Suicidal Thoughts and Behaviors Among Autistic Transgender or Gender-Nonconforming US College Students.

Importance: Suicide risk is a global public health crisis, with suicide ranking as a consistent leading cause of death among adults in the US. Autistic individuals and transgender or gender-nonconforming (TGNC) individuals represent populations with notably elevated rates of suicidal thoughts and behaviors (STBs). Objective: To characterize suicidal thoughts and behaviors among TGNC and autistic individuals, using a large, nationally representative sample. Design, Setting, and Participants: This study is a secondary analysis of cross-sectional data from students at colleges and universities throughout the US who participated in the American College Health Association National College Health Assessment from 2019 to 2023. Exposures: Autistic and TGNC identities were self-reported by participants. Main Outcomes and Measures: The frequency of intersectionality of autism and TGNC identities and whether those who had intersectional marginalized identities had increased likelihood of STBs were examined. STBs were self-reported by participants. A series of moderated regression analyses were performed to examine how the interaction between autism and possessing a marginalized gender identity (ie, TGNC status) was associated with STBs. Results: The sample included 41 507 college students with a mean (SD) age of 23.35 (6.83) years. A total of 2410 participants (5.81%) identified as being TGNC. Overall, 326 TGNC participants (13.53%) also identified as autistic, whereas 625 of those who identified as cisgender (1.58%) also identified as autistic. Gender identity and autism were associated with greater odds of STBs. For suicidal ideation, gender identity had an odds ratio (OR) of 3.34 (95% CI, 2.99-3.73), and autism had an OR of 2.06 (95% CI, 1.76-2.42). For suicide attempts, gender identity had an OR of 2.74 (95% CI, 2.13-3.52), and autism had an OR of 2.39 (95% CI, 1.62-3.52). A significant interaction existed for attempts (OR, 0.51; 95% CI, 0.27-0.97); nonautistic cisgender individuals had the lowest attempt rate. Conclusions and Relevance: This cross-sectional study addresses the dearth of information on how intersectionality in gender and autism status impacts the risk of STBs, and the results confirm the elevated risk of STBs among TGNC and autistic populations. Interventions are needed to support college students with these identities.

The associations between self-rated autistic traits, social camouflaging, and mental health outcomes in Taiwanese anime, comics and games (ACG) doujin creators: an exploratory study.

BACKGROUND: Doujin (どうじん) is a Japanese term referring to a circle where people share the same interests, usually something that belongs to the Anime, Comics, and Games (ACG) subculture. Individuals who belong to it and create related works, known as ACG doujin creators, are usually described as socially awkward and at potential risk of isolation. In such a context, they may theoretically exhibit higher autistic traits and manifest camouflaging tendencies, which may consequently be associated with their mental health. Nonetheless, the impact of autistic traits and camouflaging on mental health in this subculture remains significantly underexplored. METHODS: We recruited 183 Taiwanese ACG doujin creators (age ranges from 18 to 41, 146 female and 37 male) via social networking platforms. Participants completed Chinese online surveys assessing socio-demographic information, doujin activities, past psychiatric history, the 35-item Version of Autism-Spectrum Quotient (AQ-35), Chinese version Camouflaging Autistic Traits Questionnaire (CAT-Q-Ch), the General Anxiety Disorder-7 (GAD-7), and the Patient Health Questionnaire-9 (PHQ-9). Linear regression analysis was employed to examine the associations between the aforementioned scales. RESULTS: Our findings revealed that among ACG doujin creators, descriptively higher level of AQ-35 and CAT-Q-Ch than previous studies were found. Moreover, we observed a positive association between camouflaging behaviours and most AQ-35 subscales, with the exception of the mindreading subscale. Additionally, we identified that both camouflaging and autistic traits were significantly linked to higher PHQ-9 and GAD-7 scores. CONCLUSIONS: Through this study, we gained insight into the distinctive characteristics of autistic traits, camouflaging behaviours, and mental health among Taiwanese ACG doujin creators, as the associations between the factors mentioned above are divergent compared to previous research. This topic demonstrated that camouflaging is also associated with adverse mental health in a subculture group.

Caregivers' expectations of their non-verbal autistic children in rural KwaZulu-Natal.

BACKGROUND:  Caregiver expectations have been shown to impact child outcomes. There is limited research regarding caregivers of non-verbal autistic children in rural South Africa. Autistic individuals form part of a larger environment, which they influence and which impacts them. Caregivers form part of this environment. OBJECTIVES:  This study aims to explore caregivers' expectations of communication, education, social implications and intervention for their non-verbal autistic child in rural KwaZulu-Natal (KZN). METHOD:  Bronfenbrenner's ecological and bioecological systems theory framed the study and allowed the child's interaction with their environment to be understood through the use of a qualitative study design via interviews. Eleven caregivers (pilot study: n = 1 and main study: n = 10) of non-verbal autistic children were selected and interviewed. Data were analysed thematically. RESULTS:  Caregivers had varied expectations. Grandparents were often the primary caregivers (microsystem). Relationships within the mesosystem (caregiver and therapist) and caregiver's understanding affected their feelings and expectations that changed over time (chronosystem). Education was the predominant expectation. The study highlighted limited resources (schools) within the exosystem. Caregivers reported both support and judgement from their communities. CONCLUSION:  There is a need for public awareness, caregiver counselling and autism support groups in rural KZN and more specialised education options in order to improve caregivers' expectations.Contribution: This study contributes to the limited literature in the field of autism in South Africa, more specifically the rural context and communication disorders.

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

PURPOSE: 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. METHOD: 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. RESULTS: 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. CONCLUSION: 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.

Autistic traits linked to anxiety and dichotomous thinking: sensory sensitivity and intolerance of uncertainty as mediators in non-clinical population.

A recent theoretical cognitive model posits that three cognitive constructs-intolerance of uncertainty, lack of predictive processing, and dichotomous thinking-may interact with anxiety in autistic individuals. However, the interrelationships among these constructs remain unclear. We investigated this relationship in a non-clinical population using five questionnaires (Autism Spectrum Quotient, Glasgow Sensory Questionnaire, Short Intolerance of Uncertainty Scale, Penn State Worry Questionnaire, and Dichotomous Thinking Inventory) and conducted a path analysis. Data were collected from 405 adults (aged 20-22 years) in Experiment 1 and 628 (aged 20-49 years) in Experiment 2. In both experiments, autistic traits were significantly associated with both anxiety and dichotomous thinking, mediated by intolerance of uncertainty. Autistic traits were linked to intolerance of uncertainty, mediated by atypical sensory processing. Furthermore, autistic traits were directly associated with anxiety. No direct association was observed between anxiety and dichotomous thinking. Our results confirm the validity of Stark's cognitive model in a non-clinical population. These findings provide new insights into anxiety and dichotomous thinking and shed light on the cognitive styles of autistic individuals.

[Autism: associated medical conditions]. / Autismo: condiciones médicas asociadas.

Autism will accompany people throughout life with variations in its evolution and is frequently associated with other neurodevelopmental disorders (intellectual disability, attention deficit hyperactivity disorder, motor clumsiness, language disorder), neuropsychiatric disorders (depression, anxiety, schizophrenia, catatonia), epilepsy, sleep disorders, gastrointestinal disorders. In addition to the disorders typical of autism, we must consider an entire range of conditions, since their identification and adequate treatment will allow a better quality-of-life for people with autism. In 35% of cases, we can identify neurogenetic conditions which will allow us to prevent or identify associated medical entities. In this work we will analyze two groups, in a purely organizational way, medical conditions associated with defined entities (Down, Angelman, Fragile X, Rett, Phelan-McDermid and Timothy syndromes) and those that can be consistently associated in people with autism without an identified entity.

El autismo acompañará a las personas a lo largo de toda la vida, con variaciones en su evolución, está frecuentemente asociado a otros trastornos del neurodesarrollo (discapacidad intelectual, trastorno de déficit de atención e hiperactividad, torpeza motriz, trastorno del lenguaje), trastornos neuropsiquiátricos (depresión, ansiedad, esquizofrenia, catatonía), epilepsia, trastornos de sueño, trastornos gastrointestinales. Además de los trastornos propios del autismo, debemos tener en cuenta todo este abanico de condiciones, ya que su identificación y tratamiento permitirán una mejor calidad de vida. En el 35% de los casos podemos identificar entidades neurogenéticas, lo cual permitirá prevenir o identificar más rápidamente condiciones médicas asociadas. En este trabajo analizaremos dos grupos, de forma puramente organizativa, las condiciones médicas asociadas a entidades definidas (síndromes de Down, Angelman, X frágil, Rett, Phelan-McDermid y Timothy) y las que pueden asociarse consistentemente en personas con autismo sin una entidad identificada.

The relationship between interpersonal distance preference and estimation accuracy in autism.

People naturally seek an interpersonal distance that feels comfortable, striking a balance between not being too close or too far from others until reaching a state of equilibrium. Previous studies on interpersonal distance preferences among autistic individuals have yielded inconsistent results. Some show a preference for greater distance, while others indicate a preference for shorter distances, or reveal higher variance in preferences among autistic individuals. In a related vein, previous studies have also investigated the way autistics accurately judge distance, and these studies have received inconsistent results, with some showing superior spatial abilities and others indicating biases in distance estimations. However, the link between distance estimation and preference has never been examined. To address this gap, our study measured interpersonal distance preferences and estimations and tested the correlation between the two factors. The results indicate greater variance among autistic people in both the preference of distance and the ability to estimate distance accurately, suggesting that inconsistencies in previous studies originate from greater individual differences among autistics. Furthermore, only among autistic individuals were interpersonal distance preference and estimation bias associated in a manner that violated equilibrium. Underestimation bias (judging others as closer than they are) was linked to a preference for closer proximity, while overestimation bias (judging others as further away) was associated with a preference for maintaining a greater distance. This connection suggests that biases in the estimation of interpersonal distance contribute to extreme preferences (being too close or too far away). Taken together, the findings suggest that biases in the estimation of interpersonal distance are associated with socially inappropriate distance preferences among autistics.

Task-based functional neural correlates of social cognition across autism and schizophrenia spectrum disorders.

BACKGROUND: Autism and schizophrenia spectrum disorders (SSDs) both feature atypical social cognition. Despite evidence for comparable group-level performance in lower-level emotion processing and higher-level mentalizing, limited research has examined the neural basis of social cognition across these conditions. Our goal was to compare the neural correlates of social cognition in autism, SSDs, and typically developing controls (TDCs). METHODS: Data came from two harmonized studies in individuals diagnosed with autism or SSDs and TDCs (aged 16-35 years), including behavioral social cognitive metrics and two functional magnetic resonance imaging (fMRI) tasks: a social mirroring Imitate/Observe (ImObs) task and the Empathic Accuracy (EA) task. Group-level comparisons, and transdiagnostic analyses incorporating social cognitive performance, were run using FSL's PALM for each task, covarying for age and sex (1000 permutations, thresholded at p < 0.05 FWE-corrected). Exploratory region of interest (ROI)-based analyses were also conducted. RESULTS: ImObs and EA analyses included 164 and 174 participants, respectively (autism N = 56/59, SSD N = 50/56, TDC N = 58/59). EA and both lower- and higher-level social cognition scores differed across groups. While canonical social cognitive networks were activated, no significant whole-brain or ROI-based group-level differences in neural correlates for either task were detected. Transdiagnostically, neural activity during the EA task, but not the ImObs task, was associated with lower- and higher-level social cognitive performance. LIMITATIONS: Despite attempting to match our groups on age, sex, and race, significant group differences remained. Power to detect regional brain differences is also influenced by sample size and multiple comparisons in whole-brain analyses. Our findings may not generalize to autism and SSD individuals with co-occurring intellectual disabilities. CONCLUSIONS: The lack of whole-brain and ROI-based group-level differences identified and the dimensional EA brain-behavior relationship observed across our sample suggest that the EA task may be well-suited to target engagement in novel intervention testing. Our results also emphasize the potential utility of cross-condition approaches to better understand social cognition across autism and SSDs.

Impairment of affective and cognitive empathy in high functioning autism is mediated by alterations in emotional reactivity.

Empathy impairments are considered a key aspect of autism-spectrum disorders (ASD). Previous research consistently shows reduced cognitive empathy, but findings on affective empathy vary, possibly due to experimental design variations (e.g., stimulus modality, social distance) and individual psychological factors (e.g., perceptual abilities, emotional reactivity). This study aims to clarify deficits in affective and cognitive empathy in ASD by addressing these contributing factors. Empathy was examined in 34 autistic individuals and 33 typically developed controls (TDCs) through the Textual Empathy Test (TET). The TET was developed to assess emotional responses when imagining oneself (emotional reactivity) as compared to a target person (friend, stranger) in emotional situations presented via short verbal descriptions. Participants rated emotional states of the target person (cognitive empathy) as well as their own emotional responses when imagining the target person in that situation (affective empathy). Ratings were interpreted relative to normative mean values through standardized regression coefficients. Results showed that high-functioning autism was associated with lower cognitive and affective empathy irrespective of social distance as well as with decreased emotional reactivity compared to controls. Moreover, emotional reactivity mediated the impact of ASD on both empathic components. In summary, altered emotional reactivity may underlie impaired empathy in autistic individuals.

Study protocol of a randomized control trial on the effectiveness of improvisational music therapy for autistic children.

BACKGROUND: Music therapy is the clinical use of musical interventions to improve mental and physical health across multiple domains, including social communication. Autistic children, who have difficulties in social communication and often increased anxiety, tend to show a strong preference for music, because it can be structured and systematic, and therefore more predictable than social interaction. This makes music therapy a promising medium for therapeutic support and intervention. Previous clinical trials of music therapy compared to traditional therapy for autistic children have shown encouraging but nevertheless mixed results. KEY AIMS: The primary aim is to conduct a randomised controlled trial (RCT) of improvisational music therapy for autistic children and test its effectiveness in at improving social communication and wellbeing, and to reduce anxiety. RESEARCH PLAN: The RCT will be conducted with 200 autistic children in the UK aged 7 to 11 years old. Participants will be randomly assigned to either improvisational music therapy or support as usual. The trial will be an assessor-blind, pragmatic two-arm cluster RCT comparing the impact of 12-weeks of improvisational music therapy in addition to support as usual, vs. support as usual for autistic children. METHODS: Researchers who are blind to which arm the children are in will conduct assessments and obtain data via caregiver reports. The primary outcome will be the absolute change in the total score of the Brief Observation of Social Communication Change (BOSCC) assessed at baseline, T1 (13 weeks) and T2 (39 weeks) follow-ups. The BOSCC consists of specific items that were developed to identify changes in social-communication behaviours. Secondary outcome measures include: (1) Parent reported anxiety scale for youth with ASD (Note that we do not use the term 'ASD' or Autism Spectrum Disorder, because many autistic people feel it is stigmatising. Instead, we use the term 'autism') (PRAS-ASD) (2) Young Child Outcome Rating Scale, for wellbeing (YCORS), (3) Strengths and Difficulties Questionnaire (SDQ); and (4) Vineland Adaptive Behaviour Scale (VABS). (5) The Children's Communication Checklist-2 (CCC-2) will be completed to evaluate pragmatic speech with fluent speakers only; (6) The Music Engagement Scale (MES); and (7) Assessment of the Quality of Relationship (AQR) will be used to evaluate the child-therapist relationships using video-analysis of music therapy sessions. Additional data will be collected by administering the Wechsler Abbreviated Scale of Intelligence (WASI-II), Music at Home Questionnaire (M@H), and children's versions of the Empathy Quotient (EQ) and Systemizing Quotient (SQ). Audio and video data from the therapy sessions will be collected and analysed (using both human and computer-based feature-coding, e.g., machine learning and AI-driven methods) to identify how music and non-musical interactions foster change throughout the therapy. DISCUSSION: This study aims to observe if the interactions, engagement, and therapeutic modalities fostered during music therapy sessions can translate to non-musical contexts and improve autistic children's social communication skills, identifying possible mediating factors contributing to the effectiveness of music therapy, potentially informing policy making and governance. TRIAL REGISTRATION: This randomised control trial is registered with the NIH U.S. National Library of Medicine:  https://clinicaltrials.gov/search?term=NCT06016621 , clinicalTrials.gov Identifier: NCT0601662, Registration Date 19th August 2023.

Pupillary responses for social versus non-social stimuli in autism: A systematic review and meta-analysis.

Pupillometry has gained attention as a valuable tool for assessing autonomic nervous system activity and studying phasic changes in pupil size to comprehend underlying neurocognitive mechanisms. However, knowledge regarding pupillary responses to social processing in autism is limited. We conducted a systematic review and meta-analysis, examining research studies on pupil size changes that compare social and non-social stimuli in autism. Electronic searches were performed for articles up to September 2023 and relevant studies were evaluated following PRISMA guidelines. Out of 284 articles screened, 14 studies were eligible for systematic review. The results indicated that non-autistic individuals showed larger pupil size for social compared to non-social stimuli (g = 0.54; 95 % CI [0.25, 0.82]), whereas autistic individuals seemed to exhibit no differences between the two conditions. However, high heterogeneity was observed between studies in autistic populations, compromising interpretability. Despite such limitations, pupillary responses may constitute an objective physiological marker of social processing in autism. This review emphasizes the need for further investigations into pupillary responses in autism across different life stages.

Pursuit-worthy research in health: Three examples and a suggestion.

This paper, in a nutshell, is a plea for community participation in research along with an adapted idea for how such participation should be shaped and understood. I will give varied examples of the ways in which scientists viewing a perceived problem solely from an external perspective has led to mistakes. If we do not properly take into account the knowledge and values of people with a condition, we are liable to pursue the wrong sorts of treatments. In particular, I provide examples of three ways (exemplified in the cases of "female hysteria", autism, and chronic fatigue syndrome) scientists are liable to pursue treatment of what they perceive to be at least partially mental illnesses that they/we shouldn't. I present the idea of deliberative research-the concept is based on that of deliberative democracy. The idea of deliberative democracy is that decisions should be made on the basis of reasons that would be acceptable to the target population. I similarly argue that research decisions should be made on the basis of reasons that would be acceptable to the target population, even if it requires other experts to determine how those reasons are best to be respected in the context of a particular project.

Adapting the Early Communication Indicator as a Social Communication Outcome Measure for Young Autistic Children: A Pilot Study.

PURPOSE: We sought to conduct a pilot investigation of the reliability and administration fidelity of a new play-based measure of social communication for infants and toddlers with an autism diagnosis. METHOD: Our team adapted an existing measure, the Early Communication Indicator (ECI), for use with young autistic children in clinical and research contexts. In this brief report, we detail our adaptation process including administration and scoring of the final adapted measure based on data from a two-phase pilot study with young autistic children (N = 17). RESULTS: This adapted measure, the Early Communication Indicator-Autism (ECI-A), captured a range of scores for the ECI, Initiation of Joint Attention, and Directed Communication in pilot testing. Interrater reliability was moderate to strong across the scored behaviors. Finally, parents were able to administer the ECI-A with high fidelity with support from the research staff. CONCLUSIONS: This two-phase pilot study demonstrated promise for the ECI-A as a brief measure of social communication that can be administered by parents and reliably scored by trained staff with limited background in autism assessments. Validation of the ECI-A is presently underway. SUPPLEMENTAL MATERIAL: https://doi.org/10.23641/asha.26042077.

Gender-specific play behavior in relation to autistic traits and behavioral difficulties at the age of seven in the SELMA study.

BACKGROUND: Childhood gender nonconformity is related to psychological distress and behavioral difficulties. Similarly, there is evidence for a link between gender nonconformity, or gender dysphoria in some studies, and autism spectrum disorder and related traits. Our knowledge on those associations mostly originates from clinical populations, which might lead to overestimation. Thus, this study aimed to assess associations between gender nonconformity and behavioral difficulties in a population-based study. METHODS: In the Swedish Environmental Longitudinal, Mother and Child, Asthma and Allergy (SELMA) study, cross-sectional associations between gender-specific play behavior and behavioral outcomes and autistic traits were investigated among 718 children at 7-years of age. Play behavior was measured using the Preschool Activities Inventory; behavioral outcomes and autistic traits were measured with the Strengths and Difficulties Questionnaire and the Social Responsiveness Scale, respectively. Linear and logistic regression analyses were performed. RESULTS: Higher composite play behavior scores (indicating either increased masculine or decreased feminine play behavior) were associated with increased autistic trait scores in girls (ß = 0.13; 95% confidence interval [CI] = 0.00, 0.26). Furthermore, higher composite scores were shown to be associated with behavioral difficulties in both girls (ß = 0.11; 95% CI = 0.04, 0.18) and boys (ß = 0.10; 95% CI = 0.02, 0.19). Additionally, higher feminine scores were related with increased problems in peer relationships in boys (ß = 0.04; 95% CI = 0.00, 0.07). CONCLUSIONS: This study suggests a link between gender nonconforming play behavior and autistic traits as well as behavioral difficulties among children in a non-clinical population, which calls attention to the necessity of supporting children with gender nonconformity from early ages.

Individual differences in interoception and autistic traits share altered facial emotion perception, but not recognition per se.

While alterations in both physiological responses to others' emotions as well as interoceptive abilities have been identified in autism, their relevance in altered emotion recognition is largely unknown. We here examined the role of interoceptive ability, facial mimicry, and autistic traits in facial emotion processing in non-autistic individuals. In an online Experiment 1, participants (N = 99) performed a facial emotion recognition task, including ratings of perceived emotional intensity and confidence in emotion recognition, and reported on trait interoceptive accuracy, interoceptive sensibility and autistic traits. In a follow-up lab Experiment 2 involving 100 participants, we replicated the online experiment and additionally investigated the relationship between facial mimicry (measured through electromyography), cardiac interoceptive accuracy (evaluated using a heartbeat discrimination task), and autistic traits in relation to emotion processing. Across experiments, neither interoception measures nor facial mimicry accounted for a reduced recognition of specific expressions with higher autistic traits. Higher trait interoceptive accuracy was rather associated with more confidence in correct recognition of some expressions, as well as with higher ratings of their perceived emotional intensity. Exploratory analyses indicated that those higher intensity ratings might result from a stronger integration of instant facial muscle activations, which seem to be less integrated in intensity ratings with higher autistic traits. Future studies should test whether facial muscle activity, and physiological signals in general, are correspondingly less predictive of perceiving emotionality in others in individuals on the autism spectrum, and whether training interoceptive abilities might facilitate the interpretation of emotional expressions.

Empathy in autistic children: Emotional overarousal in response to others' physical pain.

Different empathic responses are often reported in autism but remain controversial. To investigate which component of empathy is most affected by autism, we examined the affective, cognitive, and motivational components of empathy in 25 5- to 8-year-old autistic and 27 neurotypical children. Participants were presented with visual stimuli depicting people's limbs in painful or nonpainful situations while their eye movements, pupillary responses, and verbal ratings of pain intensity and empathic concern were recorded. The results indicate an emotional overarousal and reduced empathic concern to others' pain in autism. Compared with neurotypical children, autistic children displayed larger pupil dilation accompanied by attentional avoidance to others' pain. Moreover, even though autistic children rated others in painful situations as painful, they felt less sorry than neurotypical children. Interestingly, autistic children felt more sorry in nonpainful situations compared with neurotypical children. These findings demonstrated an emotional overarousal in response to others' pain in autistic children, and provide important implications for clinical practice aiming to promote socio-emotional understanding in autistic children.

Self-Reported COVID-19 Vaccine and Booster Acceptance and Hesitancy Among Autistic Adults in Pennsylvania: Cross-Sectional Analysis of Survey Data.

BACKGROUND: The autistic population is rapidly increasing; meanwhile, autistic adults face disproportionate risks for adverse COVID-19 outcomes. Limited research indicates that autistic individuals have been accepting of initial vaccination, but research has yet to document this population's perceptions and acceptance of COVID-19 boosters. OBJECTIVE: This study aims to identify person-level and community characteristics associated with COVID-19 vaccination and booster acceptance among autistic adults, along with self-reported reasons for their stated preferences. Understanding this information is crucial in supporting this vulnerable population given evolving booster guidelines and the ending of the public health emergency for the COVID-19 pandemic. METHODS: Data are from a survey conducted in Pennsylvania from April 11 to September 12, 2022. Demographic characteristics, COVID-19 experiences, and COVID-19 vaccine decisions were compared across vaccination status groups. Chi-square analyses and 1-way ANOVA were conducted to test for significant differences. Vaccination reasons were ranked by frequency; co-occurrence was identified using phi coefficient correlation plots. RESULTS: Most autistic adults (193/266, 72.6%) intended to receive or received the vaccine and booster, 15% (40/266) did not receive or intend to receive any vaccine, and 12.4% (33/266) received or intended to receive the initial dose but were hesitant to accept booster doses. Reasons for vaccine acceptance or hesitancy varied by demographic factors and COVID-19 experiences. The most significant were previously contracting COVID-19, desire to access information about COVID-19, and discomfort with others not wearing a mask (all P=.001). County-level factors, including population density (P=.02) and percentage of the county that voted for President Biden (P=.001) were also significantly associated with differing vaccination acceptance levels. Reasons for accepting the initial COVID-19 vaccine differed among those who were or were not hesitant to accept a booster. Those who accepted a booster were more likely to endorse protecting others and trusting the vaccine as the basis for their acceptance, whereas those who were hesitant about the booster indicated that their initial vaccine acceptance came from encouragement from someone they trusted. Among the minority of those hesitant to any vaccination, believing that the vaccine was unsafe and would make them feel unwell were the most often reported reasons. CONCLUSIONS: Intention to receive or receiving the COVID-19 vaccination and booster was higher among autistic adults than the population that received vaccines in Pennsylvania. Autistic individuals who accepted vaccines prioritized protecting others, while autistic individuals who were vaccine hesitant had safety concerns about vaccines. These findings inform public health opportunities and strategies to further increase vaccination and booster rates among generally accepting autistic adults, to better support the already strained autism services and support system landscape. Vaccination uptake could be improved by leveraging passive information diffusion to combat vaccination misinformation among those not actively seeking COVID-19 information to better alleviate safety concerns.

Exploring the impact of parents' face-mask wearing on dyadic interactions in infants at higher likelihood for autism compared with general population.

Since the COVID-19 pandemic, both the public and researchers have raised questions regarding the potential impact of protective face-mask wearing on infants' development. Nevertheless, limited research has tested infants' response to protective face-mask wearing adults in real-life interactions and in neurodiverse populations. In addition, scarce attention was given to changes in interactive behavior of adults wearing a protective face-mask. The aims of the current study were (1) to examine differences in 12-month-old infants' behavioral response to an interactive parent wearing a protective face-mask during face-to-face interaction, (2) to investigate potential differences in infants at higher likelihood for autism (HL-ASD) as compared with general population (GP) counterparts, and (3) to explore significant differences in parents' behaviors while wearing or not wearing a protective face-mask. A total of 50 mother-infant dyads, consisting of 20 HL-ASD infants (siblings of individuals with autism) and 30 GP infants, participated in a 6-min face-to-face interaction. The interaction was videotaped through teleconferencing and comprised three 2-min episodes: (a) no mask, (b) mask, and (c) post-mask. Infants' emotionality and gaze direction, as well as mothers' vocal production and touching behaviors, were coded micro-analytically. Globally, GP infants exhibited more positive emotionality compared with their HL-ASD counterparts. Infants' negative emotionality and gaze avoidance did not differ statistically across episodes. Both groups of infants displayed a significant increase in looking time toward the caregiver during the mask episode. No statistically significant differences emerged in mothers' behaviors. These findings suggest that the use of protective face-masks might not negatively affect core dimensions of caregiver-infant interactions in GP and HL-ASD 12-month-old infants.