Theory of Mind and Social Informant Discrepancy in Autism.

When autistic youth are asked to assess their own social skills, they frequently rate themselves more favorably than their parents rate them. The magnitude of this informant discrepancy has been shown to relate to key clinical outcomes such as treatment response. It has been proposed that this discrepancy arises from difficulties with Theory of Mind. Participants were 167 youth 11 to 17 years old; 72% male, and their parents. Youth completed self-report measures of social skills and social cognitive tasks, while their parents completed questionnaires regarding social skills. A repeated-measures ANOVA indicated both non-autistic and autistic youth rated themselves more favorably than their parents rated them across all measures. Zero-order correlations revealed that raw differences between parent- and participant-report were negatively correlated with scores on parent-reported Theory of Mind measures. However, polynomial analysis did not indicate interaction effects between parent- and participant-report on any of the measures used. Polynomial regression revealed that increases in parent-reported social skill predicted larger increases in parent-report Theory of Mind at low levels of parent-reported social skill compared to high levels of parent-reported social skill. Participant-report social skills predicted performance on a behavioral Theory of Mind test in a curvilinear fashion, such that the relationship was positive at low levels of participant-reported social skills, but negative at high levels. This study replicates the finding that raw difference score analyses may result in illusory effects that are not supported when using more contemporary analysis methods, and that more complex and subtle relationships between social insight and perspective-taking exist within autistic youth.

Seeking contexts that promote neurodiverse social success: Patterns of behavior during minimally-structured interaction settings in autistic and non-autistic youth.

While peer interaction differences are considered a central feature of autism, little is known regarding the nature of these interactions via directly-observed measurement of naturalistic (i.e., minimally-structured) groups of autistic and non-autistic adolescent peers. 148 autistic and non-autistic adolescents (111 male, Mage = 14.22, SDage = 1.90; MIQ = 103.22, SDIQ = 15.80) participated in a 50-minute, minimally-structured, naturalistic peer interaction paradigm with activities of varying social demands: an incidental social demand (eating in a room with peers), a physical social demand (playing a physically-interactive game), and a verbal social demand (playing a verbal game). While autistic youth exhibited fewer overall interaction behaviors than non-autistic youth, the two groups did not differ in amount of positive, negative, and low-level interaction behaviors. Within activities, autistic and non-autistic youth only differed in positive interaction behaviors during the context of a verbal social demand. Youth who displayed more positive interaction behaviors during this same activity had less autism spectrum disorder symptomatology, controlling for nested group effects and relevant covariates. These results point toward subtle differences in social demands across naturalistic settings that can either support or impede prosocial interaction for autistic youth, providing a guidepost for identifying settings that best promote social success for neurodiverse populations.

Leveling Up Dialectical Behavior Therapy for Autistic Individuals with Emotion Dysregulation: Clinical and Personal Insights.

Autistic people may experience high emotion and sensory sensitivities and a slow return to baseline emotional state. Dialectical behavior therapy (DBT) was developed to address reactivity, impulsivity, and mood dysregulation in individuals with mood and personality disorders. DBT may be therapeutically beneficial to autistic individuals struggling with these or similar emotional and sensory challenges. This article is a synthesis of the first author's experiences of DBT as an autistic person and professional insights from all authors. We provide an overview of the development of DBT, its foundational components, and adaptations. Using this basis, the first author describes the benefits DBT has had, the modifications that have helped him, and how those modifications may enhance DBT for autistic people. Modifications include visuals, graphics, and a gaming format that target the client's personal interests. The essence of these alterations is to transform life skills and DBT skills into something meaningful and functional. Receptivity of the therapist to the modifications and neurodivergent problem solving may be foundational to therapeutic success. Client-initiated contributions in collaborative therapy may improve autistic participants' understanding, validation, and adherence with DBT. The authors suggest expanding work on DBT modifications for autism in the areas of daily self-monitoring, assessing for preferred visual and gaming formats, and utilizing personal interests.

Why is this topic important?: Many autistic people struggle with their emotions. There are few therapies that assist autistic people with these challenges. Dialectical behavior therapy (DBT) is a therapy that teaches skills for coping with emotions and forming healthy bonds with others. DBT may provide benefits to autistic people. What is the purpose of this article?: This article uses personal insights with DBT from the first author. The article combines the professional expertise of all authors. We talk about the strengths DBT may have for autistic people. We recommend changes to make DBT a more helpful therapy. What personal or professional perspectives do the authors bring to this topic?: The first author is an autistic researcher in psychology. He has other mental health disabilities. He has been in DBT. The second author is an autistic person working in autism research and advocacy. The remaining authors are non-autistic. They do research and therapy with autistic people. What is already known about this topic?: DBT is used to help people manage their emotions and engage with others successfully. Many autistic people struggle with these skills. There is not a lot of research on how DBT can benefit autistic people. Early work has shown that it might be effective for autistic people. What do the authors recommend?: We outline several changes to DBT that might make it more helpful to autistic people. One change included is using images to help autistic people keep track of therapy skills. Another suggested change is making therapy into a game. More research is needed to test if these changes work in larger groups of autistic people. How will these recommendations help autistic adults now or in the future?: We hope therapists use these changes to DBT to better support autistic people. We hope that this encourages more research into how DBT can better help autistic people. Autistic people may also benefit from DBT skills in their own lives.

A Systematic Review of Passing as Non-autistic in Autism Spectrum Disorder.

While long described in anecdotal accounts of the lived experiences of autistic individuals, the phenomenon of behaving in ways that appear inconsistent with the presence of autism (or passing as non-autistic; PAN) has recently seen a dramatic increase in scrutiny in the published scientific literature. Increased research attention has coincided with a proliferation of methods, definitions, measures, and population assumptions associated with PAN. To date, however, no review has sought to systematically identify and synthesize the literature on PAN. This systematic review reflects the state of the PAN literature as of May 2020. Ninety articles were screened, 66 were identified for evaluation, and 46 met inclusion criteria and were reliably coded for study characteristics and participant characteristics. Results reveal that the PAN literature includes a relatively even mix of qualitative, quantitative, and mixed-method studies, and that a variety of terms are used for PAN (with masking and camouflage being the most frequent). Sample sizes varied widely (from one to 832 participants), with 63.06% of participants being categorized as autistic. Nearly all studies reported methods for confirming autism diagnoses, with community and clinical diagnoses being most common. The majority of studies reported participant gender, with slightly more females included than males on average, but fewer than half of all studies compared PAN across genders. Nearly all studies reported participant age, demonstrating a wide range of 2 to 79 years, with a mean age of 23.85. Conversely, only 23.91% of studies provided participant race or ethnicity data. Nearly all studies formally or informally excluded participants with intellectual disability. Finally, measures of internalizing symptoms, which are often thought to be linked to PAN, were reported in only 17.4% of studies. Implications for gaps in understanding of PAN and future directions for the field are discussed.

Hooked on a feeling: Repetitive cognition and internalizing symptomatology in relation to autism spectrum symptomatology.

Repetitive cognition, including rumination such as that seen in depression, has been shown to correlate with depression symptoms in both typically developing individuals and individuals with autism spectrum disorder. Repetitive cognition is more common in autism spectrum disorder than in typically developing peers, as is depression; thus, this study evaluated the role of repetitive cognition in relation between autism spectrum symptomatology and depressive symptomatology. In all, 200 typically developing adults completed self-report questionnaires measuring autism spectrum symptomatology, different forms of repetitive cognition (general perseveration and depressive rumination), depression, and rejection sensitivity. Perseveration was found to mediate the relation between autism spectrum symptoms and depression, and to partially mediate the relation between autism spectrum symptoms and rejection sensitivity. We conclude that it is of vital importance to consider cognition when considering depression in autism spectrum disorder.