpopulations of 4.5-11% of the CAMP autistic population. A subset of 42 biomarkers could identify CAMP autistic individuals with 72% sensitivity and 90% specificity. Many participants were identified by several metabolic biomarkers. Using hierarchical clustering, 30 clusters of biomarkers were created based on participants' biomarker profiles. Metabolic changes associated with the clusters suggest that altered regulation of cellular metabolism, especially of mitochondrial bioenergetics, were common metabolic phenotypes in this cohort of autistic participants. Autism severity and cognitive and developmental impairment were associated with increased lactate, many lactate containing ratios, and the number of biomarker clusters a participant displayed. These studies provide evidence that metabolic phenotyping is feasible and that defined autistic subgroups can lead to enhanced understanding of the underlying pathophysiology and potentially suggest pathways for targeted metabolic treatments.