We examined correlates of mental health and quality of life (QoL) among Chinese caregivers of preschool-aged autistic children (aged 18–59 months), using baseline data collected prior to intervention enrollment at a specialist autism center. In this cross-sectional study, 424 caregivers (84.2
Individuals with intellectual and developmental disabilities (I/DD), especially autistic individuals, are disproportionately unemployed and underemployed. Job coaches (JCs), family members (FMs), and employers can serve as supports to improve employment outcomes of adults with I/DD. To train these individuals to provide effective, strengths-based support, our team co-designed and co-produced a training curriculum entitled DIVERSE. In this study, we sought to understand barriers and facilitators to implement DIVERSE in the community. We utilized a mixed-methods effectiveness-implementation hybrid design to determine the barriers and facilitators to implementation of DIVERSE. A total of 78 participants, including JCs, parents, and employers, completed the DIVERSE training and at least one quantitative survey. Twenty-five individuals were randomly selected to complete semi-structured interviews guided by the Consolidated Framework for Implementation Research. Transcripts of interviews were analyzed by thematic analysis. High levels of DIVERSE acceptability, feasibility, and appropriateness were found in all participant groups. Qualitative results indicated more facilitators than barriers and more similarities across groups than differences. Major facilitators included the perception that DIVERSE is helpful and easy to complete, its fulfillment of a need in the community, and its compatibility with personal or organizational values. Major barriers included participants’ individual needs for specific curriculum content and meeting each individual’s expectations of the scope of topics covered in the curriculum. DIVERSE is a feasible, acceptable, and appropriate training for supporters of individuals with I/DD. Facilitators and barriers to implementing DIVERSE will be used to further disseminate the curriculum at a larger scale.
This study uses data from the first wave of a longitudinal study, guided by the bioecological model of human development (Bronfenbrenner, 2005), to examine multilevel influences on the behavioral and academic outcomes for autistic children (AC) in mainstream education. It aimed to (1) profile family processes and behavioral and academic outcomes for AC and (2) examine the relative contribution of family processes to child outcomes compared with child and other systemic factors (i.e., family structural factors and family satisfaction with family–professional relationships). Caregivers (n = 117) of AC in mainstream education (68
The prevalence of mental health conditions is increasing globally, with mental health difficulties the leading cause of disability for young people aged 12 to 25 years. Neurodivergent young people are up to three times more likely to develop a co-occurring mental health condition, requiring formal support from childhood to adulthood. They also experience delayed access to adult mental health care once they have been discharged from child mental health services. This study aimed to investigate what could support neurodivergent young people to transition from child to adult mental health services. This qualitative research made use of a constructivist grounded theory approach. Three participant groups were recruited for this study, including 12 neurodivergent young people, 6 caregivers, and 5 healthcare professionals. Semi-structured interviews were used as the primary source of data with a follow-up workshop. We identified three themes. Across all three groups, participants emphasised that the care delivered by healthcare professionals is constrained by the structures of the mental health system, thereby limiting the level of neuro-affirming care they can implement. These limitations made the informal support that parents and caregivers provided more critical in assisting them with the service transition. This study provided new insight into what could support neurodivergent young people to transition from child to adult mental health services. The findings in this study highlight the need to develop both provider- and system-level capacity to better support this service transition, to reduce the burden on neurodivergent young people and their informal supports.
Autism spectrum disorder (ASD) is a prevalent neurodevelopmental condition that faces significant social stigma. The Societal Attitudes Towards Autism (SATA) scale assesses social perceptions and stigma toward ASD. This study examined the psychometric properties of the Persian version of the SATA scale among Iranian university students. A cross-sectional psychometric study was conducted with 413 students in Sanandaj, Iran, during the 2024–2025 academic year. Participants completed the SATA scale and the compassion scale (CS). Data were analyzed using SPSS 25 and R 4.3.3. Confirmatory factor analysis supported a 13‑item Persian version of the SATA scale after removing three items (Items 5, 11, and 12). The model demonstrated excellent fit and good internal consistency. Convergent validity was confirmed via a positive correlation with the CS. Women reported more positive attitudes than men. Attitudes also varied by level of contact with autistic individuals. The Persian SATA is a psychometrically sound tool for assessing autism-related perceptions among Iranian university students. These findings underscore the influence of gender and prior contact on societal attitudes, highlighting the importance of targeted educational and experiential interventions in reducing stigma.
Students with autism spectrum disorder (ASD) are increasingly included in mainstream classrooms; however, little is known about how they approach early algebra tasks. This study investigates how different cognitive abilities support early algebraic thinking in students with and without ASD, focusing on performance in a figural pattern generalization task. The sample comprised 52 children aged 6 to 12 years (26 with ASD and 26 without ASD), all without intellectual disabilities. Participants were assessed on working memory, processing speed, spatial reasoning, verbal reasoning, fluid reasoning, theory of mind, and mathematical age, which reflects early arithmetical ability relative to age-based expectations. Regression analyses were conducted to identify cognitive predictors of early algebra performance in each group. For students without ASD, fluid reasoning and mathematical age were significant predictors of performance. In contrast, for students with ASD, spatial reasoning and theory of mind emerged as significant predictors. These findings indicate distinct cognitive pathways underlying early algebraic thinking across groups. The results demonstrate that cognitive predictors of early algebra differ meaningfully between students with and without ASD. These findings have important implications for inclusive education, highlighting the need to tailor instructional approaches to diverse cognitive profiles.
Children with autism spectrum disorder (ASD) frequently exhibit emotional and behavioral problems, posing challenges to their overall development and well-being. To explore the current status and latent profiles of emotional and behavioral problems in children with Autism Spectrum Disorder and examine associated factors. From April to August 2023, 268 dyads of children with ASD and their parents were recruited. Emotional and behavioral problems were assessed using the parent-report Strengths and Difficulties Questionnaire. Latent profile analysis was conducted to identify distinct patterns of emotional and behavioral problems. After the optimal profile solution was selected, associations between the observed covariates and latent profile membership were examined using the automatic three-step R3STEP procedure in Mplus. The detection rate of emotional and behavioral problems was 81.3
Down syndrome regression disorder (DSRD) is a condition occurring in young people with Down syndrome. It is associated with functional decline, new onset psychopathology, and increased support needs. DSRD is often associated with catatonia, for which electroconvulsive therapy (ECT) is an effective treatment. However, there are scant studies to guide best practice in this area. We report a case series of 5 patients who have received ECT at Vanderbilt University Medical Center. A systematic review and analysis were conducted, combining this case series with previously reported data in the literature. This analysis included data from 27 patients, 5 from the VUMC case series and a further 22 from 14 studies. Combining all patients from case series and the systematic review, there were 17 pre-ECT and 15 post-ECT Bush Francis Catatonia Rating Scale (BFCRS) scores reported from 7 sites/studies. The mean pre-ECT BFCRS score from all patients was 17.40 (SD = 5.72) and the mean post-ECT BFCRS score was 4.40 (SD = 5.26). A generalized estimating equations analysis revealed that there was a significant difference in the expected BFCRS score before and after receiving ECT treatment (β = -13.00 with 95
The study explored moral decision-making in autistic and neurotypical individuals through a set of moral dilemmas that varied in the intentionality of harm and personal risk involvement. In addition, the role of Theory of Mind (ToM), empathy, and Machiavellian attitudes was explored. Twenty autistic (mean chronological age 21.60 ± 8.10; mean years of education 12.40 ± 1.93) and twenty-nine neurotypical (mean chronological age 22.28 ± 2.8; mean years of education 14.38 ± 2.27) adolescents and adults participated in the study. Mixed-design repeated-measures ANOVAs were conducted to examine the effects of group and dilemma characteristics. Exploratory correlations were performed between individual difference measures and utilitarian choices in both groups. Our results showed overall similar response patterns between the groups, with higher moral acceptability ratings for utilitarian actions in incidental than in instrumental dilemmas. Both groups showed a reduction in utilitarian choices in instrumental dilemmas, although this pattern was less pronounced in the autistic group. Personal risk involvement increased utilitarian choices in the neurotypical group, whereas it did not significantly influence choices in the autistic group. Autistic participants reported lower empathy and ToM abilities, whereas no significant differences emerged in Machiavellianism. Nevertheless, exploratory correlations suggested relationships between ToM, Machiavellianism, and utilitarian choices in specific dilemma conditions within each group. Moral decision-making in autistic individuals was broadly comparable to that of neurotypical individuals in overall outcomes, while context-dependent patterns may reflect differences in how harm intentionality, personal involvement, and normative constraints are integrated into moral decision-making.
The purpose of this study was to examine peer verbal interactions in the form of incoming and outgoing talk for children with language difficulties in preschool classrooms relative to their classmates. In addition, verbal interactions with teachers was also examined, in part to determine whether these occurred at similar rates to peer-to-peer talk. Up to eight observations using worn sensors occurred in the latter half of the academic year in 29 preschool classrooms. Incoming and outgoing talk with teachers and peers was examined for 36 children with language difficulties and compared to 145 classmates. Talk with peers occurred at much greater rates than talk with teachers. Children with language difficulties produced less outgoing talk to peers and received less incoming talk from peers relative to classmates, consistent with a very large effect size. However, talk to and from teachers occurred at similar rates for children with language difficulties and their classrooms. Peer verbal interactions are distinctive for children with language difficulties, occurring far less frequently than their classmates. The extent to which this distinctive experience is developmentally significant – in positive or concerning ways – for children with language difficulties warrants investigation in future classroom-based research.
This study explored empathy’s effect on helping behavior of children with autism spectrum disorder (ASD) under different affective priming. Experiment 1 examined the predictive effect of autistic children’s empathic ability on their helping behavior; Experiment 2 explored whether positive versus negative affective priming moderated this predictive effect for high-empathy autistic children. Two experiments were carried out. Experiment 1 used the Chinese Measure of Empathy and Sympathy (MES) to group participants into high/low-empathy groups by top/bottom 30
The aim of this umbrella systematic review was to synthesise evidence about sex/gender differences in autism across existing systematic reviews, meta-analyses, and scoping reviews. MEDLINE, Embase, Embase Classic, CINAHL, and APA PsycINFO were searched for peer-reviewed articles focused upon sex/gender differences in autistic children, adolescent, or adults, and published in English or Turkish. Analysis of 34 studies showed no conclusive evidence of sex/gender differences in social communication, friendships, play behaviours and motor stereotypies in autistic children, adolescents, and adults. There was evidence that autistic females had fewer restricted and repetitive behaviours and were more capable in their use of camouflaging although autistic males also engaged in camouflaging. There was weak evidence to suggest that autistic male children have superior visuospatial skills, and evidence to indicate sex/gender differences in some aspects of brain development. Chronological age and general intellectual functioning appear to interact with some of these sex/gender differences. There was evidence that sex/gender differences amongst autistic people are similar to those seen amongst the general population and are not autism specific. More studies involving equal numbers of both autistic and non-autistic individuals of different sexes/genders are needed to draw more conclusive evidence.
Autism spectrum disorder (ASD) is a neurodevelopmental condition characterized by atypical interactions between brain networks. These interactions and the resulting dynamic shifts are effectively captured by Hidden Markov Models (HMMs) in comparison to static functional connectivity (FC)-based approaches. This review aims to meta-analyze the application of HMM to resting-state fMRI (rs-fMRI) in individuals with ASD. A systematic search of PubMed, Scopus, and Web of Science was conducted in May 2025. Screening followed PRISMA 2020 guidelines, with independent review and consensus resolution. Eligible studies were peer-reviewed, English-language publications that have applied HMMs to rs-fMRI in ASD, with either classification performance or state-metric outcomes reported. Seven studies met eligibility criteria. HMM-derived metrics demonstrated diagnostic utility, with a pooled log odds ratio (log OR) of 2.86 (95
Autism spectrum disorder (ASD) is a clinically and genetically heterogeneous neurodevelopmental condition. Whole‑exome sequencing (WES) is a pivotal diagnostic tool, though its yield varies across populations. This study aimed to determine the diagnostic yield and characterize the genetic spectrum identified by WES in a pediatric ASD cohort from Saudi Arabia. We conducted a retrospective cohort study of 288 children (< 14 years) with DSM‑5‑confirmed ASD who underwent clinical WES at a tertiary center between 2021 and 2024. Variants were classified according to ACMG/AMP guidelines. The overall diagnostic yield for pathogenic or likely pathogenic variants was 30
Affective egocentricity, the tendency to project one’s own affect onto others, appears reduced in those with alexithymia, a condition often linked to autism. This study investigated the relationship between self-reported affectivity (implicit and explicit) and emotion perception (accuracy, perceived intensity) as well as facial muscle responses (corrugator supercilii, zygomaticus major) in autism. Autistic adults (N = 40) and a non-autistic comparison group (N = 40) watched facial expressions whilst recorded (fEMG) and judged the stimuli afterwards. For explicit affect, non-autistic participants showed affective egocentricity, with positive state affect linked to lower accuracy in recognizing angry expressions. In contrast, autistic participants showed an altered pattern, where positive state affect was associated with improved recognition of angry and fearful faces. For implicit affect, autistic participants showed an affect-incongruent link between negative affect and lower perceived intensity of fearful faces. When controlling for alexithymia, explicit state affect differences became more pronounced, but non-significant for implicit affect. These findings offer new insights into how affect shapes social perception in autism differently and highlight the need to better understand the mechanisms underlying these differences and their potential strengths.
Previous meta-analyses of physical activity interventions for children and adolescents with autism spectrum disorder (ASD) have reported variable effect sizes and substantial heterogeneity, potentially reflecting differences in included primary studies, intervention characteristics, outcome domains, and analytic approaches. This second-order meta-analysis aimed to synthesize existing meta-analytic evidence on the effects of physical activity interventions across developmental domains in children and adolescents with ASD and to examine potential moderators of these effects. Thirty-four first-order meta-analyses were included for synthesis. Statistical analyses, including subgroup analyses and meta-regression, were conducted to examine intervention effects and moderators. Physical activity interventions were associated with significant positive effects in children and adolescents with ASD, with an adjusted effect size of g = 0.58. Significant positive effects were observed across developmental domains; motor skills and sleep quality showed the largest effects, whereas executive function and cognitive outcomes showed relatively modest effects. Outdoor activities and ball sports showed larger pooled effects than other intervention types, whereas water-based exercise, dance, and expressive movement did not show statistically significant effects in this analysis. Meta-regression indicated that intervention effects increased progressively with publication year. Physical activity interventions may be promising non-pharmacological approaches for multiple developmental outcomes in ASD youth, particularly motor skills, sleep quality, and emotional-behavioral outcomes. Outdoor activities and ball sports showed larger pooled effects, but further research is needed to confirm their consistent superiority across outcomes. The positive association between publication year and effect size warrants investigation, reflecting changes in intervention design, study quality, or publication trends.
This study aimed to synthesize the international literature on the employment of adults with autism spectrum disorder (ASD), identifying the main barriers and facilitators influencing access, inclusion, and retention in the labor market. An integrative review was conducted following established integrative review guidelines, with a systematic search across seven national and international databases. Empirical studies published between 2013 and 2026 were included. Two independent reviewers performed study selection and data extraction. A qualitative thematic analysis was applied to synthesize the findings. Twenty-two empirical studies met the inclusion criteria. The thematic synthesis identified key barriers, including limited autism awareness within organizations, communication challenges, stigma, inflexible workplace practices, and inadequate managerial support. Key facilitators included supportive leadership, reasonable accommodations, structured communication, organizational flexibility, and recognition of autistic strengths. Overall, the findings highlight the central role of organizational, interpersonal, and contextual factors in shaping employment outcomes for autistic adults. Employment outcomes for adults with ASD are strongly influenced by workplace structures, managerial practices, and organizational culture rather than individual characteristics alone. The findings underscore the need for evidence-based organizational strategies and public policies aimed at fostering inclusive and sustainable employment. Future research should prioritize intervention studies and longitudinal designs examining how organizational practices and leadership shape long-term employment retention.
Parent-implemented interventions (PII) are evidence-based practices that improve developmental and functional outcomes for autistic children. However, limited attention has been given to the processes of parent engagement within PII, despite its potential to shape intervention sustainability and effectiveness. This scoping review examined how parent engagement has been incorporated and reported in parent-implemented interventions for autistic children in the United States. Following PRISMA-ScR guidelines, PubMed and EBSCO (nine sub-databases) were searched for peer-reviewed studies published between January 2013 and October 2023. Eligible studies were randomized controlled trials conducted in the United States, focused on autistic children, and included a parent-implemented component. Two reviewers independently screened records (94
This study examined emerging adult siblings’ acceptance of a sibling with developmental disabilities as a multidimensional construct and assessed how diagnosis (autism, down syndrome [DS], cerebral palsy [CP]), perceived independent functioning, and socio-cultural factors (gender and religious sector–secular, National religious, ultra-Orthodox) predict three dimensions of acceptance: perceived burden, openness to sharing, and perceived parental attention. A sample of 775 Jewish-Israeli emerging adult siblings (Mage = 22.17) of individuals with autism, DS, and CP completed the Sibling Acceptance Questionnaire and a demographic survey. Hierarchical regressions examined predictors of overall acceptance and its three dimensions. Siblings of individuals with autism reported higher overall acceptance and fewer perceived burdens and limitations than siblings of individuals with DS or CP, as well as greater openness to sharing than siblings of individuals with DS. Greater perceived independent functioning of the sibling with a disability was associated with higher overall acceptance, fewer perceived burdens and limitations, and greater openness to sharing. While women generally reported higher acceptance than men, gender differences in overall acceptance, burden and limitation, and parental attention were smaller in the autism group. National-religious participants demonstrated the highest acceptance levels, whereas both secular/traditional and ultra-Orthodox participants reported lower openness to sharing than National-religious participants. Sibling acceptance in emerging adulthood is a nuanced, multidimensional orientation shaped by the interplay of diagnostic demands, family demographics, and cultural contexts. Interventions should be dimension-specific and culturally responsive to support brothers and sisters as their sibling relationships become more elective in adulthood.
Public health surveillance of autism spectrum disorder (ASD) relies on identifying the condition in educational and/or clinical contexts. However, the criteria used to operationalize ASD for special education exceptionality and for clinical diagnosis emphasize different features of the condition. This study examined whether educational and clinical methods of community recognition of ASD identify the same children. Data from the Arizona site of the Autism and Developmental Disabilities Monitoring Network (n = 873) were used to assess (1) associations between record source availability and community recognition of ASD, (2) agreement between special education exceptionality and ICD-based clinical identification, and (3) sociodemographic predictors of community recognition category using multinomial regression. Having multiple record sources was associated with recognition of ASD through both educational and clinical systems. Among children with both education and clinical records, agreement between special education exceptionality and ICD coding was minimal (Cohen’s κ=-0.001). Special education exceptionality demonstrated moderate sensitivity but low specificity relative to ICD coding. Distinct sociodemographic patterns characterized recognition pathways, with children residing in higher social vulnerability areas more likely to be identified through special education exceptionality only. Non-Hispanic African American children were significantly more likely to be identified through a single-system recognition pathway rather than through both educational and clinical systems. Educational and clinical systems identify overlapping but systematically different subsets of children with ASD. These differences in community recognition have important implications for public health surveillance and highlight the influence of institutional frameworks on how autism is identified in the community.
