Purpose Children with autism spectrum disorder (ASD) frequently experience mental health challenges, including anxiety, emotional dysregulation and difficulties in social interactions. This study aims to explore the effectiveness of technology-based interventions, such as mobile applications, virtual reality, serious games and telehealth programs, in improving the mental well-being of children with ASD. Design/methodology/approach A comprehensive literature search was conducted across PubMed, CINAHL and the Cochrane Library, adhering to the preferred reporting items for systematic reviews and meta-analyses framework to ensure methodological rigor. Findings The findings indicate that digital interventions can significantly reduce anxiety, enhance emotional regulation and promote social engagement. However, inconsistencies in study designs, small sample sizes and limited longitudinal research highlight the need for further investigation. Originality/value This review underscores the potential of digital technologies as accessible and scalable therapeutic tools while emphasizing the necessity of standardized guidelines to optimize their implementation in clinical and educational settings.

Purpose This study aims to understand the lived experiences of culturally and linguistically diverse (CaLD) parents of autistic children who participated in a longitudinal self-directed (without clinical coaching) parent-led therapy (PLT) programme targeting social-communication skills, or who were unable to complete participation in the longitudinal study coached group sessions. This work explores how each participant’s specific context impacted their engagement with online PLT. Design/methodology/approach Five mothers from a range of CaLD backgrounds participated in this study from different countries. Semi-structured online interviews were conducted. Interpretative phenomenological analysis was used to analyse data, focusing on understanding each participant’s lived experience. Findings Two superordinate themes were developed: (1) cultural differences amplify barriers to online PLT; (2) linguistic adaptations of therapeutic strategies need to be contextualised for each CaLD environment. Research limitations/implications Participants had high English proficiency and academic backgrounds, which may not represent the CaLD population struggling most with PLT engagement. Further investigation among non-Western, educated, industrialised, rich, democratic populations is warranted. Practical implications Specific considerations for socio-cultural adaptations are needed beyond linguistic translations. Social implications CaLD minorities without heritage links to their country of residence face amplified challenges in supporting their autistic children. Such families need more contextualised support to enhance PLT engagement. Originality/value PLT is emerging as a useful support approach for parents of autistic children in bilingual environments. This study explores perspectives of CaLD parents who were not able to complete group PLT programmes to better understand to better engage parents in online PLT.

Purpose This paper examines the persistent underdiagnosis of autism spectrum disorder, particularly among women, adults and minority groups. This study aims to identify how gendered symptom expression, camouflaging behaviours, systemic barriers and cultural inequities affect diagnostic accuracy and timeliness. Design/methodology/approach A structured narrative review of 33 peer-reviewed empirical studies published between 2009 and 2024, with one historical paper from 1992 retained for context. Sources were retrieved from PubMed, Scopus and Web of Science. We used controlled vocabulary and free-text terms. Methodological quality was appraised with critical appraisal skills programme, Joanna Briggs Institute and A Measurement Tool to Assess Systematic Reviews, version 2. Reporting followed Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020. Findings were synthesised across four domains: gender differences in diagnostic timing, camouflaging and phenotypic variability, systemic barriers and cultural and linguistic factors. Findings Standard diagnostic frameworks (Diagnostic and statistical manual of mental disorders, Fifth Edition, International Classification of Diseases, 11th Revision) demonstrate limited sensitivity for atypical presentations, particularly among females and high-ability individuals. Delays are compounded by cultural and linguistic barriers, clinician knowledge gaps and fragmented services. Multimodal assessment and targeted clinician training are linked to better detection and greater equity. Research limitations/implications The included studies varied in methods and populations, which limits the generalisability of findings. Longitudinal and neurobiological evidence is scarce, especially in low- and middle-income countries. Future studies should validate culturally adapted screening tools and explore the neural basis of camouflaging. Practical implications Routine screening in primary care, clearer referral pathways, culturally adapted instruments and telehealth-enabled access may reduce diagnostic delays and disparities. Tailored clinician education may also improve early recognition and reduce misdiagnosis. Originality/value This review integrates gender, cultural and system-level perspectives on autism spectrum disorder underdiagnosis, offering actionable guidance for clinicians, educators and policymakers to support timely and equitable diagnosis.

Purpose The current report aims to provide indicators of parenting stress and coping behaviours across five diverse countries (Bangladesh, Greece, Kenya, UK, Zambia). It was hoped that the use of a single procedure would provide needed data from low-to-middle-income countries, in comparison to the better-studied higher-income countries. Design/methodology/approach In total, 200 parents of children diagnosed with autism spectrum disorder (ASD); 40 in each country) completed a series of scales about their parenting stress and coping styles. Findings The results suggested more similarities than differences. Parenting stress was high in all countries, and the highest was in the UK. Pessimism was also high in low-to-medium-income countries, and lower in Greece and the UK. Passive appraisal was used most often as a coping style, with mobilising the family being used more than social support. Cross-country, the only difference was that the UK parents used seeking spiritual support less than parents from other countries. Coping styles did not mediate the relationship between either ASD severity or behavioural problems and parenting stress. Originality/value These data suggest a degree of similarity across most aspects of parenting across diverse countries, although some atypical results from the UK may mean caution is needed in drawing generalised conclusions from such higher-income countries.

Purpose This paper describes the development of the Dynamic needs assessment tool. The tool aims to support early identification of children and young people (CYP) who may have a combination of unrecognised neurodevelopmental needs, special educational needs and disability (SEND), mental health needs or community support needs. It is intended to be used in a variety of non-specialist settings. The purpose of this study is to create a tool which identifies need across four key areas and signpost professionals to the relevant areas of support. Design/methodology/approach An audit of the adapted Thrive model for CYP (Wee et al., 2021) indicated a need for a stratification tool to support earlier recognition of intellectual needs. This led to a group of practitioners, including specialists in special educational needs and neurodevelopmental conditions working collaboratively to complete a Delphi process. This identified factors which would help identify need in 4 key areas of neurodiversity. Findings The Delphi process resulted in 26 factors being identified, which were considered using face and construct validity tool before being used to create the DNAT SEN tool. This tool can be used in universal settings to support identifying and formulating the overall profile of needs of CYP before offering guidance to support at an early stage for those with SEN or neurodivergence. Originality/value This tool bridges the gap in identifying unmet needs, previous tools have produced a single “RAG” rating, looking at the level of need. However, this tool considers four main areas: Neurodiversity, Special Educational needs, Community Needs and Mental Health Needs.

Purpose Autism is increasingly being diagnosed in older adults. Undiagnosed autism or a later diagnosis may exacerbate health inequalities experienced. This purpose of this study is to examine factors associated with later age of diagnosis for autistic adults. Design/methodology/approach A retrospective cohort study was carried out, involving adults diagnosed by a National Health Service Autism Assessment Service between July 2022 and June 2023. Routine clinical data was extracted from 234 patient records. Findings High rates of suicidality or self-harm were recorded (n = 139, 59.4%). This was significantly (p < 0.05) associated with a younger age of diagnosis, as was being assessed by Child Adolescent Mental Health Services. Factors associated with a later age of diagnosis were living with a spouse/partner (p < 0.001), having no family support (p < 0.001) and having contact with an adult mental health service (p < 0.01). Under 10% of the sample (n = 23, 9.8%) had attention deficit hyperactivity disorder (ADHD) diagnosed which was much lower than expected from previous evidence detailing co-occurrence with autism. Practical implications Clinicians should be aware of the possibility of undiagnosed autism when adults present with mental health issues, including older adults, even when not considered earlier in life. There are risks for people on autism assessment waiting lists, in particular for suicide and self-harm. Autism diagnostic services should consider the use of risk stratification tools for those on waiting lists. They should consider screening and assessment for other neurodevelopmental conditions like ADHD and record existing diagnoses appropriately. Both primary care services referring to gender clinics and mental health services, should consider screening for autism to support clinical formulation. Originality/value To the best of the authors’ knowledge, this is the first study in the UK to assess factors associated with age of autism diagnosis in adults.

Purpose Autism spectrum disorder (ASD) is characterized by deficits in social communication and interaction, restricted interests and repetitive behavior. Humor appreciation in autistic individuals has been examined from the perspective of incongruity-resolution theory but not fully examined in terms of benign violations. Therefore, this study aims to examine the benign violation theory of humor appreciation among autistic individuals. Design/methodology/approach In total, 38 and 462 autistic and non-autistic participants rated the degree of humor appreciation, violation appraisal and benign appraisal of 12 humorous stimuli. Furthermore, participants completed the Social Responsiveness Scale 2 Adult-Self Edition. Findings Restricted interests and repetitive behavior had significant positive effects on humor appreciation, violation appraisal and benign appraisal. Focusing on autistic traits, especially restricted interests and repetitive behavior, is important when considering humor appreciation in autistic individuals because differences in the degree of restricted interests and repetitive behavior are considered a gap in sharing humor. Originality/value This study focused on autistic traits such as deficits in social communication, restricted interests and repetitive behavior and examined their relationships with humor appreciation from the perspective of benign violation theory. The findings suggest that these three autistic traits are involved in the gap in sharing humor between autistic and non-autistic individuals. Therefore, identifying the association between autistic traits and humor appreciation offers a new perspective to support the formation of humorous relationships between autistic and non-autistic individuals.

Purpose In the context of the COVID-19 pandemic lockdowns, telehealth offered a platform to continue providing neurodevelopmental assessment services, however the evidence base for the experience of delivering and receiving an assessment service online is limited. This project was developed to determine the experiences of young people, their families and service clinicians when undertaking the neurodevelopmental assessment online. Design/methodology/approach The project collected data from 13 parents of children who had been assessed via telehealth during the pandemic period. In addition, eleven staff members participated in a staff focus group regarding their experiences and preferences for using telehealth. Findings The majority of parents felt that receiving the assessment via telehealth was suitable for them and their families, however a minority felt that the telehealth option was unsuitable for a range of reasons. There were concerns from both parents and staff that the online assessment was not as accurate as a clinic-based assessment. Other concerns included managing change, uncertainty and risk, technology issues, fatigue and preparing parents adequately for the assessment. Issues for staff such as validity of the process or not seeing the child in person, as well as understanding and predicting which families might benefit from online affordances compared to face-to-face still require more investigation. Originality/value This paper examines the feasibility of delivering neurodevelopmental assessment using telehealth from the perspectives of service users, as well as the staff delivering the service.

Purpose Over the past decade, many studies have investigated peer support between neurotypical and neurodivergent children. Less is known about how autistic children support each other in educational contexts, especially in basic education, where child-adult interactions are still predominant. This study aims to investigate whether and how autistic children supported each other in small-group discussions in the first years of basic education. This paper focused on unraveling the communication structures of these supportive events, aiming to understand further how autistic children make sense of social interactions and intersubjective processes that require peer support. Design/methodology/approach Building on conversation analysis methods, this paper analyzed the transcripts of the small-group discussions, identifying and analyzing the construction of support in children’s dialogues. Nine Finnish children (7–10 years old) attending mainstream school in Finland under intensified support in part-time special classrooms participated in this study. The study adopted a specific method called Idea Diary to frame the small-group discussions. The teacher guided the conversations, providing a dynamic structure for children’s interactions, but students were encouraged to interact among themselves. This paper recorded 11 sessions within the six-month implementation of the Idea Diary, totaling 240 min of data. Findings Results show that the children recognized situations where other children needed support in interactions and intervened in ways that promoted the continuation of the conversation and the clarification of ideas. Autistic children were sensitive to peers’ unspoken needs, capable of identifying subtle nuances of conversation dynamics and able to express support through comments and questions during the small-group discussions. Originality/value This study provides insights into the understudied phenomenon of peer support among autistic children in small-group discussions. It contributes to the growing corpus of research dedicated to exploring and revealing social competencies among autistic people. It discusses implications for developing educational practices that foster social interactions respecting the quality of autistic interactions and the interests of autistic students.

Purpose Navigating the banking world may be overwhelming and intimidating for autistic people due to the generally poor accessibility of banks. Banks around the world are starting to improve the accessibility of their services and products to meet the needs of autistic customers better. However, no empirical research has explored autistic adults’ banking experiences and needs. This study aims to determine what banks can do to make banking more inclusive and accessible for autistic people through understanding the banking experiences of autistic adults living in Australia and identifying the factors that shape these experiences. Design/methodology/approach In total, 57 autistic adults aged 18–67 years (Mage = 33.00, SDage = 11.03) and 29 caregivers of autistic adults aged 32–70 years (Mage = 52.24, SDage = 7.88) completed an online survey about the banking experiences of the autistic adults. In addition, 14 of the 57 autistic adults were interviewed. Findings Almost all autistic participants had a bank account, and online banking was the preferred way of banking for most autistic adults. The factor most often raised by participants that influenced the banking experiences of autistic adults was supportive and helpful bank staff. Other identified factors included autistic adults’ lack of financial and banking knowledge and banks’ poor understanding of autism. The majority of autistic adults felt that banks could become more autism-friendly and provided suggestions. Practical implications Given that most autistic adults are likely to access financial products and services, banks must become more autism-friendly to cater to the diverse needs of autistic customers. Recommendations for how financial institutions can become more inclusive were provided. Originality/value To the best of the authors’ knowledge, this is the first detailed examination of the banking experiences of autistic adults. Practical implications of the research were also provided.