The impact of depressive and anxious symptoms on quality of life in adults on the autism spectrum.

Quality of life (QoL) is lower in adults on the autism spectrum (AS) compared with typically developing (TD) adults. In this context, recent studies have examined the role of depression and anxiety in reducing QoL in AS adults. The aim of this study was to (1) replicate these findings of lower QoL and (2) assess the negative influence of depressive and anxious symptoms on QoL in an adult AS (N = 86) and TD (N = 87) German sample with a broad age range (18-70 years). For this, we used questionnaires that have been validated for the AS and TD population: the World Health Organization Quality of Life Brief Version, the Autism-Specific QoL items, and the Hospital Anxiety and Depression Scale. We replicated previous findings and extended them to autism-specific QoL. Our AS sample had lower QoL compared with the TD adults. However, depressive symptoms were the largest contributor to lower QoL in both samples, more so than group membership and anxious symptoms. We conclude that interventions to improve QoL in AS adults should specifically target depressive symptoms and for this, improvements to the diagnostic process and treatment of depression in AS are necessary.

Association between anxiety, depression and quality of life in male and female German students during the COVID-19 pandemic.

BACKGROUND: Studies show that three-quarters of mental disorders appear during young adulthood, which makes students a risk group. Especially people with anxiety and depression experience lower Quality of Life (QoL) compared to healthy persons. Furthermore, previous research found that there was a wide range of negative mental consequences triggered by the COVID-19 pandemic. This study aimed to examine the association between anxiety, depression and QoL in male and female students at the time of the COVID-19 pandemic. METHODS: 297 German students (121 men, age spanmen: 18-41 years; 176 women, age spanwomen: 18-52 years) filled in the following questionnaires: World Health Organization Quality of Life Brief Version, Hospital Anxiety and Depression Scale and the Symptom-Checklist-90-R. Men and women did not differ significantly in their physical, psychological, environmental and global QoL. RESULTS: While women showed higher raw anxiety scores, groups did not differ in terms of their raw depression scores. Furthermore, we found main effects of anxiety and depression on the four QoL subscales. Students´ QoL was highest if they were not affected by anxiety and depression, independently of gender. Psychological and social QoL was worst if the students reported marginal and particularly clinically significant levels of anxiety and depression. Men experienced worse psychological and social QoL than women for clinically significant anxiety levels. CONCLUSIONS: Interventions should target especially the psychological and the social subscales of QoL, as these areas are most affected by anxiety and depression. Possible interventions could be psychoeducational programs or participation in sports because it offers an opportunity for social interaction and goal-directed activity.

Emotions and worries during 1.5 years of the COVID-19 pandemic - how adults with and without mental health conditions coped with the crisis.

BACKGROUND: During the COVID 19 pandemic, there were social restrictions with severe mental stress for a long time. Most studies on mental health consequences of the pandemic focused primarily on the beginning of the pandemic. The present study on families of patients or study participants of a child and adolescent psychiatry aimed to examine long-term profiles of emotions and worries in adults with and without mental health condition (mhc) during the first 1.5 years of the COVID-19 pandemic. METHODS: We surveyed emotions and worries of 128 adults with (n = 32) and without (n = 96) pre-pandemic mhc over a 1.5-year study period from spring 2020 until summer/autumn 2021. Emotions and worries were captured at four time points: [i] pre-pandemic, [ii] spring 2020 (first lockdown was implemented), [iii] December 2020 (hard lockdown at Christmas time) and [iv] summer/autumn 2021 (considerable ease of regulations); [i] pre-pandemic and [iii] December 2020 were measured retrospectively). First, we run non-parametric tests to compare emotions and worries between adults with and without pre-pandemic mhc at the four time points. Next, we conducted latent profile analysis to identify subgroups from the total sample who share similar trajectories of emotions and worries. Finally, a logistic regression analysis was run to examine whether socio-demographic and psycho-social factors were related to identified trajectories of emotions and worries. RESULTS: Adults without pre-pandemic mhc reported a strong worsening of emotions and worries at the beginning of the pandemic and a lower worsening during the course, while adults with pre-pandemic mhc reported a constant worsening of emotions and worries. The latent profile analysis revealed three profiles of adults who show either i) an adaption, ii) no adaption or iii) a continuous high condition. With increasing age, higher perceived stress and pre-pandemic mhc, the likelihood of an adaption was increased. CONCLUSION: The results of the present study suggested that adults (both with and without pre-pandemic mhc) coped the crisis with different strategies and that most of them returned to their initial, pre-pandemic levels of emotions and worries when social restrictions were considerably eased or stopped.

Examining a model of anxiety in autistic adults.

ABSTRACT: Anxiety disorders commonly occur in autism. Existing studies implicate intolerance of uncertainty, alexithymia, sensory processing differences and emotion regulation difficulties as influencing factors of anxiety in autism. To date, a few studies have considered the combination of these factors within the same sample. This study used structural equation modelling to test the prediction that intolerance of uncertainty and emotion regulation constitute more direct causes of anxiety in autism that mediate the influences of sensory processing difference and alexithymia as more sequential contributing factors. Autistic (n = 86) and non-autistic adults (n = 100) completed a battery of self-report questionnaires. Only when applied to each group separately, the broad predictions of the model were confirmed for the autistic group following data-driven additions of paths between sensory processing difference and anxiety and alexithymia implying that sensory processing difference contribute indirectly as well as directly to individual differences in anxiety. For the non-autistic group, model fit could only be achieved after removing autism-related traits and sensory processing differences as predictors of anxiety. These results suggest that aetiology and expression of anxiety in autism partially overlap with what is observed in the general population except that sensory processing differences appear to play a relatively unique role in the context of autism.

Validation of the German Glasgow Sensory Questionnaire and replication of sensory processing differences in students with higher and lower Autism-Spectrum Quotient.

BACKGROUND: The Glasgow Sensory Questionnaire (GSQ) gives insight into sensory processing differences (hypo- and hyper-sensitivity across modalities), which is a clinically defining characteristic of autism spectrum disorder (ASD). Because there is no validated German version of this instrument, this study aimed at validating the German GSQ. Further, a replication of the GSQ's sensory processing differences was intended. METHODS: University students of Technische Universität or Universitätsklinikum in Dresden, Germany, were recruited via email distribution or the university homepage and 297 German-speaking students completed the online survey, comprising the German GSQ, Autism-Spectrum Quotient (AQ) and Symptom-Checklist (SCL-90). For validation of the German GSQ, confirmatory factor analyses followed by exploratory factor analyses were applied. RESULTS: The German GSQ has moderate to low validity, good to acceptable reliability, and a different internal structure from the original GSQ. Replicating the sensory processing differences in students with higher and lower AQ was not successful. CONCLUSIONS: Results indicate that the GSQ, developed especially for individuals with ASD, is less informative for the general population if there are not enough individuals with higher AQ scores in the sample.

Arousal-modulated memory encoding and retrieval in adults with autism spectrum disorder.

Recently, we have shown that pupil dilation during a recognition memory task can serve as an index of memory retrieval difficulties in autism. At the time of publication, we were unaware of specific data-analysis methods that can be used to shed further light on the origins of such memory related pupil dilation. Specifically, by distinguishing "tonic" from "phasic" changes in pupil dilation and considering their temporal progression, it is possible to draw inferences about the functional integrity of a locus coeruleus-norepinephrine system (LC-NE) that is known to play a key role in regulating memory encoding and retrieval processes. We therefore apply these analyses to our previously published eye-tracking data of adults with ASD (N = 24) and neurotypical development (TD, N = 30) during the recognition memory task. In this re-analysis, we related pupil dilation during encoding and retrieval to recognition accuracy in a per-trial analysis of linear mixed models. In ASD, we replicated attenuated recognition accuracy, which was accompanied by attenuated pupil dilation during encoding and retrieval. Group differences in pupil dilation during retrieval occurred late during the trial (after 1.75 s) and indicated an altered top-down processing like attenuated attribution of semantic salience in response to previously encoded stimuli. In addition, only in the ASD group were higher pupil dilation during encoding and lower pupil dilation during retrieval associated with decreased recognition accuracy. This supports altered modulation of memory encoding and retrieval in ASD, with LC-NE phasic activity as promising underlying mechanism. LAY SUMMARY: We investigated the changes of pupil size during memory testing in autism spectrum disorder. Adults with ASD remembered fewer items correctly than neurotypical individuals (TD). This reduced memory was related to increased pupillary responses at study and decreased pupil dilation at test only for adults with ASD indicating a different modulation of memory by the locus coeruleus.

What Can Performance in the IEDS Task Tell Us About Attention Shifting in Clinical Groups?

The Intra-Extra-dimensional set shift task (IEDS) is a widely used test of learning and attention, believed to be sensitive to aspects of executive function. The task proceeds through a number of stages, and it is generally claimed that patterns of errors across stages can be used to discriminate between reduced attention switching and more general reductions in rates of learning. A number of papers have used the IEDS task to argue for specific attention shifting difficulties in Autism Spectrum Disorder (ASD) and Schizophrenia, however, it remains unclear how well the IEDS really differentiates between reduced attention shifting and other causes of impaired performance. To address this issue, we introduce a simple computational model of performance in the IEDS task, designed to separate the competing effects of attention shifting and general learning rate. We fit the model to data from ASD and comparison individuals matched on age and IQ, as well as to data from four previous studies which used the IEDS task. Model fits do not show consistent evidence for reductions in attention shifting rates in ASD and Schizophrenia. Instead, we find performance is better explained by differences in learning rate, particularly from punishment, which we show correlates with IQ. We, therefore, argue that the IEDS task is not a good measure of attention shifting in clinical groups. LAY SUMMARY: The Intra-Extra-Dimensional Set shift task (IEDS) is often given to autistic individuals, who tend to make more errors relative to comparison groups. This higher error rate is taken to mean that autistic individuals struggle with attention control. Our computational model of the IEDS shows that the performance of ASD and some other clinical groups can be explained instead by differences in learning rate, rather than differences in attention control.

Short-Term Memory Span and Cross-Modality Integration in Younger and Older Adults With and Without Autism Spectrum Disorder.

This study tested whether adults with autism spectrum disorder (ASD) show the same pattern of difficulties and absence of age-related differences in short-term memory (STM) as those that have been reported in episodic long-term memory (LTM). Fifty-three adults with ASD (age range: 25-65 years) were compared to 52 age-, biological sex-, and intelligence-matched typically developing (TD; age range: 21-67 years) adults on three STM span tasks, which tested STM performance for letters (Verbal), grid locations (Visuospatial), or letters in grid locations (Multimodal). A subsample of 34 TD and 33 ASD participants ranging in age from 25 to 64 years completed a fourth Multimodal Integration task. We also administered the Color Trails Test as a measure of executive function. ASD participants' accuracy was lower than that of the TD participants on the three span tasks (Cohen's d: 0.26-0.50). The Integration task difference was marginally significant (p = .07) but had a moderate effect size (Cohen's d = 0.50). Regression analyses confirmed reduced STM performance only for older TD participants. Analyses also indicated that executive processes played a greater role in the ASD group's performance. The demonstration of similar difficulties and age-related patterning of STM in ASD to those documented for LTM and the greater recruitment of executive processes by older ASD participants on the Integration task suggest a compensatory role of frontal processes both as a means of achieving undiminished task performance and as a possible protection against older age cognitive decline in ASD. Longitudinal research is needed to confirm this. Autism Res 2020, 13: 1970-1984. © 2020 The Authors. Autism Research published by International Society for Autism Research and Wiley Periodicals LLC. LAY SUMMARY: Little is known about short-term memory (STM) in younger and older adults with autism spectrum disorder (ASD). This study tested different kinds of STM and showed that ASD adults remembered shorter sequences of letters, crosses, or letters in grid cells less well than matched participants with typical development. However, older ASD individuals performed similarly to younger ASD individuals, nor showing the reduction in performance usually seen with older age. The data suggest that ASD individuals use different underlying mechanisms when performing the tasks and that this might help protect their memory as they grow older.

Memory in autism spectrum disorder: A meta-analysis of experimental studies.

To address inconsistencies in the literature on memory in autism spectrum disorder (ASD), we report the first ever meta-analysis of short-term memory (STM) and episodic long-term memory (LTM) in ASD, evaluating the effects of type of material, type of retrieval and the role of interitem relations. Analysis of 64 studies comparing individuals with ASD and typical development (TD) showed greater difficulties in ASD compared with TD individuals in STM (Hedges' g = -0.53, 95% CI [-0.90, -0.16], p = .005, I² = 96%) compared with LTM (g = -0.30, 95% CI [-0.42, -0.17], p < .00001, I² = 24%), a small difficulty in verbal LTM (g = -0.21, p = .01), contrasting with a medium difficulty for visual LTM (g = -0.41, p = .0002) in ASD compared with TD individuals. We also found a general diminution in free recall compared with cued recall and recognition (LTM, free recall: g = -0.38, p < .00001, cued recall: g = -0.08, p = .58, recognition: g = -0.15, p = .16; STM, free recall: g = -0.59, p = .004, recognition: g = -0.33, p = .07). We discuss these results in terms of their relation to semantic memory. The limited diminution in verbal LTM and preserved overall recognition and cued recall (supported retrieval) may result from a greater overlap of these tasks with semantic long-term representations which are overall preserved in ASD. By contrast, difficulties in STM or free recall may result from less overlap with the semantic system or may involve additional cognitive operations and executive demands. These findings highlight the need to support STM functioning in ASD and acknowledge the potential benefit of using verbal materials at encoding and broader forms of memory support at retrieval to enhance performance. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

A Physiological Marker of Recognition Memory in Adults with Autism Spectrum Disorder? - The Pupil Old/New Effect.

This study investigated the pupil Old/New effect in individuals with Autism Spectrum Disorder (ASD) and typical development (TD). Participants studied verbal and visual meaningful and meaningless materials in black and white on a computer screen. Pupil sizes were measured while participants performed a Remember (episodic memory with context)/Know (semantic memory, no context) recognition memory test. ASD compared to TD individuals showed significantly reduced recognition rates for all materials. Both groups showed better memory for visual compared to verbal (picture superiority effect) and meaningful compared to meaningless materials. A pupil size ratio (pupil size for test item divided by baseline) for old (studied) and new (unstudied) materials indicated larger pupils for old compared to new materials only for the TD but not the ASD group. Pupil size in response to old versus new items was positively related to recognition accuracy, confirming that the pupil Old/New effect reflects a memory phenomenon in the ASD group. In addition, this study suggests an involvement of the noradrenergic neurotransmitter system in the abnormal hippocampal functioning in ASD. Implications of these findings, as well as their underlying neurophysiology, will be discussed in relation to current theories of memory in ASD. Autism Res 2020, 13: 627-640. © 2019 International Society for Autism Research, Wiley Periodicals, Inc. LAY SUMMARY: Most measures of memory in Autism Spectrum Disorder (ASD) depend on verbal answers. In addition to these verbal answers, this study measured the size of the participants' pupil in response to studied and unfamiliar materials revealing memory difficulties in ASD. Measuring pupil size works nonverbally, outside of conscious awareness and forms the basis of studies on less verbal persons with ASD. Mechanisms and brain regions underlying memory differences in ASD are discussed.

Spatial navigation from same and different directions: The role of executive functions, memory and attention in adults with autism spectrum disorder.

To resolve some of the inconsistencies in existing research into spatial navigation in autism spectrum disorder (ASD), we tested two large age- and ability-matched groups of ASD and typically developing (TD) participants for their spatial navigation abilities in a route learning task, which has been shown to shed light on the strategies participants employ when navigating complex environments. Participants studied a route through a virtual maze by watching a short video of a first-person perspective navigating a maze. The maze included four four-way intersections that were each marked with two unique landmarks in two corners of the intersection. At test, static images of the intersections, either as seen during the video or as approached from a different direction, were presented and participants had to indicate in which direction they would need to travel (straight, left, or right) in order to follow the originally studied route. On both types of test trials, the ASD group performed worse and their difficulties were related to reduced cognitive flexibility. Eye-movement data and follow-up item-memory tests suggested that navigation difficulties may have been related to differences in attention during encoding and less spontaneous use of landmarks as cues for navigation. Spatial navigation performance was best predicted by memory for landmarks as well as by executive functions. The results are discussed in relation to theories of underlying navigation-related brain regions. More research is needed to disentangle the influence of executive functions, memory and attention on spatial navigation. Autism Res 2018, 11: 798-810. © 2018 International Society for Autism Research, Wiley Periodicals, Inc. LAY SUMMARY: Navigating an environment is difficult for people with ASD independent of whether they are travelling in the same or in a different direction from that which they originally studied. The present study suggests that flexibility in alternating travel directions, difficulties in remembering landmarks as well as reduced attention to landmarks while learning a route play a role in the navigation difficulties in ASD. Guidance at route learning might help autistic individuals to improve their ability to navigate in their environments.

Allocentric Versus Egocentric Spatial Memory in Adults with Autism Spectrum Disorder.

Individuals with autism spectrum disorder (ASD) present difficulties in forming relations among items and context. This capacity for relational binding is also involved in spatial navigation and research on this topic in ASD is scarce and inconclusive. Using a computerised version of the Morris Water Maze task, ASD participants showed particular difficulties in performing viewpoint independent (allocentric) navigation, leaving viewpoint dependent navigation (egocentric) intact. Further analyses showed that navigation deficits were not related to poor visual short-term memory or mental rotation in the ASD group. The results further confirm the need of autistic individuals for support at retrieval and have important implications for the design of signposts and maps.

The Influence of task Demands, Verbal Ability and Executive Functions on Item and Source Memory in Autism Spectrum Disorder.

Autism Spectrum Disorder (ASD) is generally associated with difficulties in contextual source memory but not single item memory. There are surprising inconsistencies in the literature, however, that the current study seeks to address by examining item and source memory in age and ability matched groups of 22 ASD and 21 comparison adults. Results show that group differences in source memory are moderated by task demands but not by individual differences in verbal ability, executive function or item memory. By contrast, unexpected group differences in item memory could largely be explained by individual differences in source memory. These observations shed light on the factors underlying inconsistent findings in the memory literature in ASD, which has important implications for theory and practice.

Problem-solving styles in autism spectrum disorder and the development of higher cognitive functions.

The Vygotsky Blocks Test assesses problem-solving styles within a theoretical framework for the development of higher mental processes devised by Vygotsky. Because both the theory and the associated test situate cognitive development within the child's social and linguistic context, they address conceptual issues around the developmental relation between language and thought that are pertinent to development in autism. Our aim was to document the performance of adults with autism spectrum disorder on the Vygotsky Blocks Test, and our results showed that they made more errors than the typically developing participants and that these errors correlated with performance IQ. The autism spectrum disorder group also required more cues than the typically developing group to discern the conceptual structure of the blocks, a pattern that correlated with Autism Diagnostic Observational Schedule-Communication and Imagination/Creativity sub-scales. When asked to categorize the blocks in new ways, the autism spectrum disorder participants developed fewer principles on which to base new categorizations, which in contrast to the typically developing group correlated with verbal IQ and with the Imagination/Creativity sub-scale of the ADOS. These results are in line with a number of existing findings in the autism spectrum disorder literature and confirm that conceptualization in autism spectrum disorder seems to rely more on non-verbal and less on imaginative processes than in typically developing individuals. The findings represent first steps to the possibility of outlining a testable account of psychological development in autism spectrum disorder that integrates verbal, non-verbal and social factors into the transition from elementary to higher level processes.

An Eye-Movement Study of relational Memory in Adults with Autism Spectrum Disorder.

Persons with Autism Spectrum Disorder (ASD) demonstrate good memory for single items but difficulties remembering contextual information related to these items. Recently, we found compromised explicit but intact implicit retrieval of object-location information in ASD (Ring et al. Autism Res 8(5):609-619, 2015). Eye-movement data collected from a sub-sample of the participants are the focus of the current paper. At encoding, trial-by-trial viewing durations predicted subsequent retrieval success only in typically developing (TD) participants. During retrieval, TD compared to ASD participants looked significantly longer at previously studied object-locations compared to alternative locations. These findings extend similar observations recently reported by Cooper et al. (Cognition 159:127-138, 2017a) and demonstrate that eye-movement data can shed important light on the source and nature of relational memory difficulties in ASD.

Structural learning difficulties implicate altered hippocampal functioning in adults with autism spectrum disorder.

Structural learning is fundamental to the formation of cognitive maps that are necessary for learning, memory, and spatial navigation. It also enables successful navigation of the social world, which is something that individuals with autism spectrum disorder (ASD) find particularly difficult. To master these situations, a person needs to bind pieces of information to one another and to consider the context in which experiences happen. Such binding is a capacity of the hippocampus. Although altered hippocampal function has for long been suspected to play a role in the etiology of ASD, the relevant evidence has remained inconclusive because few behavioral tests that are known to specifically necessitate preserved hippocampal function have been employed in studies of ASD. To address this gap in the literature, a total sample of 57 pairs of age and ability matched ASD and comparison participants was divided into 3 subsamples who were asked either to complete structural learning, or 1 of 2 configural learning control tasks (biconditional discrimination and transverse patterning) drawn from animal research. As predicted, ASD adults demonstrated specific difficulty with structural learning but not with other forms of configural learning. These differences were not attributable to decreased attentional shifting or increased perseveration, which would have indicated atypical frontal modulation of hippocampal processes. Instead, the observations implicate atypical hippocampal functioning as the source of structural learning difficulties in ASD. The data suggest that disturbances in domain-general cognitive processes such as structural learning, caused by altered hippocampal function, play a critical role in the etiology of ASD. (PsycINFO Database Record

Similar exemplar pooling processes underlie the learning of facial identity and handwriting style: Evidence from typical observers and individuals with Autism.

Considerable research has addressed whether the cognitive and neural representations recruited by faces are similar to those engaged by other types of visual stimuli. For example, research has examined the extent to which objects of expertise recruit holistic representation and engage the fusiform face area. Little is known, however, about the domain-specificity of the exemplar pooling processes thought to underlie the acquisition of familiarity with particular facial identities. In the present study we sought to compare observers' ability to learn facial identities and handwriting styles from exposure to multiple exemplars. Crucially, while handwritten words and faces differ considerably in their topographic form, both learning tasks share a common exemplar pooling component. In our first experiment, we find that typical observers' ability to learn facial identities and handwriting styles from exposure to multiple exemplars correlates closely. In our second experiment, we show that observers with Autism Spectrum Disorder (ASD) are impaired at both learning tasks. Our findings suggest that similar exemplar pooling processes are recruited when learning facial identities and handwriting styles. Models of exemplar pooling originally developed to explain face learning, may therefore offer valuable insights into exemplar pooling across a range of domains, extending beyond faces. Aberrant exemplar pooling, possibly resulting from structural differences in the inferior longitudinal fasciculus, may underlie difficulties recognising familiar faces often experienced by individuals with ASD, and leave observers overly reliant on local details present in particular exemplars.

Relational Memory Processes in Adults with Autism Spectrum Disorder.

Research into memory in Autism Spectrum Disorder (ASD) suggests intact item memory but difficulties in forming relations between items (Bowler, Gaigg, & Lind, 2011). In this study, we tested memory for items as well as for sequential, spatial, and associative relations between items with the same paradigm using abstract shapes in ASD and typically developing (TD) individuals. Participants studied shape triplets on a computer screen and memory was subsequently tested either for the individual items making up the triplets, the screen-locations, the order or the combinations of items presented at study. Contrary to our predictions, performance was significantly lower in the ASD group on all four tasks. The result raises questions about how intact item memory is in ASD, which role task complexity plays, and how item-specific versus relational processing affect task performance. One possibility is that TD individuals relied more on relational processing in the current study and might have therefore had an advantage over ASD individuals. This idea is supported by the result of a preliminary analysis of age-related differences in memory across the midadult lifespan in both groups. Age seems to affect order memory less in ASD compared with TD individuals where it leads to a significant decrease in performance. This might indicate a decrease in relational processing in TD but not ASD individuals with increasing age. More research is needed to answer questions about the change in cognition in ASD individuals across the lifespan.

Object-location memory in adults with autism spectrum disorder.

This study tested implicit and explicit spatial relational memory in Autism Spectrum Disorder (ASD). Participants were asked to study pictures of rooms and pictures of daily objects for which locations were highlighted in the rooms. Participants were later tested for their memory of the object locations either by being asked to place objects back into their original locations or into new locations. Proportions of times when participants choose the previously studied locations for the objects irrespective of the instruction were used to derive indices of explicit and implicit memory [process-dissociation procedure, Jacoby, 1991, 1998]. In addition, participants performed object and location recognition and source memory tasks where they were asked about which locations belonged to the objects and which objects to the locations. The data revealed difficulty for ASD individuals in actively retrieving object locations (explicit memory) but not in subconsciously remembering them (implicit memory). These difficulties cannot be explained by difficulties in memory for objects or locations per se (i.e., the difficulty pertains to object-location relations). Together these observations lend further support to the idea that ASD is characterised by relatively circumscribed difficulties in relational rather than item-specific memory processes and show that these difficulties extend to the domain of spatial information. They also lend further support to the idea that memory difficulties in ASD can be reduced when support is provided at test.