Community Member Views on Autism Intervention: Effects of Closeness to Autistic People with Intellectual Disabilities And Nonspeaking Autistic People.

Background: Controversy regarding the neurodiversity movement (NDM), the social and medical models of disability, autism intervention goals, and causal attributions of disability contributes to divides in the autistic and autism communities. The present study investigates the views of autistic and non-autistic autistic and autism community members on these topics. We explored whether these views are shaped by having close relationships to autistic people with intellectual disabilities (ID) and nonspeaking autistic (NSA) people. Methods: A total of 504 autistic and autism community members (278 autistic, 226 non-autistic) completed an online survey about theoretical models and intervention goals. Participants reported whether they had one or more close relationships with NSA people, autistic people with ID, neither, or both. Results: Overall, there was considerable consensus regarding desired intervention goals: normalization goals were generally opposed, while participants generally supported well-being, societal reform, supportive environment, and adaptive skill goals. While autistic participants reported less support for normalization and adaptive skills goals than non-autistic participants, they expressed somewhat more enthusiasm for societal reform and supportive environments than non-autistic people. Autistic people supported the NDM more and the medical model less than non-autistic people. Those close to autistic people with ID gave higher ratings to adaptive skill goals. On average, participants not close to autistic people with ID saw the challenges of those without ID as being slightly more due to environmental/social factors than the challenges of those with ID; there was no such statistical difference among those close to autistic people with ID. Conclusion: Further research investigating community views, with the inclusion of more autistic people with ID and NSA people themselves, is needed, but the results of this study suggest that the broader autistic and autism communities see NDM-consistent intervention goals as appropriate for all autistic people, including NSA people and those with ID. As autism interventions have often pursued unpopular normalization goals, this suggests directions for reform.

Why is this an important issue? Disagreements about the neurodiversity movement have divided autistic people, their family members, and autism professionals. These include debates about whether the neurodiversity movement includes and represents the interests of autistic people who may have higher support needs, such as nonspeaking individuals and autistic people with intellectual disabilities. They also include debates about what goals autism interventions and supports should focus on. What is the purpose of this study? The purpose of this study is to explore the views of autistic and autism community members (e.g., autistic people, family members, and professionals) on: the neurodiversity movement,the social model of disability (which views society as the source of disability-related challenges),the medical model of disability (which says disabled people's own characteristics cause disability-related challenges), anddifferent autism intervention goals. We explored whether these views are related to whether participants were autistic and/or had close relationships with autistic people with higher support needs. What did the researchers do? We collected online survey responses from 504 autistic people, family members, and autism professionals. Participants shared whether they were close to nonspeaking autistic people or autistic people with intellectual disabilities. Participants answered questions about various intervention goals and their support for the neurodiversity movement and other models of disability. What were the results of this study? Both autistic and non-autistic participants supported the neurodiversity movement and interventions that aim to change society, create supportive environments for autistic people, and promote well-being. Both autistic and non-autistic participants generally opposed interventions trying to make autistic people more normal, but autistic people were especially unlikely to support the goals of making autistic people normal. Autistic people were less enthusiastic about the goal of teaching "useful" skills and more strongly opposed to the medical model. Autistic people were more likely than non-autistic people to support the neurodiversity movement, reforming society and creating better environments for autistic people, but these differences were not large. Participants close to autistic people with intellectual disabilities supported teaching useful skills slightly more than those not close. What do these findings add to what is already known? These findings further our understanding of the perspectives of autistic and autism community members on neurodiversity, models of disability, and preferred intervention goals. What are the potential weaknesses of this study? The participants in this study were mostly White women from North America and Europe. We obtained few responses from people who more strongly oppose the neurodiversity movement or from autistic individuals who have the highest support needs. This means that our findings do not represent all autistic and autism community members. Different participants may also have understood the idea of a "close relationship" differently. How will these findings help autistic adults now or in the future? These findings may be useful to autistic adults and other members of the autistic and autism communities who want to connect with others and advocate for autism intervention research that fits their shared goals. Results can help professionals to develop interventions that better match the goals of different members of the autistic and autism communities.

Characteristics of self-harm on an adolescent psychiatric inpatient unit based on neurodevelopmental diagnoses.

Introduction: Engagement in self-harm is common among youth in psychiatric inpatient units, however the nature of self-harm may be different in psychiatric care due to the increased supervision and theoretically decreased access to typical means of self-harm. This study aims to describe daily reports of self-harm experienced during psychiatric inpatient stays among adolescents and compare these inpatient self-harm experiences based on neurodevelopmental diagnoses (NDDs, including autism) given that self-harm methods differ across NDD diagnostic groups outside of the inpatient unit. Methods: Data were derived from a larger study of risk factors among a sample of 119 suicidal adolescent inpatients, recruited from a large, urban adolescent inpatient psychiatric unit. Participants answered a daily series of self-report questions, including items about self-harm engagement, frequency, and methods used since the last survey. Results: There was no difference in the number of participants who reported any engagement in self-harm based on diagnostic group (χ2 = 0.08, p = .96). There were also no differences in the frequency of self-harm across diagnostic groups (F = 2.40, p = .12). There were no differences in the use of any method across diagnostic groups (ps > 0.05). Conclusions: Findings revealed that in an inpatient unit where patients are presenting for self-harm risk, there are no significant differences in engagement, frequency, or methods used for self-harm based on autism and NDD status. These analyses provide valuable clinical information regarding a lack of differences in self-harm by these diagnostic subgroups. Future research should seek to further explore functional purposes of self-harm on inpatient unit and how this differs by diagnoses.

Student radiographers' confidence of adapting practice for autistic patients: A qualitative survey on the role of placement experiences.

INTRODUCTION: Healthcare services can be inaccessible to autistic people without adaptions to clinical practice and the care provided. Therefore, understanding how radiographer education develops students' confidence in adapting care for autistic patients is crucial. This study aimed to explore how placement experience impacts student radiographer confidence in adapting care for autistic patients. METHODS: UK final-year student diagnostic and therapeutic radiographers were invited to complete a qualitative online survey. The survey asked for a description of placement experiences; of observing and/or performing the care of autistic patients and how this impacted confidence in caring for autistic patients. The data was thematically analysed. RESULTS: 43 responses (of 44 received) were included, from which 5 themes emerged. Those who felt placement experiences developed confidence described opportunities to apply theory learnt at university (theme 1) or drew attention to the benefit of prior (external) experience with autistic people (theme 3). However, the balance of power with the supervising radiographer (theme 2), witnessing autistic patients in distress (theme 4), and the heterogeneous nature of autism (theme 5) disrupted students' development of confidence. CONCLUSION: Several participants in this study found clinical placement developed confidence with autistic patients through applying knowledge and providing an opportunity for reflexive learning. However, various obstacles hindered this development, such as witnessing distressed patients, limited experiences with autistic patients and difficulty navigating relationships with radiographers. IMPLICATIONS FOR PRACTICE: To improve student radiographers' confidence of providing care for autistic patients, educators should consider methods, e.g., co-produced simulation, to fill potential gaps in their experience. There is also a pressing need for all radiographers to understand their responsibility in educating students and their impact on student wellbeing.

Neurodiversity in the Minds of Students: From Perception to Campus Programming.

Neurodiversity is a social justice movement at the nexus of neuroscience, academia, and public policy. A contemporary view of neurodiversity is one that embraces neurological differences, encompassing all "neurotypes," including more specific identifiers like autistic or dyslexic. The goal of this study was to investigate student awareness and perception of neurodiversity since they are the next generation of public policy makers. Students enrolled in Introduction to Behavioral Neuroscience (N=146) were exposed to different information sources (popular, academic, TED talk, or choose/find their own) on the topic of neurodiversity. They then wrote a paper where they summarized: a) the information source used, b) their ideas to better support a neurodiverse society, and c) their opinions on aspects of neurodiversity. Several important findings emerged. First, 64% of the sample had never heard of the term neurodiversity; this class was their first exposure to it. Second, students conducting their own searches on neurodiversity had the highest level of optimism (p < 0.05) that society was ready to accept neurodiversity. Students identified even higher rates of receptivity (85%) amongst their friends. Third, student ideas to advance neurodiversity were organized into more salient categories for campuses to consider. Our findings challenge neuroscience programs to consider their role in providing "first exposure" opportunities to students in the diversity, equity, and inclusion realm, especially in areas directly related to our field. We also discuss the growing relevance of neurodiversity in research and academia and offer programming possibilities to enhance neurodiversity awareness and support on college campuses.

Neurodivergent students. A continuum of skills with an emphasis on creativity and executive functions.

This study analyses Executive Functions (EF) and Creativity among neurodivergent students -including students with Attention Deficit Hyperactivity Disorder (ADHD), Dyslexia, Intellectual Disability (ID), Giftedness-, and a group with Neurotypical development. A sample of 181 secondary school students participated in the study. Creativity was assessed by using the PIC-J test, focusing on verbal and figural components of divergent thinking, while EF were evaluated through Nesplora Ice-Cream, a virtual reality tool assessing flexibility, working memory, and inhibition. Results showed statistically significant differences in Verbal Creativity, especially in Originality: students with ADHD outperformed their Neurotypical peers, while those with ID showed the lowest scores. Although no statistically significant differences emerged in Figural Creativity, students with ADHD showed the lowest scores in Elaboration or Figural details, whereas those with Dyslexia exhibited high levels of Figural Originality, similar to their Neurotypical peers. Concerning EF, students with ID had the highest scores in Interference and Perseveration, indicating poorer Flexibility. In contrast, Gifted students performed better than the other groups in Working Memory, while students with ADHD did not exhibit special difficulties in EF. These findings emphasize the importance of personalized interventions for Neurodivergent students, that recognize and capitalize on their unique strengths while addressing specific challenges.

Mental health and timing of gender-related events among transgender and gender-diverse children and adolescents seeking gender-affirming consultation and care.

Transgender and gender-diverse (TGD) youth encounter unique challenges affecting their mental health, largely related to societal stigma and gender dysphoria. Limited research considers the specific needs of TGD youth. This study examined demographic and developmental factors, including the ages at which gender-related events occur, and their relationship to mental health among TGD youth seeking gender-affirming consultation and care (GACC). We examined the medical records of 674 TGD children and adolescents, comparing demographics, gender-related events, and mental health across gender groups. The total sample comprised 261 patients assigned male at birth, and 413 patients assigned female at birth. Non-binary individuals reported higher rates of psychopathology compared to binary transgender patients, with transgender boys exhibiting higher rates than transgender girls. Seeking GACC at a more advanced pubertal stage and older age was associated with an increased likelihood of psychopathology. Later recollection of first gender incongruence memory was correlated with higher rates of depression and anxiety. Finally, socioeconomic status was linked to GACC healthcare-seeking behaviors. These findings underscore the importance of recognizing the diverse experiences and needs of TGD youth seeking GACC services, highlighting that early identification and access to care may be crucial for improving mental health outcomes.

Continuing the conversation about echolalia and gestalt language development: A response to Haydock, Harrison, Baldwin, and Leadbitter.

LAY ABSTRACT: It was recently suggested that a set of ideas known as gestalt language development be embraced as a neurodiversity-affirmative practice. Neurodiversity refers to the idea that people interact with the world in many different ways and that there is not a single right way to do so. Some aspects of gestalt language development, such as embracing autistic communication, are consistent with neurodiversity. However, gestalt language development is also associated with numerous ideas, assertions, and clinical strategies that lack theoretical and empirical support. For this reason, we believe it is premature to embrace gestalt language development as a neurodiversity-affirmative practice. We propose that it is important to make sure we use language that differentiates between delayed echolalia and the broader set of ideas that comprise gestalt language development. We also suggest that it is important to discuss the relationship between neurodiversity-affirmative practices and practices supported by research evidence.

Aesthetic processing in neurodiverse populations.

Neurodiversity is a perspective on cognition which suggests a non-pathological view of individual cognitive differences. Aesthetics research on neurodivergent brains has generally been limited to neuropsychological cases. Although this research has been integral to establishing the neurological correlates of aesthetic experience, it is crucial to expand this paradigm to more psychologically complex disorders. We offer a review of research on aesthetic preference in neurodivergent brains beyond neuropsychological cases: across populations with psychotic disorder, anhedonia and depression, anxiety disorder, and autism. We identify stable patterns of aesthetic bias in these populations, relate these biases to symptoms at perceptual, emotional, and evaluative levels of cognition, review relevant neurological correlates, and connect this evidence to current neuroaesthetics theory. Critically, we synthesize the reviewed evidence and discuss its relevance for three brain networks regularly implicated in aesthetic processing: the mesocorticolimbic reward circuit, frontolimbic connections, and the default mode network. Finally, we propose that broadening the subject populations for neuroaesthetics research to include neurodiverse populations is instrumental for yielding new insights into aesthetic processing in the brain.

Eating competence is related to executive function skills in college students.

PURPOSE: This study aimed to determine the relationship between eating competence (EC) and executive function (EF) skills in college students. METHODS: This cross-sectional study was part of a larger study in which an online survey was administered during autumn quarter 2020 to undergraduate students at a northwestern U.S. public university. Sociodemographic data were collected, along with measures of EC (16-item Satter Eating Competence Inventory, ecSI-2.0™) and EF skills (27-item Executive Function Index, EFI). Multiple linear regression was used to examine the ecSI-2.0™ total score and its four domain scores with each of the five EF skills. RESULTS: Of the 1996 respondents included in the final analyses, 40.2 % were eating competent (total ecSI-2.0™ ≥32). The mean ecSI-2.0™ score among participants was 28.7. Gender distribution was 72.0 % women, 23.3 % men, and 4.7 % trans-and-gender non-conforming (TGNC) or preferred not to answer. EFI scores were higher among women (70.9) than among men (68.2) and TGNC (64.9). Both total ecSI-2.0™ score and the contextual skills domain were significantly associated with four of the EFI subscales. Internal regulation was related to impulse control and motivational drive. Further significant associations were found with other domains of ecSI-2.0™ and specific EFI subscales. CONCLUSION: EF skills are associated with EC in college students, particularly skills related to food management and internal regulation. Since both EF and EC can be developed, this study offers promise for future research in an increasingly gender-diverse and neurodiverse college population during a time of increasing independence and autonomy.

Community views of neurodiversity, models of disability and autism intervention: Mixed methods reveal shared goals and key tensions.

LAY ABSTRACT: What is already known about the topic? Some people support the neurodiversity movement and other people criticize it. They often disagree about what the neurodiversity movement means. Confusion about what the neurodiversity movement is makes it hard for people to agree about how best to support autistic or disabled people.What does this article add? We studied autistic and autism community members' views on the neurodiversity movement and autism interventions. Most participants supported the neurodiversity movement. Support for the neurodiversity movement was related to wanting to change society and make places more comfortable for autistic people. Neurodiversity supporters felt autistic children should choose their own intervention goals and that autistic adults should help children choose goals. Neurodiversity supporters did not think autistic people should be taught to act less autistic. Both those agreeing and disagreeing with the neurodiversity movement said that it is important to help autistic people be well. Many participants said that society causes all the difficulties disabled people experience. Yet they were somewhat open to helping people grow by teaching them useful skills and trying to cure depression and epilepsy.Implications for practice, research or policy. To better help autistic people, we should listen to participants in this study. They called for improving society, building more spaces where autistic people feel comfortable and helping autistic people lead change. They warned against teaching autistic people to hide their autism. Critics of the neurodiversity movement should read this article to better understand what neurodiversity movement supporters believe. By taking time to learn from one another, we can work together to better support autistic people.

Is neurodiversity a Global Northern White paradigm?

LAY ABSTRACT: Scholarship addressing neurodiversity has made enormous progress in challenging and providing alternative narratives to the dominant frameworks of medical model. Although this is a necessary and important development, scholars need to think and act beyond the immediate local context of theory generation (Global North-mainly the United Kingdom and the United States) and examine its impact on the racialized neurodivergent individuals of the Global Majority. This article will provide a decolonial framework that has been missing in the neurodiversity scholarship. The arguments presented in the article aligns well with the goals of critical autism studies and will further inform the knowledge in this area. Through a decolonial lens, this article brings the crucial issue of knowledge production outside of Global Northern countries, specifically, knowledge systems from the Global South that have parallels with neurodiversity. The article frames neurodiversity as part of an interconnected knowledge continuum rather than considering Global North alone as the only loci of knowledge production. Furthermore, it highlights the lack of focus on the intersections between racialisation and neurodivergence and the implications of this for the racialized neurodivergent individuals of the global majority. The article provides new avenues for theoretical discourses to emerge within the academy. It will have important research implications in relation to how neurodiversity will be viewed and framed outside Global Northern countries. The article highlights the importance of engaging in intersectional and interdisciplinary research and establishing a critical link with the scholars of neurodiversity, critical autism studies, and disability critical race studies.

(Re)thinking about self-harm and autism: Findings from an online qualitative study on self-harm in autistic adults.

LAY ABSTRACT: There is a higher prevalence of self-harming behaviours within the autistic community than is experienced by the general population, in addition to co-occurring mental health conditions such as anxiety and depression. To date, research has focused on quantifying and categorising the numbers of autistic people self-harming, what types of harming they are engaging in and what functions the harming performs. Autism research has historically focused on the opinions and experiences of parents, carers and clinicians, with a belief that autistic people are unable to present their own experiences and thoughts accurately. This study adopted a qualitative method to develop themes arising from online forum discussions, using the words of autistic adults talking about how they experience and understand their self-harming behaviours. The analysis discovered that self-harming behaviours are used by autistic people as a way of coping with anxiety and depression and to relieve the build up of stress and sensory or mental overload that can otherwise lead to a meltdown. Repetitive behaviours such as stimming are also used to relieve the buildup of sensory over-stimulation and anxiety, but both stimming and meltdowns can also be self-harming behaviours if they cause tissue damage, and are believed to be childhood presentations which are stigmatised if expressed by an autistic adult. Many autistic adults find it hard to get help with self-harming behaviours because they are not taken seriously by professionals, as it is seen as part of autism and cannot be helped, or the professionals do not have enough knowledge of autism.

Fundamental intersectionality of menopause and neurodivergence experiences at work.

This investigation explores the complex interplay between menopause and neurodivergence in the workplace, employing thematic analysis of qualitative data from 43 participants across the United Kingdom and the United States. Findings reveal that menopause transitions intensify symptoms of neurodivergence, and can interrupt how women engage with paid work. By shining a light on these under-reported experiences at work, we demonstrate how employers can better support their neurodivergent employees during menopause. Applying the Demand-Control model, this research underscores the necessity for workplaces to adopt more inclusive practices and supportive adaptations that go beyond flexible work and that are focused on pressures faced by neurodivergent women during menopause. Participants were more likely to report a decrease in workplace experiences than work performance in response to the disruptive effects of menopause on neurodiversity. This is an important insight for people managers as experiences of work might be less closely monitored than performance. This study advocates for a unified approach of organisational support for the intersectional effects of menopause and neurodiversity.

Eating Disorder and Autism Collaborative project outline: promoting eating disorder research embedded in a neurodiversity-affirming culture.

EDAC (Eating Disorders and Autism Collaborative) is an innovative project aiming to increase research capacity by supporting collaboration in the fields of eating disorders and autism. EDAC comprises four integrated workstreams to co-produce interdisciplinary research, directed by Autistic individuals with lived experience of eating disorders. Workstream 1 will outline best collaborative practices, informing the research network. Workstream 2 will use arts-based methodologies to set research priorities, with emphasis on the perspectives of underrepresented groups. Workstream 3 will support interdisciplinary collaborations to develop innovative research. Finally, workstream 4 will maximise knowledge mobilisation with the aim of reducing barriers to rapid incorporation of research into policy and clinical practice. A core aim of EDAC is to embed a neurodiversity-affirming culture within eating disorder research and to support the development of a new generation of researchers conducting innovative and meaningful research with the potential to improve clinical outcomes.

"Because people don't know what it is, they don't really know it exists": a qualitative study of postgraduate medical educators' perceptions of dyscalculia.

BACKGROUND: Dyscalculia is defined as a specific learning difference or neurodiversity. Despite a move within postgraduate medical education (PGME) towards promoting inclusivity and addressing differential attainment, dyscalculia remains an unexplored area. METHODS: Using an interpretivist, constructivist, qualitative methodology, this scoping study explores PGME educators' attitudes, understanding and perceived challenges of supporting doctors in training (DiT) with dyscalculia. Through purposive sampling, semi-structured interviews and reflexive thematic analysis, the stories of ten Wales-based PGME educators were explored. RESULTS: Multiple themes emerged relating to lack of educator knowledge, experience and identification of learners with dyscalculia. Participants' roles as educators and clinicians were inextricably linked, with PGME seen as deeply embedded in social interactions. Overall, a positive attitude towards doctors with dyscalculia underpinned the strongly DiT-centred approach to supporting learning, tempered by uncertainty over potential patient safety-related risks. Perceiving themselves as learners, educators saw the educator-learner relationship as a major learning route given the lack of dyscalculia training available, with experience leading to confidence. CONCLUSIONS: Overall, educators perceived a need for greater dyscalculia awareness, understanding and knowledge, pre-emptive training and evidence-based, feasible guidance introduction. Although methodological limitations are inherent, this study constructs novel, detailed understanding from educators relating to dyscalculia in PGME, providing a basis for future research.

Stress, resilience, and emotional well-being in children and adolescents with specific learning disabilities.

This article reviews the prevalence of stress and explores resilience factors in children and adolescents with specific learning disabilities (SLDs). We show that the increased stress and emotional challenges faced by this group are likely due to societal pressures and stigma. Recent findings on neuroendocrine changes in this population are discussed, suggesting a predisposition to psychiatric disorders. This review advocates for a societal shift towards the neurodiversity paradigm, which recognizes SLDs as natural variations in brain function, emphasizing individual strengths and promoting a more inclusive approach that values cognitive diversity. Such advocacy is likely important to combat stress and stigma in those with SLDs. This article also reviews recent work identifying resilience-promoting factors, such as perception of self and peer/teacher relationships, for enhancing emotional well-being and mental health for children and adolescents with SLD.

Addressing Sensory Challenges in Athletes with Autism Spectrum Disorder: A Clinical Commentary.

Athletes with autism spectrum disorder (ASD) experience lesser care for injuries and athletic trainers (ATs) report feeling unprepared to provide care competently for this population. Provision of sports-related care can be impacted by sensory differences associated with ASD such as hyper-reactivity to sensation or poor integration of sensory information. An in-depth review of the literature using the Strength of Recommendation Taxonomy (SORT) guidelines was used to identify articles that address the sensory features of autism for athletic trainers with the purpose of informing athletic trainers about the sensory features of ASD and to present the most current evidence-based recommendations for providing care to athletes with ASD and other neurodivergent individuals who present with sensory differences. Relevant articles were reviewed by four independent researchers and organized by theme. Key themes included use of sensory friendly or adapted environments, sensory kits, and informed communication strategies that acknowledge sensory differences. Providing individualized care for athletes with ASD and sensory features can improve the quality of and participation in sports for autistic persons.

Relationships between autistic traits, self-efficacy, and internalizing symptoms in a nonclinical sample of Indian early adolescents.

INTRODUCTION: Having more "autistic traits" is associated with an increased risk of mental health conditions. However, few studies have examined autistic traits in nonclinical samples. This study aims to analyze the relationship between autistic traits and internalizing symptoms among early adolescents and to examine the moderating effect of self-efficacy. METHODS: Survey data were collected from early adolescents ages 10-14 living in Darjeeling, India (n = 274) to assess autistic traits, self-efficacy, and internalizing symptoms. RESULTS: Higher internalizing symptoms were significantly associated with a higher report of autistic traits. Academic, social, and emotional dimensions of self-efficacy moderated the relationship between autistic traits and internalizing symptoms. CONCLUSION: The moderation effects between social and emotional self-efficacy among youth with high versus low autism trait scores suggest the need for social-emotional learning interventions designed for and with neurodivergent youth. Such interventions aim to reduce internalizing symptoms during early adolescence and improve future mental health trajectories.