In recent years, referrals of youth to specialised gender services have risen sharply, with ~11% of these youth diagnosed as autistic compared with a general population rate of ~1%. In two preregistered studies, we addressed this insufficiently understood intersection. In Study 1, we examined the number and developmental trajectory of autism traits in autistic and nonautistic gender clinic-referred and cisgender youth (aged 7–16 years) using both screening measures (Autism-Spectrum Quotient Children’s Version and Autism-Spectrum Quotient Adolescent Version, Social Communication Questionnaire–Lifetime) and diagnostic tools (Autism Diagnostic Interview–Revised, Brief Observation of Symptoms of Autism). In Study 2, we examined autism traits among the caregivers of participants from each group using the Autism-Spectrum Quotient Adolescent Version. Study 1 results showed the autism phenotype in autistic gender clinic-referred youth closely resembled that of their cisgender autistic peers. In addition, after addressing methodological limitations in previous research, we found no evidence of elevated autism traits in nonautistic gender clinic-referred youth, challenging findings of some earlier studies. Study 2 provided evidence of familial aggregation of both autism traits and diagnoses among caregivers of both autistic gender clinic-referred and cisgender participants. Taken together, these findings challenge the hypothesis that autism in gender-diverse youth is merely a ‘phenomimic’ of autism and provide valuable clinical insights into the presentation of autism in this population.Lay abstractIn recent years, more young people have been referred to specialised gender clinics for support with their gender identity. Interestingly, about 11% of these young people are also diagnosed with autism–much higher than the general population rate of only around 1%. This overlap has raised important questions about how autism and gender diversity are related, and even whether autism traits in gender-diverse people with an autism diagnosis really reflect autism. In this research, we carried out two studies to understand this link better. In the first study, we looked at autism traits in gender-diverse children and adolescents aged 7–16 years who were referred to a gender clinic for issues with their gender identity. We compared them with both autistic and nonautistic children who were not referred to gender services. We used several standard tools to assess autism-related traits, including both questionnaires and clinical interviews. We found that gender-diverse youth who were also autistic showed similar patterns of autism traits as cisgender autistic children who were not exploring their gender. Importantly, nonautistic gender-diverse youth did not show unusually high levels of autism traits, which challenges some earlier studies that suggested they might. In the second study, we explored autism traits in the caregivers (mostly mothers) of the young people in our first study. We found that caregivers of autistic children–whether the children were gender-diverse or not–were more likely to be autistic than the caregivers of nonautistic children. Moreover, even nonautistic caregivers of autistic children displayed more autism traits than caregivers of nonautistic children, irrespective of whether their child was gender-diverse or not. Overall, our findings challenge the idea that autism in gender-diverse youth is just a mimic of ‘true’ autism caused by gender-related stress or experiences. Instead, the results point to genuine autism that presents in a typical way. This research provides important insights for clinicians and families, and highlights the need to take the gender-related concerns of autistic children as seriously as of nonautistic children.

Autism spectrum disorders are potentially associated with gastrointestinal dysfunction, although the underlying mechanisms remain unclear. Recently, the oral cavity has gained attention as the starting point of the digestive tract. We aim to explore the potential association between altered oral microbiota and oxidative stress in individuals with autism spectrum disorders. We conducted a case-control study involving 54 subjects with autism spectrum disorders and 46 typically developing participants. Oral epithelial cells and saliva samples were collected to analyze oxidative stress markers and oral microbiota composition using 16S rDNA sequencing. Compared with typically developing participants, individuals with autism spectrum disorders exhibited suppressed mRNA levels of superoxide dismutase 2 and RAR-related orphan receptor α, increased H3K9me2 modifications at superoxide dismutase 2 promoter, elevated levels of 8-oxo-dG in oral epithelial cells, and a reduced ratio of reduced glutathione/oxidized glutathione (GSH/GSSG) ratio in saliva. In addition, alpha and beta diversity analyses showed significant differences in microbial richness, evenness, and intersample variation between the autism spectrum disorder and typically developing groups. Statistical analyses confirmed marked distinctions in microbial diversity and community structure between the two groups. Individuals with autism spectrum disorders show increased oxidative stress and altered oral microbiota compared with typically developing participants. While the underlying mechanisms remain unclear, these findings suggest that altered oral microbiota may be linked to oxidative stress, providing insights into autism spectrum disorder pathology and potential avenues for clinical intervention.Lay Autism spectrum disorders are linked to gut-related issues, but the exact causes are still unclear. Recent research focuses on the mouth, the first part of the digestive system, to understand how it may play a role. This study looked at how the oral microbiome (the community of microorganisms in the mouth) and oxidative stress (an imbalance between harmful free radicals and antioxidants in the body) differ in people with autism spectrum disorders compared with typically developing individuals. Researchers studied 54 people with autism spectrum disorders and 46 typically developing individuals by analyzing their saliva and oral cells. Results showed that people with autism spectrum disorders had higher levels of oxidative stress markers and noticeable differences in their oral microbiota diversity and structure. These findings suggest a potential connection between changes in oral bacteria and oxidative stress in autism spectrum disorders, opening the door for new ways to study and treat autism spectrum disorders–related health issues.

Autistic adults experience more daily stress compared to non-autistic adults. However, stress recognition is often delayed, potentially leading to chronic stress and significant (mental) health risks. We evaluated the effectiveness of Stress Autism Mate (SAM), a stress-monitoring mobile health application co-created with autistic individuals. We ran a two-arm, parallel, superiority randomized controlled trial. Autistic adults (n = 214) (mean age: 50.5 years; 66.4% female) were randomized to 1-month SAM usage or waitlist control. Participants self-reported on primary (Perceived Stress Scale; Warwick-Edinburgh Mental Wellbeing Scale), and secondary outcomes (Coping Self-Efficacy Scale) at baseline and 4 weeks later, after which the control group could start using the app. Hierarchical multiple regression analyses revealed that the intervention group had significantly lower perceived stress (d = 0.27), greater mental well-being (d = 0.35), and improved coping self-efficacy (d = 0.16) compared to the control group after 1 month. No intervention effect moderators could be identified. More frequent app usage was significantly associated with a stronger decrease in perceived stress (r = −0.293). However, 42.9% of app users indicated increased stress from app use, warranting further investigation. Our results suggest that SAM may be effective in reducing perceived stress and improving mental well-being for some autistic individuals. Further refinement and investigation are recommended.Lay abstractAutistic adults often experience more daily stress than non-autistic individuals, but they may not always recognize this stress timely, which can lead to long-term health problems. To help address this, we tested an app called Stress Autism Mate (SAM), which was designed together with autistic individuals to help autistic adults monitor and manage their stress. In our study, 214 autistic adults (average age: 50.5 years; 66.4% female) were randomly assigned to either use the app for 1 month or wait before using it. We asked participants to complete surveys before and after the 1-month period to measure changes in their stress levels, mental well-being, and confidence in coping. Results showed that participants who used the app reported lower stress, improved mental well-being, and better coping skills compared to those who did not use the app. We also found that the more often someone used the app, the more their stress levels decreased. However, 42.9% of users felt more stressed using the app, which needs further study. Overall, our findings suggest that SAM can help reduce stress and improve well-being for some autistic adults, but more work is needed to improve the app and better understand its effects.Trial registry ISRCTN Registry: ISRCTN17394910.

Many community–academic partnerships are established to conduct meaningful research and practice. Yet, little is written about their sustainability and what does exist suggests that effective partnerships are hard to sustain. In this study, we sought insights into what might support successful, enduring community–academic partnerships focused on early childhood autism service provision. We conducted semi-structured interviews and focus groups with 30 staff connected to a university-based early childhood service in education, allied health, management, and research roles, who had been involved in a decade-long community–academic partnership. We analysed the data using reflexive thematic analysis adopting an inductive approach. We identified three key themes. Staff shared strong values and commitments towards inclusive practice and evidence-based practice, which were embedded in the ethos of the partnership (Theme 1). They reported tangible, mutual benefits from working in partnership, with gains in learning and confidence supporting autistic children and families (Theme 2). Interviewees also highlighted the importance of strong equitable relationships, open communication, and fair processes, even if these were not always straightforward to achieve (Theme 3). These insights illustrate the value of ongoing monitoring of community–academic partnerships seeking to inform autism research programmes, policies and practices, while also building sustained community capacity.Lay When academic researchers work in partnership with community members, the research that gets done is usually more meaningful to people’s everyday lives. But these ‘community–academic partnerships’ can be difficult to set up, and even more difficult to keep going. In this project, we wanted to know what factors help to support the success of long-term community–academic partnerships, specifically for early childhood autism services. We spoke in depth to 30 staff connected to a university-based early childhood service, including early childhood educators, allied health professionals (psychologists, speech pathologists, occupational therapists), people managing the service and researchers. All had been involved in a community–research partnership that had been going on for a decade. Two researchers independent of the service led the interviews and analysis, looking for patterns in participants’ responses. We identified three main ideas or ‘themes’. Staff spoke of their strong values and commitments towards inclusive practice and evidence-based practice, which were shared among those within the partnership (Theme 1). They felt they had learned a lot from being involved in the partnership and had gained confidence supporting autistic children and families (Theme 2). Above all, though, they spoke of how the relationships within the partnership really mattered to making it a success. They emphasised the importance of trust, good communication and fair processes – but also noted that these things were not always achievable (Theme 3). These findings help us understand how researchers and community members can work effectively together to bring lasting benefits to autism research and services, and to the community more broadly.

There has been a growing focus on the importance of understanding strengths in children with neurodevelopmental conditions and how such knowledge can support clinical practices. However, limited research has explored systematic reports of strengths from caregivers of children with neurodevelopmental conditions, most commonly autism. In this study, we explored caregiver-identified strengths in children attending their first neurodevelopmental assessment. Caregivers of 686 children attending a tertiary assessment service answered a survey question about their children’s strengths. Content analysis identified 61 unique categories of strengths, which were grouped into six themes: cognitive and intellectual, social and interpersonal, hobbies and passions, character and personality, physical, and behavioural. The most frequently reported specific strengths were kind caring, and compassionate, social and friendly, loving and affectionate, music singing and dancing, and good memory recall. The breadth of positive strengths identified here may reflect the larger population sampled or the diversity of presentations in this cohort. We then present a caregiver checklist, the Child Autism and Neurodevelopment Strengths (CANS) Checklist, that was developed with community representatives, to inform assessment and feedback of child strengths. We discuss what is required to use this knowledge to inform strengths-based practices that can support clinical practice and inform on child development and family well-being.Lay There has been a growing focus on the importance of understanding strengths in children with neurodevelopmental conditions, but there is little research exploring caregiver-reported strengths at the time of diagnostic assessment. In this study, we explored caregiver-identified strengths in 686 children who were attending a neurodevelopmental assessment. Content analysis identified 61 unique categories of strengths, which we grouped into six main themes. These six themes were cognitive and intellectual, social and interpersonal, hobbies and passions, character and personality, physical, and behavioural. The most common strengths identified by caregivers were ‘kind, caring, and compassionate’, ‘social and friendly’, ‘loving and affectionate’, ‘music, singing, and dancing’, and ‘good memory recall’. Based on these strengths, we present a checklist that was developed with community representatives, to make sure a strengths-based framework can be used during the diagnostic process. We discuss how we can use this knowledge to develop strengths-based practices that can support clinical practice and inform on child development and family well-being.

Despite very high rates of suicidal thoughts and behaviors (STB) in autistic adults, the key psychosocial drivers of this phenomenon remain unknown. To investigate, we examined how lifetime stressor exposure and severity, which have been found to predict STB in non-autistic populations, related to STB in a multinational dataset of 226 autistic adults from the United Kingdom and Australia (67% female; Mage = 41.8, SD = 13.6, range = 19–73 years old). Results revealed that autistic men and women differ with respect to the count, severity, and type of stressors they experienced over the life course. Whereas autistic men were exposed to more numerous legal/crime-related stressors, autistic women experienced more stressors related to social relationships and chronic humiliation and typically experienced stressors as more severe. In addition, whereas chronic interpersonal loss was related to STB for men, acute stressors involving physical danger and lower exposure to chronic entrapment were related to STB in autistic women. These findings indicate that certain lifetime stressors may be differentially experienced, and relevant to STB, in autistic men versus women. They also suggest that screening for lifetime stressor exposure may help identify autistic individuals at greatest risk of suicide.Lay abstractWhen we encounter life events that we experience as stressful (“stressors”), it sets off a biological stress response that can impact mental health and contribute to suicidal thoughts and behaviors (STB). Although we know about specific stressors that are associated with STB in the general population, little is known about the kinds of stressors that increase the risk of STB in autistic people and whether these associations differ by gender. To examine this issue, we cataloged the life stressors that autistic men and women experienced over the entire life course and investigated how these stressors were related to STB. Data were derived from a multinational sample of 226 autistic adults from the United Kingdom and Australia who completed the Stress and Adversity Inventory for Adults. We found that autistic men and women differed in terms of both the lifetime stressors they experienced as well as their perceived severity. Whereas men experienced more legal/crime-related stressors, women experienced more stressors related to relationships with other people and more long-lasting stressors associated with humiliation. Autistic women often perceived life stressors as more severe than men, which is important given that it is the perceived severity of stressors that most strongly affects our health. We also found that different stressors may predict STB in autistic men versus women. Whereas loss of loved ones was most strongly associated with STB for men, for women, physically dangerous stressors were most relevant. In addition, women with fewer lifetime stressors involving entrapment had higher lifetime STB. These results suggest that lifetime stressor exposure may be important to assess to understand suicide risk in autistic people. Additional research is needed to confirm these associations and to examine possible mechanisms linking stress and STB.

In this article, we engage in a critical conversation with scholars of neurodiversity. We emphasize the transformative role neurodiversity has in creating a crucial space for scholarship to emerge within the academy centering autistic voices. Despite this advancement, research addressing neurodiversity has overlooked and failed to engage with important issues of geography (Global South) and intersectionality (racialized neurodivergent other in the Global North). The first issue of geography relates to the marginalization of Global Southern epistemologies in the neurodiversity scholarship. We ask, why has neurodiversity failed to acknowledge Indigenous and Southern epistemologies and consider the evolution of relatively new Northern scholarship as the epicenter of knowledge production? Second, we highlight how intersectional experiences of the racialized other within the Global North are underrepresented and excluded from the neurodiversity scholarship. Homogenization of neurodiversity as “White Neurodiversity Movement” destabilizes the social justice and emancipatory goals of the movement. In highlighting these issues, we call attention toward knowledge systems that exist within the Global South, marginalization of scholarship and voices within neurodiversity scholarship and accentuate the need for this academic community to commit to a serious scholarship rooted and the intersectional experiences of racialized neurodivergent individuals.Lay 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.

Autistic people experience a higher prevalence of self-harming behaviours than do the general population. Self-harm remains a stigmatised topic, and until recently, self-harming behaviours in autism were considered to be limited to self-injurious behaviours experienced by intellectually impaired autistic children and not to be experienced by cognitively able autistic adults. Because of the belief held by many professionals that many mental health-related problems are inherently part of autism and immune to treatment or help, many autistic people are left unable to access the help and support that they desperately need. This study adopts an online qualitative methodology to explore this under-researched phenomenon, thematically analysing online forum posts from autistic adults to determine what forms of self-harm are described, what precipitates the self-harm and how forum users support each other. The findings reveal that self-harming behaviours are nuanced and complex, highlighting the connections between sensory overload, meltdowns, stimming and impulsive repetitive blunt trauma seen as autistic self-injurious behaviours. When seeking help, barriers include navigating misdiagnoses of other mental illnesses and being misunderstood or disbelieved by professionals. Online forum users offer help in the form of emotional empathy, as well as practical solutions, providing an example of valuable peer support.Lay abstractThere 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.

While overt social atypicalities remain a key component of the autistic phenotype, recent reframing of autistic social motivation suggests that these atypicalities do not overlap with their actual level of social engagement. Our study aimed to investigate autistic preschoolers’ visual attention toward social situations with unequal interactive load and determine the potential benefits of parallel competition, a form of lateral tutorship. The study observed 26 autistic preschoolers and 20 typically developing children. First, a gaze-contingent procedure measured visual attention toward videos of parallel competitive play, overtly cooperative play, and a non-social object. Then, a motor task and a cognitive task were conducted, both independently and with a parallel competitor to assess the effect of parallel engagement on children’s performance. Eye-tracking demonstrated autistic children displayed reduced attention toward competition than typically developing children. However, behavioral data revealed the presence of a parallel competitor significantly and similarly improved performance for autistics and typically developing children. These findings suggest a dissociation between social attention and social facilitation in young autistic children, indicating that atypical visual patterns toward social situations do not necessarily preclude them from benefiting from these situations. As such, activities parallel to the child activities, or lateral tutorship, may represent an addition to traditional joint-interactive activities in early education for autistic children.Lay Recent research suggests that we might have underestimated the social motivation of autistic individuals. Autistic children might be engaged in a social situation, even if they seem not to be attending to people in a typical way. Our study investigated how young autistic children behave in a “parallel” situation, which we call “parallel competition,” where people participate in friendly contests side-by-side but without direct interaction. First, we used eye-tracking technology to observe how much autistic children pay attention to two video scenarios: one depicting parallel competition, and the other where individuals play directly with each other. The results showed that autistic children looked less toward the parallel competition video than their typically developing peers. However, when autistic children took part in parallel competitions themselves, playing physical and cognitive games against a teacher, their performance improved relative to playing individually just as much as their typically developing peers. This suggests that even though autistic children pay attention to social events differently, they can still benefit from the presence of others. These findings suggest complementing traditional cooperative activities by incorporating parallel activities into educational programs for young autistic children. By doing so, we can create more inclusive learning environments for these children.

In low-resource settings, non-profit organisations play an essential role in providing services and support for families with young children with autism. However, resource constraints limit access to quality training in evidence-based interventions. Web-based training may help fill this gap. This study examined the feasibility, acceptability and appropriateness of the web-based Autism Navigator® JumpStart to Coaching in Everyday Activities course for 26 non-profit organisation providers (10 specialists and 16 non-specialists) in South Africa. Quantitative and qualitative methods were used including a post-training survey. Sixteen providers (62%) completed the course over an average period of 5.58 months, with many completing the course during lockdown restrictions, suggesting time as a barrier to course completion. No provider characteristics were related to attrition, nor to the time taken to complete the course. Better English proficiency, higher education levels and more positive attitudes to implementing an evidence-based intervention were associated with the number of attempts needed to pass some learner assessments, and to perceptions of course feasibility, acceptability, and appropriateness. Adaptations in the training delivery (using a group format and local group conference calls) and inclusion of South African video clips were identified as potential facilitators to acceptability and appropriateness.Lay In low-resource settings, non-profit organisations play an essential role in providing services and support for families with young children with autism, including in Africa. However, non-profit organisation service providers may not have access to quality training in proven intervention methods. Web-based or online courses may help to meet this need. In this study, we invited a group of specialist (10) and non-specialist (16) non-profit organisation providers in South Africa to complete a web-based course, Autism Navigator® JumpStart to Coaching in Everyday Activities, a 20-h self-paced course that provides training in an evidence-based parent coaching intervention called Early Social Interaction. We evaluated acceptability, appropriateness, and feasibility of the training. Of the 26 who enrolled, 16 completed the course (7 specialists and 9 non-specialists). All providers found it difficult to find time to do the course until the lockdown restrictions due to COVID-19, when most completed the course. Those whose first language was not English experienced more difficulties with two of six learner assessments and those who were not clinical specialists had more difficulty with the coaching strategies learner assessment. Most providers rated the course highly feasible, acceptable, and appropriate stating that the course content was very valuable and helpful in equipping them to serve their families. They felt the extensive video clips and regular meetings with a local trainer helped them engage with and understand the material. They suggested that including South African video clips would make the course more relatable. The fact that the course was web-based was identified as a strong benefit, especially during COVID-19 restrictions.