Repetitive Behaviors in Autism and Obsessive-Compulsive Disorder: A Systematic Review.

PURPOSE: Obsessive-compulsive disorder (OCD) and autism are characterized by the presence of repetitive behaviors. Differentiating between repetitive behaviors attributable to a diagnosis of autism, and those attributable to OCD, poses challenges for differential and co-occurring diagnosis. Differentiation is important to inform appropriate supports and interventions for phenotypically similar but functionally distinct behaviors. In this systematic review, the quantitative literature was examined to explore the similarities and differences in repetitive behaviors (including restricted and repetitive behaviors and interests, and obsessive-compulsive behaviors) in autistic individuals and those with OCD, and those with co-occurring diagnoses, in terms of: (1) expression, (2) content, and (3) associated factors. METHODS: Thirty-one studies were identified that compared repetitive behaviors in autistic individuals, individuals with OCD, or individuals with both diagnoses. RESULTS: The results suggest considerable overlap in the intensity and content of repetitive behaviors between groups. The findings of this review highlight that research aimed specifically at understanding similarities and differences in repetitive behaviors between autistic individuals and individuals with OCD is limited and frequently only compare at total score or composite measure levels. CONCLUSION: Further research into differences in the presentation of repetitive behaviors at a subscale and item level is required to inform clearer differentiation of specific behaviors in autism versus OCD. Understanding and more accurately differentiating is essential for efficient diagnosis, effective treatment, and better outcomes.

High Autistic Traits or Low Social Competence? Correlates of Social Camouflaging in Non-Autistic Adults.

Background: Autistic traits have been linked with the use of social camouflaging behavior by non-autistic people. In addition, low social competence (i.e., poor social skills) has also been posited as a possible explanation for the use of social camouflaging by non-autistic people. In this study, we investigated the comparative influence of autistic traits and social competence on three components of social camouflaging (compensation, masking, and assimilation) in a sample of non-autistic adults. Methods: Using a cross-sectional design, we recruited 284 undergraduate students (28.5% male; 69.7% female; 1.8% not specified) who reported that they had never been diagnosed with autism. Participants completed standardized measures assessing social camouflaging, autistic traits, social competence, and psychological distress via an online questionnaire. Results: We found that women reported greater use of social camouflaging, and greater social camouflaging use was associated with worse psychological distress. We also found that both social competence and autistic traits were associated with the use of social camouflaging, with higher autistic traits influencing camouflaging use to a greater degree than low social competence. Compared with the use of compensation- and assimilation-based social camouflaging, masking was the least well explained by the current predictors. Conclusions: We conclude that social competence and autistic traits are important factors influencing the use of social camouflaging by non-autistic adults. However, there are other (unknown) factors that contribute to the use of each aspect of camouflaging by non-autistic individuals, and a deeper understanding of the individual motivations for social camouflaging use is still needed. In turn, this may allow for the development of psychosocial interventions to offset the need for social camouflaging and mitigate the negative psychological consequences often associated with its use.

Why is this an important issue?: Autistic traits have been linked with the use of social camouflaging behavior by non-autistic people. Poor social skills have also been suggested as a possible explanation for social camouflaging use by non-autistic people. By exploring social camouflaging with non-autistic people, we may be able to offer different, and possibly complimentary, understandings about the developing construct of social camouflaging and its link with psychological well-being. What was the purpose of this study?: We explored the links between aspects of autism and social skills, and the use of different social camouflaging behaviors, among non-autistic people with varying levels of autistic traits and social skills. What did the researchers do?: We conducted an online survey with 284 undergraduate students who stated that they had never been diagnosed with autism. Our participants provided personal information (e.g., age, gender) and answered questionnaires that investigated different types of autistic traits (rigid personality, pragmatic language deficits, and aloof personality) and aspects of social competence (initiating relationships, asserting displeasure, self-disclosure, providing emotional and managing interpersonal conflict) in relation to three different types of social camouflaging behavior (compensation, masking, and assimilation) and their psychological well-being. What were the results of the study?: We found that both low self-assessed social skills and high autistic traits were associated with the use of social camouflaging behaviors by non-autistic adults. Women reported more social camouflaging than men. We also found that higher autistic traits influenced social camouflaging use more than low social skills, although the strength of influence varied with the type of social camouflaging behavior. All types of social camouflaging were related to worse psychological well-being. What do these findings add to what is already known?: This study is among the first to investigate social camouflaging, autistic traits, and social skills in a nuanced way with non-autistic people. Our findings offer new explanations for how specific camouflaging behaviors may be influenced by different aspects of social behavior in non-autistic people. What are potential weaknesses in this study?: Our participants were university students, so most participants were young, female, and Caucasian. Therefore, research within diverse samples of non-autistic people is still needed. Also, we only looked at a broad measure of psychological distress, so more in-depth investigation of social camouflaging and specific psychological experiences, such as social anxiety, is still needed. How will these findings help autistic adults now or in the future?: Social camouflaging seems to be costly in terms of the effort required to camouflage and its flow-on effects for psychological well-being. Understanding what factors might contribute to camouflaging for both autistic and non-autistic adults might lead to better ideas about less effortful ways to manage difficult social situations or techniques to reduce possible costs of camouflaging.

Perceived vocational support needs and return-to-work outcomes in the first 12-months post-discharge in individuals with acquired brain injury and spinal cord injury: A retrospective cohort study.

BACKGROUND: Return-to-work (RTW) is often viewed as an important outcome following acquired brain injury (ABI) and spinal cord injury (SCI), although not all individuals have vocational goals and many experience barriers to RTW. OBJECTIVE: This study investigated the relationship between RTW and psychosocial functioning at 12-months post-discharge after ABI and SCI and examined patterns of RTW according to perceived need for and receipt of vocational support. METHODS: A file audit was conducted for 69 participants with ABI (n = 44) and SCI (n = 25). Data on employment status and perceived vocational support at 3- and 12-months post-discharge, home and community participation, psychological distress, and health-related quality of life were extracted. RESULTS: Individuals in paid employment at 12-months post-discharge (22%, n = 15) reported significantly better psychosocial functioning at this timepoint compared to those not employed (78%; n = 54). For those not employed, three subgroups were identified: 1) Did not perceive the need for or receive vocational support (50%; n = 27); 2) Perceived vocational support needs were unmet (19%; n = 10); and 3) Perceived and received vocational support (31%; n = 17). Psychological distress was highest for those who perceived and received vocational support but were not employed. CONCLUSION: RTW was associated with better psychosocial functioning after acquired neurological injury. The findings highlight the need for clinicians to explore and revisit individuals' perceived need for and preferences for vocational support and monitor the psychological well-being of those with RTW goals that are not yet successful.

Stigma following acquired brain injury and spinal cord injury: relationship to psychological distress and community integration in the first-year post-discharge.

PURPOSE: This study aimed to compare stigma levels after acquired brain injury (ABI) and spinal cord injury (SCI) during the first 12-months post-discharge and investigate relationships between stigma, psychological distress and community integration. METHODS: 110 adults with ABI (55%) or SCI (45%) were recruited from brain and spinal cord injury inpatient rehabilitation units of a tertiary healthcare facility. They were administered Neuro-QOL Stigma subscale and Depression Anxiety and Stress Scales (DASS-21) at discharge, 3-months and 12-months post-discharge, and Community Integration Measure at 12-months post-discharge. RESULTS: Stigma levels did not significantly differ between individuals with ABI and SCI. However, stigma significantly decreased between discharge and 12-months post-discharge for the total sample. Stigma was positively associated with psychological distress at discharge and 3-months post-discharge, but not at 12-months post-discharge. Lower functional status and power wheelchair use were associated with higher stigma at 12-months post-discharge. Stigma at 3-months post-discharge predicted community integration at 12-months post-discharge, controlling for psychological distress and functional status. CONCLUSION: Experience of stigma in the first few months post-discharge may negatively impact individuals' community reintegration. The early post-discharge period may be a pivotal time for supporting individuals to explore disability and injury-related appraisals and enhance connection to their community.

Lower functional status and use of a power wheelchair after acquired neurological injury may increase the experience of stigma.Individuals with acquired brain injury or spinal cord injury who perceive high levels of stigma in the first few months post-discharge are more likely to experience poorer long-term community integration.The first few months post-discharge represent an important phase for health professionals to support individuals to explore their beliefs regarding disability and injury-related self-appraisals and enhance connection to their community.