Non-autistic Peers Research Articles

Self-regulation skills and prosocial behaviours in preschool children with and without autism

Objectives The purpose of this study was to examine the self-regulation skills and prosocial behaviours of children on the autism spectrum (AS) and their non-autistic (NA) peers of the same chronological age. For this purpose, self-regulation skills and prosocial behaviours of children on the AS and NA children were compared, and the relationships between self-regulation skills and prosocial behaviours in both groups were examined. Methods To measure self-regulation skills, Self-Regulation Skills Scale for 4–6-Year-Old Children was used. To measure prosocial behaviours, prosocial sub-domain of Strengths and Difficulties Questionnaire was used. All measures were based on mother reports. Results Findings showed that (a) there were significant differences between groups in both self-regulation skills and prosocial behaviours, (b) there were moderately positive relationships between self-regulation skills and prosocial behaviours in both groups, and (c) self-regulation was a significant predictor of prosocial behaviours in both children on the AS and their NA peers. Conclusions This study shows that children on the AS and their NA peers differ in both self-regulation skills and prosocial behaviours in preschool years. Self-regulation is positively correlated with, and an important predictor of prosocial behaviours. Supporting self-regulation skills can be an important facilitator for preschoolers on the AS to develop prosocial skills which are important for both academic achievements and social skills. Further research examining other variables which may be effective on prosocial behaviours, such as language, educational experience, and symptom severity are needed.

The Feasibility of Occupation-Based Coaching for Autistic Children and Primary Caregivers.

Autistic children participate less and have fewer opportunities to develop participation skills than nonautistic peers. The extent to which occupation-based coaching (OBC), a metacognitive strategy training intervention, affects participation in school-age autistic children is unknown. We conducted a single-group pretest-posttest design to evaluate the feasibility and preliminary effect of telehealth OBC for autistic children (n = 13) and primary caregivers (n = 12). Participants completed eight telehealth OBC sessions to address activity-based goals; they completed child, caregiver, and family outcomes pre- and post-intervention. Recruitment, retention, caregiver measure completion, and intervention adherence rates exceeded feasibility benchmarks. OBC had large effects on child performance (Hedge's g = 1.65) and satisfaction (Hedge's g = 1.89), a moderate effect on child sleep disturbance (Hedge's g = 0.60), and small effects on child participation (Hedge's g = 0.23) and family quality of life (Hedge's g = 0.26). Further research in a large-scale study is warranted with changes to better support child measure completion and enhance the study protocol.

“You Don’t ‘Just Know’”: Difficulties in Determining Desire, Recognizing Trauma, and Accessing High-Quality Sexual Education in Neurodiverse Young Adults

Prior literature has indicated that autistic students report unsatisfactory sexual education experiences and may also be at greater risk of both sexual assault victimization and perpetration than non-autistic peers. Current mixed methods findings combine data from two related studies to explore satisfaction with sexual education among autistic and non-autistic college students. Findings support hypotheses that autistic students are less satisfied with consent education than non-autistic peers. Qualitatively, a theme of difficulties in identifying one’s own desire to consent was observed across groups. Within the autistic group, a theme of delayed recognition of sexual assault was observed. Findings support the importance of early and comprehensive sexual education and suggest further attention may be needed to support students in navigating healthy sexual decision-making.

Participatory longitudinal qualitative interview study to understand Autistic gynaecological and obstetric health: the Autism from menstruation to menopause study protocol

IntroductionAutism is a lifelong minority neurotype present from birth. There is a dearth of credible evidence to suggest gender variation in Autism prevalence, despite historical under-diagnosis of women. Autistic people...

Trait and state mathematics anxiety in autistic and non-autistic school-aged boys.

Autistic children and adolescents may encounter difficulties at school, especially in mathematics, experiencing a pattern of negative feelings, distress, and concerns, which has been called mathematics anxiety. We asked 110 boys (50 autistic, 60 non-autistic) aged between 8 and 16 years old to report their feelings toward mathematics. Specifically, we asked them to fill in a questionnaire on their levels of mathematics anxiety at school and to report their emotional (valence, arousal) and cognitive (perception of competence, worries) responses before and after completing a mathematical task with time pressure. Mathematics anxiety might be an important factor to consider when assessing academic functioning of autistic children and adolescents, to understand whether it can interfere with their school success and well-being. In our sample, no significant group differences emerged for mathematics anxiety experienced at school. However, autistic children and adolescents performed worse in the timed math test than non-autistic peers. Regarding emotional and cognitive factors, lower valence, higher arousal, and higher worries were reported by the autistic participants compared with non-autistic peers. No group differences emerged for perception of competence. Teachers and clinicians should be aware that time pressure could be a negative factor in terms of proficiency and worries in autistic children and adolescents. Furthermore, it is essential to discourage the development of resignation toward academic learning and to improve positive feelings, self-esteem, and self-awareness for a more supportive learning environment.

Browsing problematic social media use in autism spectrum disorder: The role of social anxiety

Accessing the Internet is one of the most frequent free-time activities among autistic and non-autistic adolescents. Autistic individuals may experience communicative benefits from using the Internet. However, they may also be at risk of developing Problematic Social Media Use (PSMU). To date, PSMU in autistic adolescents remains underinvestigated, and no research, has analyzed the role of emotional correlates. The present study aims to investigate possible differences in terms of PSMU comparing autistic participants to their non-autistic peers, and examine the role of two dimensions of social anxiety (i.e., humiliation/refusal and performance anxiety) as reported by both children and parents in worsening the levels of PSMU. A total of 183 participants (76 on the autism spectrum), aged (8–17 years) participated in the study. Questionnaires on social media use and on social anxiety were administered. Moreover, parents’ participants were asked to complete a questionnaire related to their children’s social anxiety. Results showed similar levels of PSMU across the two groups. However, a different pattern of relationships between PSMU and age, and the two dimensions of social anxiety was observed in autistic adolescents as compared to the non-autistic peers, revealing that individual characteristics and specific social anxiety beliefs might be relevant to understanding PSMU in autism. The clinical and preventive implications of these findings are discussed.

Spatial Perspective Taking in Non-Autistic Children and Autistic Children: Do Social Processes Benefit or Obstruct?

ABSTRACT The present study investigated whether the presence of another person in a visuospatial perspective taking (VSPT) paradigm would influence the performance of non-autistic and autistic children. Experiment 1 tested non-autistic children aged 5–7 (N = 82, 42 girls) in a self-condition (pure spatial updating of self-mental rotation) and an other-condition (taking another agent’s perspective). Experiment 2 compared 18 autistic children (3 girls, aged 7.17–14.33 years old) and 22 mental ability-matched non-autistic peers (10 girls, M age = 6.82). Both experiments were conducted in mainland China with Chinese participants. Non-autistic children below 7 years of age and autistic children performed better in the self-condition than in the other-condition, especially when angular disparities were greater than 90°, while no such differences were observed in 7-year-old non-autistic children. The interaction between perspective and angular disparity indicated the interference of another agent’s presence in typical VSPT tasks from a developmental perspective. The results were discussed with regard to the nonsynchronous development of spatial and social ability involved in the VSPT paradigm and its implications for the purity of VSPT as a measure of spatial ability.

Neuronormativity, naturalism and the neurotypical gaze: the equating of neurotypicality and quality in actor training

Neuroinclusion in performer training is an emerging area of research, with work being published on the needs of particular neurominority groups and on general neuroinclusive practice. Similarly, discussions on inclusive performer training have advanced rapidly in recent years; including those around decolonisation and interculturalism in actor training. This paper explores some of the findings of my doctoral research, in which I conducted interviews with autistic participants currently studying in drama schools. One key finding from this research concerns the effect of neuronormativity on the autistic student-actor, whose socio-emotional reality may look different to that of their non-autistic peers. This is particularly present in naturalistic and Stanislavskian techniques which have focuses on ‘realistic’, ‘truthful’ or ‘authentic’ performances, but also permeates more broadly into ideas of what ‘good acting’ looks like. In this paper, I place autistic students’ descriptions of their training in conversation with others’ work about inclusion within actor training to draw parallels between neuronormativity and other normative power structures. I frame these findings with ideas of the ‘Neurotypical Gaze’ (McDermott 2022) to articulate how ‘legibility’ of emotional expression operates within actor training. I draw on ideas of autistic culture and practical explorations to propose how practice can be improved.

Seeing it in others versus doing it yourself: Social desirability judgements and conversation production data from autistic and non-autistic children.

During a conversation, on average, autistic individuals are often more likely than non-autistic people to provide an off-topic comment and/or to pause for longer before providing a response. One possible explanation for this is that autistic individuals prefer, or are more tolerant of, unconventional communication styles. To explore this possibility, we investigated whether autistic and non-autistic 9-13-year-olds find off-topic or delayed responding a deterrent to friendship or interaction. Participants listened to scripted conversations and then rated social desirability statements, such as 'I would enjoy chatting to the [target speaker]'. We also examined the prevalence of these behaviours in children's own conversational responses. We found that autistic children were just as likely as non-autistic children to dis-prefer unconventional conversational responding. Both groups indicated that they were less likely to want to be friends with the speaker, or to chat with them, when they provided off-topic or delayed responses. However, despite their judgements of others, the same autistic children were more likely to provide off-topic responses themselves than their non-autistic peers, as well as giving fewer on-topic responses which facilitate back-and-forth conversation. Overall, this is problematic for autistic children, as our findings suggest that the tendency to exhibit unconventional conversational behaviours will have negative social consequences, even when interacting with other autistic peers.

LEGO®-Based Therapy in School Settings for Social Behavior Stimulation in Children with Autism Spectrum Disorder: Comparing Peer-Mediated and Expert Intervention.

LEGO®-based therapy is a social development protocol that uses LEGO® activities to support the development of a wide range of interaction skills, enhancing prosocial behaviors and mitigating the challenges associated with mental health difficulties and behavioral issues commonly observed in children with autism spectrum disorder (ASD). This study aimed to explore the effects of LEGO®-based therapy on the social behavior and mental health of children with ASD, comparing stimulation mediated by expert and stimulation mediated by non-autistic peers. This study was approved by the Ethical Committee at Mackenzie Presbyterian University, ensuring adherence to ethical standards throughout the research process. This study involved 18 children with ASD, levels 1 or 2, with an intelligence quotient (IQ) above 70, and three typically developing peers, intelligence quotient (IQ) above 80, aged between 5 and 8 years old, of both sexes. Participants were randomized into three groups for stimulation (stimulation mediated by expert, by a non-autistic peer and control group). The measures were the Wechsler Abbreviated Scale of Intelligence, the Strengths and Difficulties Questionnaire (parent and teacher versions), the Inventory of Difficulties in Executive Functions, Regulation, and Aversion to Delay-Child Version, the Developmental Coordination Disorder Questionnaire, the Autism Behavior Checklist, and the Autistic Behavior Inventory. After 14 sessions of 45 min in school settings, the participants of both groups (mediated by experts and non-autistic children) showed significant gains on social behavior. A statistically significant difference was observed between baseline sessions and probes (χ2 (5) = 25.905, p < 0.001). These gains were maintained in both follow-up points, 30 and 90 days after the completion of the stimulation sessions. Additionally, maladaptive behavior showed a significant decline when compared pre- and post-intervention. These improvements were sustained during follow-up assessments at 30 and 90 days. The results suggest that a structured intervention combined with peer-mediated stimulation may be an effective method for promoting adaptive and prosocial behaviors in children with ASD.

Daily living skill support for autistic people through a neurodiversity-affirming practice lens.

Supporting daily living skill (DLS) development for autistic people is a component of occupational therapy practice. DLSs are essential for an increased quality of life (QoL), independent living, and community participation. Autistic young people experience poorer outcomes in terms of QoL and independent living than non-autistic peers. Finding a balance between targeted DLS support to maximise independent living and improve QoL, while avoiding attempts to 'normalise' or 'change' autistic people, presents as a dilemma for therapists striving to align with neurodiversity-affirming practice. This theoretical paper explored literature pertaining to DLS and the neurodiversity movement in the context of occupational therapy values and the Canadian Model of Occupational Participation. Consideration of whether targeted DLS support is neurodiversity-affirming or whether occupational therapists are compelling autistic people to mimic behavioural norms perceived by society was discussed. DLSs are an important factor for maximising QoL, regardless of neurotype. Occupational therapy values align with the core tenets of the neurodiversity movement, and occupational therapists are equipped with the values and skills to support the development of DLSs utilising affirming practice. Occupational therapists should critically reflect on their practice to ensure alignment with the professions core values and recent occupational therapy models, to ensure affirming practice. Further research investigating DLS and neurodiversity-affirming practice would benefit occupational therapists striving to align with neurodiversity-affirming practice. No consumer or community involvement. Consumers have been considered throughout the development of this paper through their representation in the literature. This involved a process of reviewing the literature and considering it in the scope of the questions and how occupational therapy sits within the neurodiversity movement. It is important to help autistic people to learn to do everyday things. Everyday things include activities like showering, cleaning, and cooking. These things are important so that autistic people can live on their own. It has shown that autistic young people are less likely to be able to do everyday activities on their own. It is important that therapists help autistic people learn how to do everyday things; however, do not try and change who they are. This is because completing everyday activities is an important part of QoL for all people.

The Relation of Linguistic Awareness Skills to Reading and Spelling for Autistic and Non-Autistic Elementary School-Age Children.

For non-autistic children, it is well established that linguistic awareness skills support their success with reading and spelling. Few investigations have examined whether these same linguistic awareness skills play a role in literacy development for autistic elementary school-age children. This study serves as a first step in quantifying the phonological, prosodic, orthographic, and morphological awareness skills of autistic children; how these skills compare to those of non-autistic children; and their relation to literacy performance. We measured and compared the phonological, prosodic, orthographic, and morphological awareness skills of 18 autistic (with average nonverbal IQs) and 18 non-autistic elementary school-age children, matched in age, nonverbal IQ, and real-word reading. The relations between linguistic awareness and the children's word-level literacy and reading comprehension skills were examined, and we explored whether the magnitude of these relations was different for the two groups. Regression analyses indicated the relative contribution of linguistic awareness variables to performance on the literacy measures for the autistic children. The non-autistic children outperformed the autistic children on most linguistic awareness measures. There were moderate-to-strong relations between performances on the linguistic awareness and literacy measures for the non-autistic children, and most associations were not reliably different from those for the autistic children. Regression analyses indicate that the performance on specific linguistic awareness variables explains unique variance in autistic children's literacy performance. Although less developed than those of their non-autistic peers, the linguistic awareness skills of autistic elementary school-age children are important for successful reading and spelling.

Routine vaccine uptake in school-aged autistic and non-autistic youth: A linked database study.

This study was conducted to determine whether school-aged autistic youth received routine vaccines at a lower rate than their non-autistic peers. In Nova Scotia (NS), Canada, vaccines routinely delivered in early adolescence are administered to Grade 7 students through a school-based Public Health vaccination program. NS youth eligible to receive Grade 7 vaccinations between 2011 and 2017 were included in this study. Autism spectrum disorder (ASD) diagnoses were determined from administrative health data. Rates of receipt of any Grade 7 vaccine and of individual vaccines were compared between autistic and non-autistic youth. Subgroup analyses included comparing Grade 7 vaccine receipt between autistic youth and their non-autistic siblings and early childhood vaccine receipt between autistic and non-autistic cohorts. The rates of receipt of any vaccine were 73% among 916 autistic youth and 82% among 49,599 non-autistic youth (adjusted relative risk = 0.91; 95% confidence interval = 0.87-0.95). Similar results were found for individual vaccines. Subgroup analyses revealed lower rates of Grade 7 vaccine receipt among autistic youth compared to among their non-autistic siblings. Rates of early childhood vaccine receipt did not differ between autistic and non-autistic cohorts. Autistic youth were under-vaccinated compared to their non-autistic peers for Grade 7 vaccinations. Lower vaccination rates in autistic youth than in their non-autistic siblings suggest that setting-related factors may contribute more to the under-vaccination of autistic youth than parental vaccine hesitancy. Barriers to vaccine uptake for school-aged autistic youth, including those unique to school-based vaccination programs, must be explored and addressed.

Disfluencies as a Window into Pragmatic Skills in Russian-Hebrew Bilingual Autistic and Non-Autistic Children

AbstractThere is little research on the production of speech disfluencies such as silent pauses, repetitions, self-corrections, and filled pauses (e.g., eh, em) in monolingual autistic children, and there is no data on this crucial part of speech production in bilingual autistic children. This study aims to address this gap by examining disfluency production in bilingual autistic and non-autistic children across two linguistically distinct languages, HL-Russian (the home language) and SL-Hebrew (the societal language). Fifty-one bilingual Russian-Hebrew-speaking autistic and non-autistic children aged 5–9 (autistic: n = 21; non-autistic: n = 30), matched for age and non-verbal intelligence, participated in picture-based story-generation tasks (LITMUS MAIN, Gagarina et al., ZAS Papers in Linguistics, 63:1–36, 2019). Audio recordings of narrative samples were transcribed, coded, and scored for eleven disfluency types using CLAN tools. The non-autistic group produced higher overall disfluency rate than the autistic group. The autistic group exhibited fewer filled and silent pauses than the non-autistic group in HL-Russian. Furthermore, non-autistic children manifested varied distribution of disfluency types across languages, while autistic children displayed more consistent patterns across languages. In summary, we replicated findings from previous research on monolinguals only partly, as no between-group difference in filled pauses was found in SL-Hebrew. Additionally, bilingual autistic children exhibited language-universal patterns of disfluency production, whereas their non-autistic peers displayed language-specific patterns.

Developmental Impacts of Early Sensory Patterns on School-Age Adaptive, Maladaptive, and Participation Outcomes in Autistic and Non-autistic Children.

Early sensory differences may cascade into later social-communication difficulties in autism, yet their impacts on broader functional outcomes have remained understudied. This study aimed to conduct a comprehensive investigation into the longitudinal impacts of sensory patterns, including sensory hyperresponsiveness, hyporesponsiveness, and sensory repetitions/seeking behavior, on various school-age outcome domains among a community sample of children with autistic and non-autistic conditions. We prospectively followed 1,517 children with caregiver-reported sensory questionnaires across three timepoints from infancy to school age. A subsample (n = 389; 88 with reported autism diagnosis/concerns) was further assessed with adaptive, maladaptive and participation outcome measures at age 6-7. Structural equation modeling approaches were used to evaluate the multivariate associations between latent growth parameters (i.e., intercepts and slopes) of sensory patterns and school-age outcomes. Increasing sensory hyperresponsiveness was directly associated with poorer adaptive/maladaptive outcomes and indirectly with lower participation in activities with higher functional demands across settings at school age. Elevated sensory hyporesponsiveness was associated with lower adaptive functioning, more externalizing problems, and lower classroom participation. Trajectories of sensory patterns accounted for more unique variances in adaptive functioning and participation in daily life settings with higher functional and environmental demands among autistic children compared to their non-autistic peers.

The impact of first impression on non-autistic children’s willingness to interact with autistic peers

The influence of first impressions on non-autistic children’s willingness to interact with autistic peers has not been studied rigorously with an experimental paradigm. Fifty-eight elementary non-autistic children participated in the study. A 2 (diagnosis: autistic children, non-autistic children) × 3 (social cues: face, face-voice, face-behavior) repeated measurement experimental design was conducted to answer the following question: to what extent are non-autistic children willing to interact with autistic peers when they acquire different kinds of social cues from a thin slice? The results showed that participants’ social interaction willingness toward autistic children was significantly lower than that of non-autistic children after short exposure to face and face-voice cues but marginally significantly higher than non-autistic peers after brief exposure to face-behavior cues. Among the three types of stimuli, face-behavior cues had the most significant negative influence on participants’ social interaction willingness toward autistic children, followed by face-voice cues, and the lowest was face cues. This finding implied that autistic children’s facial, vocal, and behavioral features all play roles in forming negative first impressions of them in non-autistic children. Guiding non-autistic children to embrace diversity could help remove the negative first impressions.

Completion of Upper Secondary Mainstream School in Autistic Students in Sweden.

Higher education is an increasingly necessary achievement to attain employment. However, even in cases where a student has the academic skills to succeed, educational environments may not support students across all other domains necessary for education success, including social and communication needs. This is especially true for students with disabilities and autistic students, where the rate of completion of non-compulsory education is unknown. We used the Stockholm Youth Cohort (children aged 0-17 years from 2001 to 2011), a total population cohort (N = 736,180) including 3,918 autistic individuals, to investigate the association between autism without intellectual disability and completion of upper secondary education. We assessed the impact of sex and co-occurring Attention-Deficit/Hyperactivity Disorder (ADHD) on this association. By age 20 years (the expected age of completion), 68% of autistic students and 91% of non-autistic students admitted to upper secondary education had completed. In logistic regression models adjusted for student demographics, autistic students had almost five-fold higher odds of not completing secondary school (OR 4.90, 95% CI 4.56 5.26) compared to their non-autistic peers. Autistic students with ADHD had particularly high odds of non-completion of upper secondary school. Autistic students without intellectual disability attending mainstream education are substantially less likely to complete upper secondary education as compared to their peers. These findings have implications for the appraisal of how inclusive school policies serve autistic students' academic and social needs, ultimately addressing population health and independent living.

Empathy among autistic and non-autistic adolescents: The importance of informant effects.

Empathy is the ability to recognize the emotions of others (cognitive empathy) and to share in those emotions while maintaining a self-other distinction (emotional empathy). Previous research often, but not always, showed that autistic adults and children have lower levels of overall and cognitive empathy than non-autistic individuals. Yet how empathy manifests during adolescence, a developmental period marked by physiological, social, and cognitive change, is largely unclear. As well, we aimed to compare self versus parents' perceptions regarding adolescents' empathy. To do so, parents (N = 157) of 10-16-year-olds (N = 59 autistic) and their children (N = 133) completed empathy questionnaires. Adolescents also completed a measure of mental state recognition (Reading the Mind in the Eyes Test; RMET) and parents reported on their child's autistic traits. The tasks were completed twice ~six months apart. We found that autistic adolescents reported having lower empathic concern and higher personal distress than their non-autistic peers, whereas parents of autistic adolescents perceived them as having overall lower levels of empathy. Performance on the mental state recognition task of autistic and non-autistic adolescents' was comparable. The gap between self and parent reports regarding adolescents' empathy was explainable by parent-reported autistic traits, mainly communication difficulties. Empathy remains stable across the study's two time points. Thus, the findings do not support previous views of autistic people as having less empathy and these are possibly explainable by informant effects.

Diurnal cortisol profiles in autistic adolescents and young adults: Associations with social difficulties and internalizing mental health symptoms.

Several autism-related characteristics, such as social difficulties, may contribute to high perceived stress and increased exposure to stressful life events in some autistic individuals. Repeated exposure to stress might lead to the dysfunction of the hypothalamic-pituitary-adrenocortical-axis and be a vulnerability factor for developing mental health difficulties. Previous studies show contradictory findings on salivary cortisol in autism. In the current study, we investigated diurnal cortisol profiles in autistic adolescents and young adults, as well as their associations with social difficulties, stress exposure, and mental health symptoms. Autistic (n = 48, Mage = 17.6) and nonautistic (n = 51, Mage = 18.4) participants collected salivary cortisol at home six times a day for 2 days. Social difficulties, exposure to stressful life events/bullying, and mental health symptoms were assessed with questionnaires and clinical interviews. Similar diurnal cortisol slopes (DCS) and cortisol awakening responses were observed between the groups, but autistic participants showed higher total cortisol output (AUCG, area under the curve with respect to ground) during the day (b = 19.09, p = 0.009). In the autistic group, more severe social difficulties were associated with flatter DCS (b = 0.01, p = 0.007). Finally, cortisol alterations were associated with self-reported mental health symptoms, especially in autistic females in analyses uncorrected for multiple comparisons. In conclusion, our results do not indicate autism-related group-level alterations in most diurnal cortisol measures, but autistic youth showed higher total cortisol (AUCG) compared with nonautistic peers. More detailed investigation of interindividual variability in cortisol profiles within autistic people might give us important insights into vulnerability to developing stress-related mental health difficulties.

A systematic review identifying factors associated with emotionally based school non-attendance in autistic children and young people

Aim:Research suggests that autistic children and young people (CYP) are more likely to experience Emotionally Based School Non-Attendance (EBSNA) than their non-autistic peers. As such, this paper aims to explore factors associated with EBSNA behaviours in autistic children and CYPMethod:The paper takes the form of a systematic literature review, in which quantitative research was examined. Eight papers were found that researched factors associated with EBSNA in autistic CYP. These were critically appraised using Cardiff University’s SURE checklist prior to engaging in a narrative synthesis to critically review the findings.Findings:The literature synthesis identified overarching themes that grouped together potential factors associated with EBSNA in autistic CYP: child-based factors (age, social-emotional wellbeing and cognitive factors), family-based factors (parental mental wellbeing, parental employment and family illness) and school-based factors (bullying and transition).Limitations:There was methodological heterogeneity across the studies reviewed, and therefore meta statistical analyses were not performed. This impacts on our ability to make conclusions about the precise impact of the factors identified.Conclusions:A range of factors impact on autistic CYP EBSNA behaviours, and as such a holistic approach needs to be taken when providing support.