Autism-friendly eyecare: Developing recommendations for service providers based on the experiences of autistic adults.

PURPOSE: People with autism face significant barriers when accessing healthcare services. Eye examinations present unique challenges. Accessibility of this healthcare sector for people with autism has not been investigated previously. The aim of this research was to investigate eye examination accessibility for autistic adults and produce recommendations for autism-friendly eyecare. METHODS: Two qualitative studies were conducted. In Study 1, 18 autistic adults took part in focus groups to elicit their eye examination experiences. Transcripts of the recorded discussions were thematically analysed. Study 1 findings were used to design autism-friendly eye examinations for autistic adults. These were conducted in Study 2. Twenty-four autistic adults participated in these examinations, during which they were interviewed about their experience and how it might be improved by reasonable modifications. Audio recordings of the interviews were content analysed. RESULTS: Knowledge of what to expect, in advance of the eye examination, could greatly reduce anxiety. Participants liked the logical structure of the examination, and the interesting instrumentation used. However, the examination and practice environment did include sensory challenges, due to lights, sound and touch. Changes in practice layout, and interacting with multiple staff members, was anxiety provoking. Participants expressed a need for thorough explanations from the optometrist that outlined the significance of each test, and what the patient was expected to do. CONCLUSION: A number of accessiblity barriers were identified. These suggested that UK eye examinations are not very accessible for autistic adults. Barriers began at the point of booking the appointment and continued through to the dispensing of spectacles. These caused anxiety and stress for this population, but could be reduced with easy-to-implement adaptations. Based on the findings, recommendations are presented here for the whole eyecare team which suggest how more autism-friendly eye examinations can be provided.

How does ageing affect grasp adaptation to a visual-haptic size conflict?

Previous research suggests that the ability to adapt motor behaviour to sudden environmental changes may be impaired in older adults. Here, we investigated whether the adaptation of grasping behaviour in response to a visual-haptic size conflict is also affected by increasing age. 30 older and 18 young adults were instructed to grasp a hidden block whilst viewing a second block in a congruent position. Initially block sizes were equal, but after a set number of trials a sensory conflict was introduced by covertly changing the hidden block for a smaller or larger block. The scale and speed of maximum grasp aperture adaptation to the increase or decrease in the size of the hidden block was measured. Older adults successfully adapted to the visual-haptic size conflict in a similar manner to young adults, despite a tendency to adapt less when the hidden block increased in size. This finding is attributed to the physical capabilities of the grasping hand of older adults, rather than an effect of age-related sensory or cognitive decline. The speed of grasp adaptation did not differ between age groups; however, awareness of the visual-haptic conflict lead to faster adaptation. These findings suggest that sensorimotor adaptation for grasping is intact for cognitively healthy older adults.

Investigating the spatial and temporal modulation of visuotactile interactions in older adults.

Previous research has shown that spatially and temporally disparate multisensory events are more likely to interact for older adults. For visuotactile interactions, this suggests that the representation of peripersonal space is expanded and temporal perception within this space is less precise. Previously, visuotactile space has been found to expand horizontally into the opposite hemispace, and here we sought to replicate and extend this by exploring both horizontal and vertical space from the hand. Moreover, we investigated whether both spatial and temporal domains are affected for an individual, which have previously been measured using distinct tasks and different participants. We presented a modified cross-modal congruency task (Poole et al. in Multisens Res. doi: 10.1163/22134808-00002475 , 2015a) to thirty older participants (age range 65-85 years), with unisensory tactile performance equated for each individual. For the temporal manipulation, the timings of visual distractors and tactile targets were offset. For the spatial manipulation, visual distractors were presented from multiple positions in ipsilateral and contralateral hemispaces. Whilst the temporal modulation of visuotactile interactions for older adults was equivalent to that observed in young adults, spatial modulation was reduced; significant visuotactile interactions were observed for visual distractors presented in the same and opposite hemispace to the stimulated hand, in the lower visual field. This suggests an expanded representation of visuotactile space surrounding the hand in older adults, which occurs horizontally into the contralateral hemispace only, rather than expanding both vertically and horizontally. This is likely to have consequences for perception of space and goal-directed action in ageing.

Enhancing voluntary imitation through attention and motor imagery.

Action observation activates brain areas involved in performing the same action and has been shown to increase motor learning, with potential implications for neurorehabilitation. Recent work indicates that the effects of action observation on movement can be increased by motor imagery or by directing attention to observed actions. In voluntary imitation, activation of the motor system during action observation is already increased. We therefore explored whether imitation could be further enhanced by imagery or attention. Healthy participants observed and then immediately imitated videos of human hand movement sequences, while movement kinematics were recorded. Two blocks of trials were completed, and after the first block participants were instructed to imagine performing the observed movement (Imagery group, N = 18) or attend closely to the characteristics of the movement (Attention group, N = 15), or received no further instructions (Control group, N = 17). Kinematics of the imitated movements were modulated by instructions, with both Imagery and Attention groups being closer in duration, peak velocity and amplitude to the observed model compared with controls. These findings show that both attention and motor imagery can increase the accuracy of imitation and have implications for motor learning and rehabilitation. Future work is required to understand the mechanisms by which these two strategies influence imitation accuracy.

Cognitive predictors of perceptual adaptation to accented speech.

The present study investigated the effects of inhibition, vocabulary knowledge, and working memory on perceptual adaptation to accented speech. One hundred young, normal-hearing adults listened to sentences spoken in a constructed, unfamiliar accent presented in speech-shaped background noise. Speech Reception Thresholds (SRTs) corresponding to 50% speech recognition accuracy provided a measurement of adaptation to the accented speech. Stroop, vocabulary knowledge, and working memory tests were performed to measure cognitive ability. Participants adapted to the unfamiliar accent as revealed by a decrease in SRTs over time. Better inhibition (lower Stroop scores) predicted greater and faster adaptation to the unfamiliar accent. Vocabulary knowledge predicted better recognition of the unfamiliar accent, while working memory had a smaller, indirect effect on speech recognition mediated by vocabulary score. Results support a top-down model for successful adaptation to, and recognition of, accented speech; they add to recent theories that allocate a prominent role for executive function to effective speech comprehension in adverse listening conditions.

Dissociating affordance and spatial compatibility effects using a pantomimed reaching action.

Previous research has demonstrated faster reaction times in response to appropriately oriented action-inducing stimuli (affordance effect, e.g. Tucker and Ellis in J Exp Psychol Hum Percept Perform 24:830-846, 1998). However, it has been argued that faster responses may be due to a spatial compatibility effect. In the current investigation, we aimed to dissociate the affordance and spatial compatibility effects. Moreover, we explored these effects beyond button-press responses by measuring detailed kinematics of the arms and hands during a naturalistic reach response. Participants were presented with images of a door handle (affording) or an abstract (non-affording) stimulus and made a pantomimed reach response with either hand depending on a colour change of the stimulus (i.e. Blue = left, Green = right). Stimuli could be aligned as spatially compatible or incompatible with the responding hand. The colour change occurred after a delay of 0, 500 or 1,000 ms. Only spatially compatible affordance stimuli facilitated reach onset compared to other stimuli and compatibility combinations, replicating previous reaction time studies. Therefore, in the absence of graspable stimuli, spatial compatibility alone was not sufficient to facilitate reach onset. There was also a larger outwards deviation of reach trajectory for spatially incompatible abstract stimuli compared to spatially compatible abstract stimuli, which waned with stimulus onset delay. However, no such affect was observed for the affording stimuli. Accordingly, later kinematics of the reaching action was influenced by the spatial compatibility of the stimulus alone. Overall, the dissociation of affordance and spatial compatibility effects suggests that these effects are driven by visuomotor priming and the inhibition of the incompatible spatial location, respectively.

Motor imagery in autism: a systematic review.

Introduction: Motor Imagery (MI) is when an individual imagines performing an action without physically executing that action and is thought to involve similar neural processes used for execution of physical movement. As motor coordination difficulties are common in autistic individuals it is possible that these may affect MI ability. The aim of this systematic review was to assess the current knowledge around MI ability in autistic individuals. Methods: A systematic search was conducted for articles published before September 2023, following PRISMA guidance. Search engines were PsycINFO, PubMed, Web of Science, Scopus, Wiley Online Library and PsyArXiv. Inclusion criteria included: (a) Original peer-reviewed and pre-print publications; (b) Autistic and a non-autistic group (c) Implicit or explicit imagery tasks (d) Behavioral, neurophysiological or self-rating measures, (e) Written in the English language. Exclusion criteria were (a) Articles only about MI or autism (b) Articles where the autism data is not presented separately (c) Articles on action observation, recognition or imitation only (d) Review articles. A narrative synthesis of the evidence was conducted. Results: Sixteen studies across fourteen articles were included. Tasks were divided into implicit (unconscious) or explicit (conscious) MI. The implicit tasks used either hand (6) or body (4) rotation tasks. Explicit tasks consisted of perspective taking tasks (3), a questionnaire (1) and explicit instructions to imagine performing a movement (2). A MI strategy was apparent for the hand rotation task in autistic children, although may have been more challenging. Evidence was mixed and inconclusive for the remaining task types due to the varied range of different tasks and, measures conducted and design limitations. Further limitations included a sex bias toward males and the hand rotation task only being conducted in children. Discussion: There is currently an incomplete understanding of MI ability in autistic individuals. The field would benefit from a battery of fully described implicit and explicit MI tasks, conducted across the same groups of autistic children and adults. Improved knowledge around MI in autistic individuals is important for understanding whether MI techniques may benefit motor coordination in some autistic people.

Stimulus specificity in combined action observation and motor imagery of typing.

Combined action observation and motor imagery (AO + MI) can improve movement execution (ME) in healthy adults and certain patient populations. However, it is unclear how the specificity of the observation component during AO + MI influences ME. As generalised observation could result in more flexible AO + MI rehabilitation programmes, this study investigated whether observing typing of target words (specific condition) or non-matching words (general condition) during AO + MI would have different effects on keyboard typing in healthy young adults. In Experiment 1, 51 students imagined typing a target word while watching typing videos that were either specific to the target word or general. There were no differences in typing execution between AO + MI conditions, though participants typed more slowly after both AO + MI conditions compared with no observation or imagery. Experiment 2 repeated Experiment 1 in 20 students, but with a faster stimulus speed in the AO + MI conditions and increased cognitive difficulty in the control condition. The results showed that the slowed typing after AO + MI was likely due to a strong influence of task-switching between imagery and execution, as well as an automatic imitation effect. Both experiments demonstrate that general and specific AO + MI comparably affect ME. In addition, slower ME following both AO + MI and a challenging cognitive task provides support for the motor-cognitive model of MI.

The diversity of speech-perception difficulties among autistic individuals.

Background & aims: Communicative and sensory differences are core autistic traits, yet speech-perception abilities and difficulties among autistic individuals remain poorly understood. Laboratory studies have produced mixed and inconclusive results, in part because of the lack of input from autistic individuals in defining the hypotheses and shaping the methods used in this field of research. Little in-depth qualitative research on autistic experiences of speech perception has been published, yet such research could form the basis for better laboratory research, for improved understanding of autistic experiences, and for the development of interventions. Existing qualitative research describes widespread autistic listening differences with significant impacts, but these results rely on data gathered via oral interviews in a small sample. The present study addresses these limitations and employs a mixed-methods approach to explore autistic listening experiences. Methods: We gathered survey data from 79 autistic individuals aged 18-55 without diagnosed hearing loss. The questionnaire included 20 closed-set questions on listening abilities and difficulties and three free-text questions on listening experiences. The free-text questions underwent deductive content analysis using a framework composed of themes from previous interview data on listening experiences (including auditory differences, contributing factors, impacts, and coping strategies). Concepts in the free-text data that were not part of the analysis framework were analyzed inductively. Results: In the closed-set data, participants reported listening difficulties in most specified environments, but complex background sounds and particularly background voices caused the most difficulty. Those who reported listening difficulties expressed having substantially greater difficulties than other people the same age. Participants indicated multiple impacts from listening difficulties, most prominently in their social lives. Concepts in the free-text data strongly supported previous interview data on listening differences and factors that affect listening ability, especially the diversity of types of listening difficulties. Consistent with the closed-set data, background-sound complexity and concurrent voices were especially troubling. Some concepts in the free-text data were novel, particularly difficulties with remote, broadcast, and recorded audio, prompting the creation of new themes. Conclusions: Both forms of data indicate widespread listening differences-predominantly listening difficulties-affecting most autistic adults. Diverse types of listening difficulty are evident, potentially indicating heterogeneous underlying mechanisms, and complexity of background noise is consistently identified as an important factor. Listening difficulties are said to have substantial and varied impacts. Autistic adults are keen to share coping strategies, which are varied and usually self-devised. Implications: Based on both the quantitative and qualitative results, we provide recommendations to improve future research and support the autistic community. The data-revealing types of listening difficulties can guide better quantitative research into underlying mechanisms. Such research should take into account potential heterogeneity in listening difficulties. Suggestions for optimized collection of self-report data are also offered. Additionally, our results could be used to improve societal understanding of autistic listening differences and to create beneficial interventions for and with autistic individuals. Moreover, given the willingness of the autistic community to share coping strategies, systematic collation of these strategies could form the basis for self-help and clinical guidance.

Binocular saccades in myopes and emmetropes.

PURPOSE: To compare saccadic eye movements in groups of myopes and emmetropes, as eye movements could have an influence on refractive error development. Individual saccadic eye movement parameters were also compared with subjective refraction and axial length data. METHODS: Horizontal eye movements of 28 participants (14 myopes and 14 emmetropes; mean age [SD], 27.0 [4.7] years) were recorded using a head-mounted eye tracker. To reduce the influence of head movements, a chin rest was used. Two fixation stimuli lying symmetrically at ±10 degrees on either side of the median line were presented on a computer monitor and were alternately displayed for durations of 2 seconds each. The participants alternated their fixation between the target positions immediately after they became aware that the target had changed. Only right eye data were considered for analysis. RESULTS: Durations, amplitudes, and peak velocities of the main saccades and the numbers of overshoots, undershoots, and exact fixations were analyzed. For all analyzed parameters, no significant differences were found between myopes and emmetropes. When analyzing the whole study population or the emmetropic group alone, none of the saccadic eye movement parameters were correlated with axial length or refractive error. In myopes, only the peak velocity showed a weak correlation with refractive error and axial length, but this failed to reach statistical significance when allowance was made for multiple testing. CONCLUSIONS: Because saccadic eye movements seem to be similar in myopes and emmetropes, there is no evidence that saccadic eye movements are involved in myopia development.

Symmetry Detection in Autistic Adults Benefits from Local Processing in a Contour Integration Task.

Symmetry studies in autism are inconclusive possibly due to different types of stimuli used which depend on either local or global cues. Therefore, this study compared symmetry detection between 20 autistic and 18 non-autistic adults matched on age, IQ, gender and handedness, using contour integration tasks containing open and closed contours that rely more on local or global processing respectively. Results showed that the autistic group performed equally well with both stimuli and outperformed the non-autistic group only for the open contours, possibly due to a different strategy used in detecting symmetry. However, there were no group differences for the closed contour. Results explain discrepant findings in previous symmetry studies suggesting that symmetry tasks that favour a local strategy may be advantageous for autistic individuals. Implications of the findings towards understanding visual sensory issues in this group are discussed.

From "one big clumsy mess" to "a fundamental part of my character." Autistic adults' experiences of motor coordination.

Altered motor coordination is common in autistic individuals affecting a range of movements such as manual dexterity, eye-hand coordination, balance and gait. However, motor coordination is not routinely assessed leading to undiagnosed and untreated motor coordination difficulties, particularly in adults. Few studies have investigated motor coordination difficulties and their impact from the viewpoint of autistic people. Therefore, the current study used FGs and thematic analysis to document the experience of motor coordination difficulties from the viewpoint of 17 autistic adults. Four main themes were identified. First, motor coordination difficulties were pervasive and variable, being present life-long and within multiple movements and affecting many aspects of life. Furthermore, the nature of the difficulties was variable within and between participants along with differing awareness of coordination ability. Second, participants described motor coordination as an active process, requiring concentration for most actions and at a level seemingly greater than other people. Third, motor coordination difficulties impacted upon social and emotional wellbeing by placing strain on relationships, prompting bullying and exclusion, putting safety at risk and causing a range of negative emotions. Fourth, in the absence of any support, participants described multiple learning and coping strategies. Findings highlight how it is essential to address the current lack of support for motor coordination considering the significant social and emotional consequences described by our participants. Further investigation of motor learning and interactions between sensory and motor performance in autistic adults is also warranted.

Investigating eye examination-related anxiety in autistic adults.

CLINICAL RELEVANCE: It is important to investigate whether anxiety is a barrier to accessing eye examinations for autistic adults, because existing research suggests this population are more likely to develop ophthalmic abnormalities. BACKGROUND: Anxiety influences healthcare accessibility for autistic people without learning disabilities. Previous qualitative studies by the research team, with a small sample of autistic adults, have indicated several aspects of eyecare services which cause anxiety. Considering the limited existing research suggesting autistic individuals are more likely to develop ophthalmic abnormalities, this study explored whether this population more widely experiences anxiety when accessing eye examinations. METHODS: A total of 322 UK-based autistic adults completed the Optometric Patient Anxiety Scale (OPAS) online, between July and December 2020. Rasch analysis was used to validate this questionnaire for an autistic adult population, and compare optometric anxiety levels to the general population. RESULTS: Item infit (0.77 to 1.39) and outfit (0.78 to 1.33) values, the person separation index (2.64), and item (0.99) and person (0.97) reliability coefficients suggested that all 10 items in the OPAS are useful to assess optometric anxiety in an autistic adult population. Item probability curves confirmed the response scale to be appropriate. A comparison of optometric anxiety between the autistic population in the current study and a general population in previous work found no statistically significant difference. CONCLUSION: The OPAS is a statistically valid tool for use in the autistic adult population. It appears to suggest no significant difference in optometric anxiety between the autistic adult and general population. However, it is possible that it underestimates the true optometric anxiety of autistic adults since the items do not include some of the anxiety provoking factors for this population which have been indicated in previous studies by the research team.

When 2 become 1: Autistic simultaneity judgements about asynchronous audiovisual speech.

It has been proposed that autistic people experience a temporal distortion whereby the temporal binding window of multisensory integration is extended. Research to date has focused on autistic children so whether these differences persist into adulthood remains unknown. In addition, the possibility that the previous observations have arisen from between-group differences in response bias, rather than perceptual differences, has not been addressed. Participants completed simultaneity judgements of audiovisual speech stimuli across a range of stimulus-onset asynchronies. Response times and accuracy data were fitted to a drift-diffusion model so that the drift rate (a measure of processing efficiency) and starting point (response bias) could be estimated. In Experiment 1, we tested a sample of non-autistic adults who completed the Autism Quotient questionnaire. Autism Quotient score was not correlated with either drift rate or response bias, nor were there between-group differences when splitting based on the first and third quantiles of scores. In Experiment 2, we compared the performance of autistic with a group of non-autistic adults. There were no between-group differences in either drift rate or starting point. The results of this study do not support the previous suggestion that autistic people have an extended temporal binding window for audiovisual speech. In addition, exploratory analysis revealed that operationalising the temporal binding window in different ways influenced whether a group difference was observed, which is an important consideration for future work.

Observation and imitation of object-directed hand movements in Parkinson's disease.

Action observation and imitation may facilitate movement in Parkinson's disease (PD). People with PD have been found to imitate intransitive actions similarly to neurologically healthy older adults, but their imitation of object-directed hand movements has not previously been investigated using kinematic measures. The present study examined observation and imitation of object-directed hand movements in 18 participants with PD and 21 neurologically healthy age-matched control participants. Participants observed and immediately imitated sequences showing a human hand reaching for and transferring an object between horizontal positions. Both groups significantly modulated their finger movements, showing higher vertical amplitude when imitating elevated compared to direct trajectories. In addition, movements were lower in vertical amplitude and higher in velocity when imitating the reaching segment than the transfer segment. Eye-tracking revealed that controls made smaller saccades when observing predictable than unpredictable elevated movements, but no effects of predictability on eye movements were found for the PD group. This study provides quantitative evidence that people with mild to moderate PD can imitate object-directed hand movement kinematics, although their prediction of such movements may be reduced. These findings suggest that interventions targeting object-directed actions may capitalize on the ability of people with PD to imitate kinematic parameters of a demonstrated movement.

Measuring the prediction of observed actions using an occlusion paradigm: Comparing autistic and non-autistic adults.

Action prediction involves observing and predicting the actions of others and plays an important role in social cognition and interacting with others. It is thought to use simulation, whereby the observers use their own motor system to predict the observed actions. As individuals diagnosed with autism are characterized by difficulties understanding the actions of others and motor coordination issues, it is possible that action prediction ability is altered in this population. This study compared action prediction ability between 20 autistic and 22 non-autistic adults using an occlusion paradigm. Participants watched different videos of a female actor carrying out everyday actions. During each video, the action was transiently occluded by a gray rectangle for 1000 ms. During occlusions, the video was allowed to continue as normal or was moved forward (i.e., appearing to continue too far ahead) or moved backwards (i.e., appearing to continue too far behind). Participants were asked to indicate after each occlusion whether the action continued with the correct timing or was too far ahead/behind. Autistic individuals were less accurate than non-autistic individuals, particularly when the video was too far behind. A trend analysis suggested that autistic participants were more likely to judge too far behind occlusions as being in time. These preliminary results suggest that prediction ability may be altered in autistic adults, potentially due to slower simulation or a delayed onset of these processes. LAY SUMMARY: When we observe other people performing everyday actions, we use their movements to help us understand and predict what they are doing. In this study, we found that autistic compared to non-autistic adults were slightly less accurate at predicting other people's actions. These findings help to unpick the different ways that social understanding is affected in autism.

The blind men and the elephant: The case for a transdiagnostic approach to initiation.

Difficulty initiating voluntary action is an under-recognized and often invisible impairment in various psychiatric, neurodevelopmental, and neurological conditions. Understanding the commonalities of volition impairments across diagnoses is limited by a lack of consistent terminology, arbitrary distinctions between conditions, the habit of looking only to the prevailing definitions and theories to explain observed traits, and the covert nature of initiation. The siloed approach to research in this area evokes the parable of the blind men and the elephant, where understanding the whole picture is impeded by a limited view. There has been little effort to consider how differing terms overlap or to use objective methods to differentiate phenomena along meaningful lines. We propose a triad of interacting elements, all of which are needed for successful initiation of voluntary action: (i) executive function, (ii) volition, and (iii) movement. Failure to initiate a response may be due to impairments in any of these, which often co-occur. This paper calls for the following considerations to improve research in this area: (i) put aside preconceptions about conditions and their mechanisms to adopt a flexible transdiagnostic approach; (ii) consider executive function, movement, and volition as possible dimensional variations with related underlying mechanisms; (iii) carefully differentiate components of complex functions; (iv) look to first-hand reports for covert and previously unrecognized traits. These approaches have the potential to elucidate the cognitive and biological mechanisms underpinning voluntary action and create a foundation to develop more appropriate and informed interventions.

Time perception in autistic adults: Interval and event timing judgments do not differ from nonautistics.

It has previously been proposed that autistic people have problems with timing which underlie the behavioral and cognitive differences in the condition. However, the nature of this postulated timing issue has not been well specified and the existing experimental literature has generated mixed findings. In the current study, we attempted a systematic investigation of timing processes in autistic adults using scalar expectancy theory as a theoretical framework. Autistic (n = 58) and nonautistic (n = 91) adults matched for age, sex, and full-scale IQ completed a battery of auditory and visual timing tasks measuring basic subsecond duration perception (temporal discrimination thresholds), clock processes (verbal estimation), clock and memory processes (temporal generalization), and event timing (temporal order judgments). Participants also completed suprasecond retrospective duration estimates where the participant was not warned in advanced that they would be required to make a timing judgment, and questionnaires measuring self-reported timing behaviors in daily life. The groups reported differences on questionnaires, but measures of timing performance were comparable overall. In an exploratory analysis, we performed principal components analysis to investigate the relationship between timing judgments and participants' self-reported social-communicative, sensory, and motor traits. Measures of timing performance were not well correlated with these questionnaire scores. The current study, the largest conducted on time and autism to date, shows no clear evidence for reduced timing performance in autistic adults. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Chasing the conversation: Autistic experiences of speech perception.

Background and aims: Humans communicate primarily through spoken language and speech perception is a core function of the human auditory system. Among the autistic community, atypical sensory reactivity and social communication difficulties are pervasive, yet the research literature lacks in-depth self-report data on speech perception in this population. The present study aimed to elicit detailed first-person accounts of autistic individuals' abilities and difficulties perceiving the spoken word. Methods: Semi-structured interviews were conducted with nine autistic adults. The interview schedule addressed interviewees' experiences of speech perception, factors influencing those experiences, and responses to those experiences. Resulting interview transcripts underwent thematic analysis. The six-person study team included two autistic researchers, to reduce risk of neurotypical 'overshadowing' of autistic voices. Results: Most interviewees reported pronounced difficulties perceiving speech in the presence of competing sounds. They emphasised that such listening difficulties are distinct from social difficulties, though the two can add and interact. Difficulties were of several varieties, ranging from powerful auditory distraction to drowning out of voices by continuous sounds. Contributing factors encompassed not only features of the soundscape but also non-acoustic factors such as multisensory processing and social cognition. Participants also identified compounding factors, such as lack of understanding of listening difficulties. Impacts were diverse and sometimes disabling, affecting socialising, emotions, fatigue, career, and self-image. A wide array of coping mechanisms was described. Conclusions: The first in-depth qualitative investigation of autistic speech-perception experiences has revealed diverse and widespread listening difficulties. These can combine with other internal, interpersonal, and societal factors to induce profound impacts. Lack of understanding of such listening difficulties - by the self, by communication partners, by institutions, and especially by clinicians - appears to be a crucial exacerbating factor. Many autistic adults have developed coping strategies to lessen speech-perception difficulties or mitigate their effects, and these are generally self-taught due to lack of clinical support. Implications: There is a need for carefully designed, adequately powered confirmatory research to verify, quantify, and disentangle the various forms of listening difficulty, preferably using large samples to explore heterogeneity. More immediate benefit might be obtained through development of self-help and clinical guidance materials, and by raising awareness of autistic listening experiences and needs, among the autistic community, communication partners, institutions, and clinicians.

Decreased visual attention further from the perceived direction of gaze for equidistant retinal targets.

The oculomotor and spatial attention systems are interconnected. Whereas a link between motor commands and spatial shifts in visual attention is demonstrated, it is still unknown whether the recently discovered proprioceptive signal in somatosensory cortex impacts on visual attention, too. This study investigated whether visual targets near the perceived direction of gaze are detected more accurately than targets further away, despite the equal eccentricity of their retinal projections. We dissociated real and perceived eye position using left somatosensory repetitive transcranial magnetic stimulation (rTMS), which decreases cortical processing of eye muscle proprioceptive inflow and produces an underestimation of the rotation of the right eye. Participants detected near-threshold visual targets presented in the left or right visual hemifield at equal distance from fixation. We have previously shown that when the right eye is rotated to the left of the parasagittal plane, TMS produces an underestimation of this rotation, shifting perceived eye position to the right. Here we found that, in this condition, TMS also decreased target detection in the left visual hemifield and increased it in the right. This effect depended on the direction of rotation of the right eye. When the right eye was rotated rightward and TMS, we assume, shifted perceived gaze direction in opposite direction, leftward, visual accuracy decreased now in the right hemifield. We suggest that the proprioceptive eye position signal modulates the spatial distribution of visual processing resources, producing "pseudo-neglect" for objects located far relative to near the perceived direction of gaze.