Barriers and needs in mental healthcare of adults with autism spectrum disorder in Germany: a qualitative study in autistic adults, relatives, and healthcare providers.

BACKGROUND: Autism refers to a neurodevelopmental condition with characteristic impairments in social interaction and communication, restrictive and repetitive behaviors, as well as difficulties in sensory information processing and daily living skills. Even though symptoms persist from early childhood throughout the lifespan and often require long-term support, there is a lack of mental health services that sufficiently meet the needs of autistic adults. Previous evidence suggested individual, professional and structural barriers to healthcare for autistic adults. Here, using a peer research approach, we sought to systematically investigate barriers and needs in mental healthcare of autistic adults in Germany at the three relevant levels (individual, professional, structural) and from three relevant perspectives (autistic adults, relatives and healthcare providers), in order to obtain specific recommendations for optimized healthcare. METHODS: Maximum variation sampling was used to account for the complexity of the research field. Semi-structured, open-ended interviews were conducted with autistic adults (n = 15) and focus groups with relatives/partners (n = 12), and healthcare providers of several professions (n = 15). Data analysis was performed using the codebook approach of thematic analysis. RESULTS: Poor mental healthcare of autistic adults in Germany was characterized by six central and overarching themes: (i) lack of knowledge about autism, (ii) a need for increased participation/involvement, (iii) consideration of autism-specific needs in treatment, (iv) lack of services, (v) limited access to services, and (vi) improvement of stakeholder collaboration. Themes were similarly reported across participants, emphasizing dissatisfaction in all stakeholders. CONCLUSIONS: We identified major barriers to mental healthcare for autistic adults in Germany that affect autistic adults, but are also of concern to relatives and healthcare providers. Our results point to specific and generic areas for improvement, independent of stakeholder perspectives, which could guide future development of needs- and evidence-based services, recommendations and guidelines of mental healthcare for people with autism across the lifespan. TRIAL REGISTRATION: This study protocol was preregistered at the Open Science Framework ( https://osf.io/5x8pg ).

Perceptual Integration Deficits in Autism Spectrum Disorders Are Associated with Reduced Interhemispheric Gamma-Band Coherence.

The integration of visual details into a holistic percept is essential for object recognition. This integration has been reported as a key deficit in patients with autism spectrum disorders (ASDs). The weak central coherence account posits an altered disposition to integrate features into a coherent whole in ASD. Here, we test the hypothesis that such weak perceptual coherence may be reflected in weak neural coherence across different cortical sites. We recorded magnetoencephalography from 20 adult human participants with ASD and 20 matched controls, who performed a slit-viewing paradigm, in which objects gradually passed behind a vertical or horizontal slit so that only fragments of the object were visible at any given moment. Object recognition thus required perceptual integration over time and, in case of the horizontal slit, also across visual hemifields. ASD participants were selectively impaired in the horizontal slit condition, indicating specific difficulties in long-range synchronization between the hemispheres. Specifically, the ASD group failed to show condition-related enhancement of imaginary coherence between the posterior superior temporal sulci in both hemispheres during horizontal slit-viewing in contrast to controls. Moreover, local synchronization reflected in occipitocerebellar beta-band power was selectively reduced for horizontal compared with vertical slit-viewing in ASD. Furthermore, we found disturbed connectivity between right posterior superior temporal sulcus and left cerebellum. Together, our results suggest that perceptual integration deficits co-occur with specific patterns of abnormal global and local synchronization in ASD. SIGNIFICANCE STATEMENT: The weak central coherence account proposes a tendency of individuals with autism spectrum disorders (ASDs) to focus on details at the cost of an integrated coherent whole. Here, we provide evidence, at the behavioral and the neural level, that visual integration in object recognition is impaired in ASD, when details had to be integrated across both visual hemifields. We found enhanced interhemispheric gamma-band coherence in typically developed participants when communication between cortical hemispheres was required by the task. Importantly, participants with ASD failed to show this enhanced coherence between bilateral posterior superior temporal sulci. The findings suggest that visual integration is disturbed at the local and global synchronization scale, which might bear implications for object recognition in ASD.

The right temporoparietal junction plays a causal role in maintaining the internal representation of verticality.

Perception of the visual vertical is strongly based on our ability to match visual inflow with vestibular, proprioceptive, tactile, and even visceral information that contributes to maintaining an internal representation of the vertical. An important cortical region implicated in multisensory integration is the right temporoparietal junction (rTPJ), which also is involved in higher order forms of body- and space-related cognition. To test whether this region integrates body-related multisensory information necessary for establishing the subjective visual vertical, we combined a psychophysical task (the rod-and-frame test) with transient inhibition of the rTPJ via continuous theta burst stimulation (cTBS). A Gabor patch visual detection task was used as a control visual task. cTBS of early visual cortex (V1-V3) was used to test whether early visual cortices played any role in verticality estimation. We show that inhibition of rTPJ activity selectively impairs the ability to evaluate the rod's verticality when no contextual visual information, such as a frame surrounding the rod, is provided. Conversely, transient inhibition of V1-V3 selectively disrupts the ability to visually detect Gabor patch orientation. This anatomofunctional dissociation supports the idea that the rTPJ plays a causal role in integrating egocentric sensory information encoded in different reference systems (i.e., vestibular and somatic) to maintain an internal representation of verticality.

Susceptibility to the rubber hand illusion does not tell the whole body-awareness story.

The rubber hand illusion (RHI) is an enigmatic illusion that creates a feeling of owning an artificial limb. Enthusiasts of this paradigm assert that it operationalizes bodily self-awareness, but there are reasons to doubt such a clear link. Because little is known about other functional contributions to the RHI, including effects of context-dependent visual processing and cognitive control or the ability to resolve intermodal conflict, we carried out two complementary experiments. In the first, we examined the relationships between the RHI and (1) body awareness, as assessed by the Body Perception Questionnaire (BPQ); (2) context-dependent visual processing, as assessed by the rod-and-frame test (RFT); and (3) conflict resolution, as assessed by the Stroop test. We found a significant positive correlation between the RHI-associated proprioceptive drift and context-dependent visual processing on the RFT, but not between the RHI and body awareness on the BPQ. In the second experiment, we examined the RHI in advanced yoga practitioners with an embodied lifestyle and a heightened sense of their own body in space. They succumbed to the illusion just as much as did yoga-naïve control participants, despite significantly greater body awareness on the BPQ. These findings suggest that susceptibility to the RHI and awareness of one's own body are at least partially independent processes.

Health-related quality of life in family caregivers of autistic adults.

Introduction: Family members of autistic individuals often provide support for their autistic relative throughout the lifespan which can lead to massive burden themselves. Reduced health-related Quality of Life (HRQoL) in family caregivers is assumed; however, only a handful studies on the HRQoL of family caregivers providing care to adult relatives exist as opposed to autistic children. Thus, the current study aimed to (i) investigate the current state of physical and mental HRQoL of family caregivers of autistic adults compared to the general population, and (ii) examine caregiver-related (e.g., age, subjective caregiver burden) and care recipient-related variables (e.g., symptom severity, utilization of formal services) explaining variance in the caregivers' HRQoL. Methods: N = 149 family caregivers completed a nationwide online survey, including the Short-Form Health Survey (SF-8) in order to assess the HRQoL. T-tests were used to compare the HRQoL of family caregivers with the general population. Bivariate correlational and multiple linear regression analyses were conducted in order to identify predictors explaining variance in family caregivers' HRQoL. Results: Family caregivers of autistic adults reported significantly lower physical (M = 46.71, SD = 8.72, Cohen's d = 0.42) and mental HRQoL (M = 40.15, SD = 11.28, Cohen's d = 1.35) compared to the general population. Multiple linear regression with the mental HRQoL as the outcome showed a significant model (F(11, 95) = 5.53, p < .001, adj. R2 = .32) with increased subjective burden explaining most of the variance in mental HRQoL (ß = .32, GDW = .141, p < .001). Multiple linear regression analysis with the outcome physical HRQoL did not reveal a statistically significant model (F(11,95) = 1.09, p = .38). However, bivariate analyses also showed a positive correlation with the subjective caregiver burden (r= .20, p < .05). Discussion: Findings highlight the need to consider HRQoL (and caregiver burden) of family caregivers of autistic adults in several healthcare settings to monitor a potential comprised health status in early stages, with the long-term goal to improve family caregivers' HRQoL.

Mixed-methods investigation of barriers and needs in mental healthcare of adults with autism and recommendations for future care (BarrierfreeASD): study protocol.

INTRODUCTION: Autism refers to an early-onset neurodevelopmental condition with characteristic impairments and difficulties in practical living skills, which persist across the lifespan such that adults with autism often require substantial support and comprehensive care. Yet, mental health and other services are frequently unavailable for adults with autism despite considerable need for mental healthcare and individual, familial and socioeconomic burdens. This study will (1) examine current needs, barriers and burdens related to ineffective healthcare of adults with autism in Germany, (2) develop specific recommendations for a need-oriented mental healthcare model and (3) evaluate its future implementation. METHODS AND ANALYSIS: A mixed-methods design with three phases will be conducted. In phase 1, current mental healthcare for adults with autism will be assessed at three levels (individual, structural and professional) and from three perspectives (adults with autism, relatives and healthcare providers) using (1) focus groups/interviews (qualitative data) and (2) large-scale online surveys (quantitative data). Furthermore, service utilisation and related costs will be estimated. In phase 2, recommendations for a future healthcare model will be derived based on phase 1, considering the heterogeneous and complex needs within the autism spectrum and specifying indications for recommended services. In phase 3, these will again be evaluated by the three stakeholder groups using mixed-methods and analysed regarding feasibility of implementation and cost-effectiveness. Our study will, thus, contribute to a better translation of recommendations into practice to reduce disability, burden and costs related to ineffective healthcare and improve mental health outcomes for adults with autism and those who support them. ETHICS AND DISSEMINATION: This study was approved by the Local Psychological Ethics Commission of the Center for Psychosocial Medicine at the University Medical Center Hamburg-Eppendorf (LPEK-0227). Findings will be disseminated via scientific meetings and peer-reviewed journals. Cooperating partners and associations will be informed about the study's course and findings by regular newsletters and meetings. TRIAL REGISTRATION NUMBER: This study protocol was preregistered at the Open Science Framework (osf.io/5x8pg).

Split Chloramphenicol Acetyl-Transferase Assay Reveals Self-Ubiquitylation-Dependent Regulation of UBE3B.

Split reporter protein-based genetic section systems are widely used to identify and characterize protein-protein interactions (PPI). The assembly of split markers that antagonize toxins, rather than required for synthesis of missing metabolites, facilitates the seeding of high density of cells and selective growth. Here we present a newly developed split chloramphenicol acetyltransferase (split-CAT) -based genetic selection system. The N terminus fragment of CAT is fused downstream of the protein of interest and the C terminus fragment is tethered upstream to its postulated partner. We demonstrate the system's advantages for the study of PPIs. Moreover, we show that co-expression of a functional ubiquitylation cascade where the target and ubiquitin are tethered to the split-CAT fragments results in ubiquitylation-dependent selective growth. Since proteins do not have to be purified from the bacteria and due to the high sensitivity of the split-CAT reporter, detection of challenging protein cascades and post-translation modifications is enabled. In addition, we demonstrate that the split-CAT system responds to small molecule inhibitors and molecular glues (GLUTACs). The absence of ubiquitylation-dependent degradation and deubiquitylation in E. coli significantly simplify the interpretation of the results. We harnessed the developed system to demonstrate that like NEDD4, UBE3B also undergoes self-ubiquitylation-dependent inactivation. We show that self-ubiquitylation of UBE3B on K665 induces oligomerization and inactivation in yeast and mammalian cells respectively. Finally, we showcase the advantages of split-CAT in the study of human diseases by demonstrating that mutations in UBE3B that cause Kaufman oculocerebrofacial syndrome exhibit clear E. coli growth phenotypes.

Sense of agency and mentalizing: dissociation of subdomains of social cognition in patients with schizophrenia.

The sense of agency, i.e., the sense that "I am the one who is causing an action", and mentalizing, the ability to understand the mental states of other individuals, are key domains of social cognition. It has been hypothesized that an intact sense of agency is an important precondition for higher-level mentalizing abilities. A substantial body of evidence shows that both processes rely on similar brain areas and are severely impaired in schizophrenia, suggesting a close link between agency and mentalizing. Yet this relationship has not been explicitly tested. We investigated 40 individuals with schizophrenia and 40 healthy controls on an agency and mentalizing task. On the agency task, participants carried out simple mouse movements and judged the partially manipulated visual feedback as either self- or other-generated. On the mentalizing task, participants inferred mental states from pictures that depicted others' eyes ("Reading the mind in the eyes test"). Neuropsychological, psychopathological and social functioning levels were also evaluated. Both sense of agency and mentalizing were impaired in schizophrenia patients compared to healthy controls. However, testing for a relationship revealed no significant correlations between the two processes, either in the schizophrenia or the control group. The present findings demonstrate a dissociation of agency and mentalizing deficits in schizophrenia, suggesting that the multifaceted construct of social cognition consists of independent subdomains in healthy and psychiatrically ill individuals.

Mercury concentrations and loads in a large river system tributary to San Francisco Bay, California, U.S.A.

In order to estimate total mercury (HgT) loads entering San Francisco Bay, U.S.A., via the Sacramento-San Joaquin River system, unfiltered water samples were collected between January 2002 and January 2006 during high flow events and analyzed for HgT. Unfiltered HgT concentrations ranged from 3.2 to 75 ng/L and showed a strong correlation (r2 = 0.8, p < 0.001, n=78) to suspended sediment concentrations (SSC). During infrequent large floods, HgT concentrations relative to SSC were approximately twice as high as observed during smaller floods. This difference indicates the transport of more Hg-contaminated particles during high discharge events. Daily HgT loads in the Sacramento-San Joaquin River at Mallard Island ranged from below the limit of detection to 35 kg. Annual HgT loads varied from 61 +/- 22 kg (n=5) in water year (WY) 2002 to 470 +/- 170 kg (n=25) in WY 2006. The data collected will assist in understanding the long-term recovery of San Francisco Bay from Hg contamination and in implementing the Hg total maximum daily load, the long-term cleanup plan for Hg in the Bay.

Belief of agency changes dynamics in sensorimotor networks.

Controlling an event through one's own action usually induces a sense of agency, a feeling that arises when an expected outcome matches the intention. The neural correlates of this feeling remain controversial however, as experimental manipulation of the action-outcome chain often introduces mismatch or prediction errors that strongly correlate with the sense of agency. Here, we took a different approach and manipulated the causal belief (self-attribution vs. computer-attribution) by external cues during matched visuo-motor tapping conditions. With magneto-encephalography, we studied the sense of agency from a network perspective, investigating in source space the modulation of local population activity and changes in functional connectivity with motor cortex. Our results show that during the belief of agency primary motor cortex (M1) shows stronger functional connectivity (mediated by the beta band) to inferior parietal lobe and right middle temporal gyrus (MTG). Furthermore, the local feed-forward activity (gamma band power) in extrastriate body area and MTG disappears with that belief. After changes in action context, left M1 shows stronger connectivity in the alpha band with right premotor cortex and left insular-temporal cortex a network that might support active inference in social action context. Finally, a better tapping performance in this rhythmic task was related to alpha power modulations in the bilateral cerebellum and bilateral fusiform body-area, with power suppression during a more precise performance. These findings highlight the role of multiple networks supporting the sense of agency by changing their relative contribution for different causal beliefs.

Dissociation between key processes of social cognition in autism: impaired mentalizing but intact sense of agency.

Deficits in social cognition and interaction, such as in mentalizing and imitation behavior, are hallmark features of autism spectrum disorders. Both imitation and mentalizing are at the core of the sense of agency, the awareness that we are the initiators of our own behavior. Little evidence exists regarding the sense of agency in autism. Thus, we compared high-functioning adults with autism to healthy control subjects using an action monitoring and attribution task. Subjects with autism did not show deficits in this task, yet they showed significant mentalizing deficits. Our findings indicate a dissociation between the sense of agency and ascription of mental states in autism. We propose that social-cognitive deficits in autism may arise on a higher level than that of action monitoring and awareness.

The "sense of agency" and its underlying cognitive and neural mechanisms.

The sense of agency is a central aspect of human self-consciousness and refers to the experience of oneself as the agent of one's own actions. Several different cognitive theories on the sense of agency have been proposed implying divergent empirical approaches and results, especially with respect to neural correlates. A multifactorial and multilevel model of the sense of agency may provide the most constructive framework for integrating divergent theories and findings, meeting the complex nature of this intriguing phenomenon.

Parametric induction of animacy experience.

Graphical displays of simple moving geometrical figures have been repeatedly used to study the attribution of animacy in human observers. Yet little is known about the relevant movement characteristics responsible for this experience. The present study introduces a novel parametric research paradigm, which allows for the experimental control of specific motion parameters and a predictable influence on the attribution of animacy. Two experiments were conducted using 3D computer animations of one or two objects systematically introducing variations in the following aspects of motion: directionality, discontinuity and responsiveness. Both experiments further varied temporal kinematics. Results showed that animacy experience increased with the time a moving object paused in the vicinity of a second object and with increasing complexity of interaction between the objects (approach and responsiveness). The experience of animacy could be successfully modulated in a parametric fashion by the systematic variation of comparably simple differential movement characteristics.

White Matter Microstructure of the Human Mirror Neuron System is Related to Symptom Severity in Adults with Autism.

Mirror neuron system (MNS) dysfunctions might underlie deficits in autism spectrum disorders (ASD). Diffusion tensor imaging based probabilistic tractography was conducted in 15 adult ASD patients and 13 matched, healthy controls. Fractional anisotropy (FA) was quantified to assess group differences in tract-related white matter microstructure of both the classical MNS route (mediating "emulation") and the alternative temporo-frontal route (mediating "mimicry"). Multiple linear regression was used to investigate structure-function relationships between MNS connections and ASD symptom severity. There were no significant group differences in tract-related FA indicating an intact classical MNS in ASD. Direct temporo-frontal connections could not be reconstructed challengeing the concept of multiple routes for imitation. Tract-related FA of right-hemispheric parieto-frontal connections was negatively related to autism symptom severity.

Interactions Between Body and Social Awareness in Yoga.

BACKGROUND/OBJECTIVE: Bodily processes have been intimately linked to social-cognitive and affective functions, such as compassion and empathy. Yet, little is known about how awareness of bodily processes influences social awareness and vice versa, especially in nonobservational but experiential investigations. This study investigated the relationship between psychometrically reported body and social awareness (including altruism, empathy, perspective-taking, and compassion) in 90 yoga and yoga-/mediation-naive control participants. In modern postural yoga, advanced practitioners claim both increased compassion and inner focus. METHODS: Multiple regression analyses were conducted to predict (1) the level of yoga practice from body awareness and social awareness skills in the yoga group and (2) body awareness from social skills in both groups. RESULTS: Body awareness and compassion were significant positive and independent predictors of yoga expertise. This finding supports practitioners' anecdotal claims but also implies that both functions tap into different aspects of yoga expertise. When body awareness was predicted, altruism emerged as a significant negative predictor in the yoga group (but not control group) as a function of yoga practice. CONCLUSION: These results might compellingly suggest that, despite high compassion, heightened bodily self-awareness might increase a self-centred perspective and limit altruistic acts in advanced yoga practitioners.

Quantitative Sensory Testing in adults with Autism Spectrum Disorders.

Altered sensory perception has been found in patients with autism spectrum disorders (ASD) and might be related to aberrant sensory perception thresholds. We used the well-established, standardized Quantitative sensory testing (QST) protocol of the German Research Network on Neuropathic Pain to investigate 13 somatosensory parameters including thermal and tactile detection and pain thresholds in 13 ASD adults and 13 matched healthy controls with normal IQ values. There were no group differences between somatosensory detection and pain thresholds. Two ASD patients showed paradoxical heat sensations and another two ASD subjects presented dynamic mechanical allodynia; somatosensory features that were absent in controls. These findings suggest that central mechanisms during complex stimulus integration rather than peripheral dysfunctions probably determine somatosensory alterations in ASD.

Long-term variation in concentrations and mass loads in a semi-arid watershed influenced by historic mercury mining and urban pollutant sources.

Urban watersheds are significantly anthropogenically-altered landscapes. Most previous studies cover relatively short periods, without addressing concentrations, loads, and yields in relation to annual climate fluctuations, and datasets on Ag, Se, PBDEs, and PCDD/Fs are rare. Intensive storm-focused sampling and continuous turbidity monitoring were employed to quantify pollution at two locations in the Guadalupe River (California, USA). At a downstream location, we determined loads of suspended sediment (SS) for 14yrs., mercury (HgT), PCBs, and total organic carbon (TOC) (8yrs), total methylmercury (MeHgT) (6yrs), nutrients, and trace elements including Ag and Se (3yrs), DDTs, chlordanes, dieldrin, and PBDEs (2yrs), and PCDD/Fs (1yr). At an upstream location, we determined loads of SS for 4yrs. and HgT, MeHgT, PCBs and PCDD/Fs for 1yr. These data were compared to previous studies, climatically adjusted, and used to critically assess the use of small datasets for estimating annual average conditions. Concentrations and yields in the Guadalupe River appear to be atypical for total phosphorus, DDTs, dieldrin, HgT, MeHgT, Cr, Ni, and possibly Se due to local conditions. Other pollutants appear to be similar to other urban systems. On average, wet season flow varied by 6.5-fold and flow-weighted mean (FWM) concentrations varied 4.4-fold, with an average 7.1-fold difference between minimum and maximum annual loads. Loads for an average runoff year for each pollutant were usually less than the best estimate of long-term average. The arithmetic average of multiple years of load data or a FWM concentration combined with mean annual flow was also usually below the best estimate of long-term average load. Mean annual loads using sampled years were also less than the best estimate of long-term average by a mean of 2.2-fold. Climatic adjustment techniques are needed for computing estimates of long-term average annual loads.

The Sense of Agency Is More Sensitive to Manipulations of Outcome than Movement-Related Feedback Irrespective of Sensory Modality.

The sense of agency describes the ability to experience oneself as the agent of one's own actions. Previous studies of the sense of agency manipulated the predicted sensory feedback related either to movement execution or to the movement's outcome, for example by delaying the movement of a virtual hand or the onset of a tone that resulted from a button press. Such temporal sensorimotor discrepancies reduce the sense of agency. It remains unclear whether movement-related feedback is processed differently than outcome-related feedback in terms of agency experience, especially if these types of feedback differ with respect to sensory modality. We employed a mixed-reality setup, in which participants tracked their finger movements by means of a virtual hand. They performed a single tap, which elicited a sound. The temporal contingency between the participants' finger movements and (i) the movement of the virtual hand or (ii) the expected auditory outcome was systematically varied. In a visual control experiment, the tap elicited a visual outcome. For each feedback type and participant, changes in the sense of agency were quantified using a forced-choice paradigm and the Method of Constant Stimuli. Participants were more sensitive to delays of outcome than to delays of movement execution. This effect was very similar for visual or auditory outcome delays. Our results indicate different contributions of movement- versus outcome-related sensory feedback to the sense of agency, irrespective of the modality of the outcome. We propose that this differential sensitivity reflects the behavioral importance of assessing authorship of the outcome of an action.

Variability of cortical oscillation patterns: A possible endophenotype in autism spectrum disorders?

Autism spectrum disorders (ASD) have been associated with altered neural oscillations, especially fast oscillatory activity in the gamma frequency range, suggesting fundamentally disturbed temporal coordination of activity during information processing. A detailed review of available cortical oscillation studies in ASD does not convey a clear-cut picture with respect to dysfunctional oscillation patterns in the gamma or other frequency ranges. Recent evidence suggests that instead of a general failure to activate or synchronize the cortex, there is greater intra-participant variability across behavioral, fMRI and EEG responses in ASD. Intra-individual fluctuations from one trial to another have been largely ignored in task-related neural oscillation studies of ASD, which instead have focused on mean changes in power. We highlight new avenues for the analysis of cortical oscillation patterns in ASD which are sensitive to trial-to-trial variability within the participant, in order to validate the significance of increased response variability as possible endophenotype of the disorder.

Mirror me: Imitative responses in adults with autism.

Dysfunctions of the human mirror neuron system have been postulated to underlie some deficits in autism spectrum disorders including poor imitative performance and impaired social skills. Using three reaction time experiments addressing mirror neuron system functions under simple and complex conditions, we examined 20 adult autism spectrum disorder participants and 20 healthy controls matched for age, gender and education. Participants performed simple finger-lifting movements in response to (1) biological finger and non-biological dot movement stimuli, (2) acoustic stimuli and (3) combined visual-acoustic stimuli with different contextual (compatible/incompatible) and temporal (simultaneous/asynchronous) relation. Mixed model analyses revealed slower reaction times in autism spectrum disorder. Both groups responded faster to biological compared to non-biological stimuli (Experiment 1) implying intact processing advantage for biological stimuli in autism spectrum disorder. In Experiment 3, both groups had similar 'interference effects' when stimuli were presented simultaneously. However, autism spectrum disorder participants had abnormally slow responses particularly when incompatible stimuli were presented consecutively. Our results suggest imitative control deficits rather than global imitative system impairments.