Background: Despite the high prevalence of eating disorders (EDs) in Autistic people, few qualitative studies explore this overlap beyond Autistic women with anorexia nervosa (AN). Methods: We used Photovoice to explore the experiences of Autistic people with EDs across diverse genders and ED typologies. Our final sample included 14 Autistic individuals (male n = 3, female n = 8, gender-queer n = 3; m = 31.07 years). Participants completed five workshops across four groups ( n = 20 group sessions), capturing images that best represented their ED experiences and discussing them with their group. We conducted content analysis on the images and inductive-reflexive thematic analysis on the workshop transcripts, Microsoft Teams messages, and image narratives. Results: Our analysis produced five key themes: (1) Autistic identity: how autism diagnoses shape ED experiences and perceptions of normality; (2) the “overwhelm bucket”: how cognitive and sensory overload trigger ED behaviors; (3) diagnostic intersectionality: how traits interact across Autism, EDs, and co-occurring diagnoses, complicating clinical separation; (4) “go without me” (social consequences): how ED-driven social withdrawal conflicts with a desire for reconnection; and (5) services and support: key barriers to accessing care, the necessity of autism-informed treatment, and the value of creative methods. Our findings align with existing Autistic-ED models while broadening representation to men, gender-diverse individuals, and people experiencing bulimia nervosa and binge eating disorder. Conclusion: Our findings challenge deficit-based views of Autistic sociality, underscore how identity, overwhelm, and intersectionality shape ED experiences, and demonstrate the urgent need for autism-informed, community-led care that rejects neuronormative assumptions.
Background: There is a growing focus on a positive autistic identity; however, we know very little about self-defined autistic self-concept beyond what it means to be “autistic.” Methods: We conducted semistructured interviews (written or spoken) with 103 people; 51 were autistic, 10 were neurodivergent but not autistic, and 42 were neurotypical. We asked them questions about their identity and self-concept. We also invited them to submit an artifact (e.g., a photograph or a drawing) that they felt represented who they were. We analyzed the data using inductive reflexive thematic analysis, based on semantic and latent content. Results: We developed three themes. In theme 1, “The idea of the self might be one of those neurotypical things,” autistic participants suggested that the self was hard to define and might be a neurotypical construct. However, the non-autistic participants also found the self difficult to define. Overall, participants across groups believed the self was multifaceted and context dependent. Theme 2, It made me who I am, highlighted factors at different levels of a person’s social ecology (e.g., their development, their wider family and friends, and society) that impact the development of self-concept. Autistic and neurodivergent people experienced increased social stigma that impacted their ability to know and express themselves. Theme 3, Unapologetically me, showed that autistic people developing comfort was prevented by perceived social power dynamics and consequences of not following social norms. Autistic people highlighted the importance of embodied experience in their own authentic expression; being able to stim freely was a core part of who they were. Conclusion: Our findings suggest that rather than seeing the autistic self as impaired compared with non-autistic peers, we might recognize that it can be difficult to describe due to the influence of external neuronormative expectations and external power structures that prevent self-knowledge.
Background: Learning that one is autistic can be a pivotal turning point in self-understanding, but autistic people learn of this information under highly variable conditions. How these disclosure conditions shape autistic people’s experiences of learning and making sense of the diagnosis remains underexamined, particularly for those who received an autism diagnosis in childhood but learned about it later, and in non-Western contexts. Methods: We conducted semi-structured qualitative interviews with 22 formally diagnosed autistic adults in South Korea from two diagnostic pathways (11 self-initiated diagnosis in adolescence/adulthood; 11 received a childhood diagnosis and learned about it later). Among participants who received a childhood diagnosis, disclosure conditions varied, with some receiving direct disclosure and others learning about the diagnosis unexpectedly (e.g., through records hidden in the closet). We conducted one-on-one interviews and analyzed the data using reflexive thematic analysis. Results: The analysis suggested that core themes transcended diagnostic pathways. Participants described learning of the diagnosis as an identity-relevant turning point marked by mixed emotions, shifting from self-blame toward more coherent self-understanding while also experiencing grief about time spent not knowing. Disclosure contexts, including epistemic positioning, interpretive support for connecting the medical label to everyday life, and prior understanding of autism, shaped whether the diagnosis became valuable self-knowledge or a source of stigma. Participants’ accounts indicated that supportive disclosure involves framing autism without stigma or idealization, balancing timing with stigma risk and developmental readiness, prioritizing trust and rapport, and providing follow-up support. Conclusion: The findings highlight the importance of autistic people knowing their diagnosis to support positive, self-determined identity development, as well as directly disclosing the diagnosis as information autistic people are entitled to know. We need more efforts to develop neuro-affirming training for parents and professionals to share a diagnosis in ways that support self-understanding, alongside broader stigma-reduction efforts in South Korea.
Many autistic people experience clinically-significant motor differences that pose lifelong physical health risks including physical inactivity, cardiometabolic disease, falls and injuries, and chronic pain. These differences amplify existing cognitive and social-emotional features of autism and limit daily living skills, which in turn negatively impacts mental health and participation. Yet, professionals often overlook or mischaracterize autistic people's motor difficulties, in part because non-motor factors can affect assessment outcomes. Most standardized motor assessments presume typical communication, sensory processing, regulation, and tolerance of unfamiliar testing environments, leading to construct-irrelevant variance and potential misinterpretation of results. This risk increases when examiners lack autism-specific experience or use rigid administration practices without appropriate adaptation. Adopting a neurodiversity-affirming framework improves validity, equity, and uptake of motor assessment across research, education, and clinical contexts. Here, we present an Adapted Motor Assessment Toolkit for Autism with implementation examples grounded in the Movement Assessment Battery for Children-Third Edition. An interdisciplinary team of clinicians and researchers developed and refined the toolkit in partnership with autistic people and parents of autistic children. The toolkit enables preservation of core task demands and scoring while adapting assessment practices to support accessibility and improve validity of results. Adaptations span five domains: pre-assessment preparation, sensory supports, procedural adaptations, communication supports, and motivation/engagement. The toolkit helps examiners to identify support needs, implementing adaptations, interpreting results, and determining whether normative comparisons remain appropriate. Neurodiversity-affirming assessment practices enable earlier identification of motor differences, inclusion of more diverse participants in research, and tailored intervention and prevention planning to advance physical health equity across the lifespan.
Background:Autistic young adults face elevated risks for depression, and emerging evidence indicates that some engage in substance use. Residential status and social satisfaction may be related to these outcomes, yet little research has examined their interplay in autistic populations. Methods:Baseline data were drawn from 267 autistic young adults ages 18-24 (M=21.56; SD=1.76). Participants were predominantly female (65.63%), non-Hispanic White (75%), and enrolled in school (68.76%). Participants reported their current residential status, mental health, and substance use, and completed measures of social and role functioning, social satisfaction, and demographic characteristics. A unified mediation model tested whether social satisfaction mediated associations between residential status and (1) depression, (2) alcohol use, and (3) cannabis use, adjusting for relevant covariates. Results:Living alone, compared to living with a parental figure, was associated with greater social satisfaction, which in turn predicted fewer depression symptoms. In contrast, living alone or with friends or roommates was directly associated with elevated alcohol and cannabis use but showed no indirect effects through social satisfaction. Social satisfaction predicted lower depression but was not significantly related to alcohol or cannabis use. Conclusion:Residential status and social satisfaction jointly shape emotional and behavioral outcomes among autistic young adults. Independent living may enhance well-being when accompanied by fulfilling social connections, whereas peer cohabitation may increase exposure to substance use. Interventions that support autonomy, foster social engagement, and incorporate harm reduction strategies may be particularly valuable in promoting healthy transitions to adulthood for autistic individuals.
At the intersection of two highly pathologized experiences, research increasingly investigates autistic trans people as a medicalized cause for concern, and anti-trans—or “gender critical”—arguments against trans rights, lives, and health care repeatedly weaponize the perceived vulnerability of autistic people. The interplay of the “vulnerable” autistic person and “predatory” or “seductive” transness (or “gender ideology”) combines with a research literature which focuses on causation to incorrectly paint a picture that autistic trans people cannot exist: lacking in epistemic authority and self-knowledge, autistic people cannot “truly” be trans; we must just think we are. Researchers continue to generate co-occurrence theories but often fail to acknowledge or take accountability for the harm caused by their continued signaling that autistic trans people are a problem which research must solve. In a time of such politicization, where anti-trans narratives of “vulnerability” and “social contagion” increasingly highlight autistic trans people, it is both a major oversight for research not to acknowledge this context and an ethical failing not to consider the impact that research might have. With this argument in mind, this article outlines the ways in which this research interacts with the wider contexts of the anti-trans panic and the problematic histories of autistic and trans pathologization in research and calls for a broader engagement with critical work beyond the bounds of psychology. Community Brief What is the purpose of this article? The purpose of this article is to highlight some of the problems in how autistic trans people are thought of and spoken about in research. It also demonstrates the negative impact that the ideas produced by this research can have on autistic and/or trans people. What personal or professional perspectives do the authors bring to the topic? The lead author is an autistic trans PhD researcher and is therefore personally invested in improvement in this area. Why is the topic important? The topic is important because research should avoid contributing to the spread of harmful ideas or stereotypes. This article highlights how the current focus on causal links between being autistic and trans can be harmful. Research about autistic trans people has mostly focused on trying to find out why, how, or if some autistic people are trans. Lots of theories about this (co-occurrence theories) suggest that autistic people might wrongly think they are trans because of specific autistic traits. For example, that autistic people may have a special interest in gender which leads us to wrongly believe we are trans. There is little to no reliable evidence for any of these theories. Other research shows that autistic trans people have been harmed by the idea that being autistic and trans are incompatible. For example, some autistic trans people have been denied gender-affirming care because of their autism diagnosis. Furthermore, anti-trans arguments have used these theories to suggest that many autistic children are being harmed by “falsely” believing that they are trans. However, the research that proposes these theories rarely acknowledges the role it has played in spreading these harmful ideas. What do the authors recommend? The authors recommend that future research should: • move away from questioning why, how, or if autistic trans people exist; • focus more on how research can improve and enrich autistic trans lives; • consider how research might impact autistic trans people both directly and indirectly; • meaningfully engage with the problematic history and present of autistic and/or trans research; and • meaningfully engage with autistic trans people and their work as activists, academics, and lived experience experts. How will this work help autistic adults now or in the future? This research highlights the negative impact of current research about autistic trans people and suggests some ways that this could be different. The authors hope that this could contribute to research which has a more positive impact on autistic trans lives and reduce harm done.
Background: Autistic adults experience depression at higher rates than non-autistic adults, yet there is limited evidence describing how psychologists identify depressive symptoms in this group. Autism-related characteristics may influence how autistic adults express and describe depressive experiences, and how psychologists interpret them in relation to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, Text Revision ( DSM-5-TR ) criteria. This study examined how psychologists identify depressive symptoms in autistic adults, including how they interpret DSM-5-TR criteria and what additional indicators they consider. Methods: We conducted an exploratory qualitative study using semi-structured interviews with 20 psychologists experienced in providing psychological care to autistic adults, from October 2024 to January 2025. Using direct content analysis, we coded responses to DSM-5-TR depressive symptom criteria and used inductive coding to identify additional indicators. Results: Psychologists described DSM-5-TR criteria as a guiding framework but emphasized that their clinical usefulness depended on autism-informed interpretation in relation to baseline presentation, co-occurring conditions, and contextual factors. Psychologists often described depressed mood as hopelessness, anger, irritability, or somatic distress. They described anhedonia sometimes involving ongoing engagement in deep and focused interests despite diminished enjoyment or emotional connection. Psychologists described brief acute episodes of overwhelming hopelessness and suicidal ideation, which some termed “depression attacks,” as clinically important indicators of escalating distress. They frequently interpreted worthlessness in relation to repeated exclusion and invalidation. Psychologists described several DSM-5-TR indicators as diagnostically ambiguous because of overlap with autistic characteristics. Additional indicators included changes in autistic presentation, altered sensory sensitivities, increased need for routine, shifts in the thematic content of deep and focused interests, and self-injurious behavior requiring careful contextual interpretation. Conclusion: DSM-5-TR criteria remain applicable to autistic adults, but identification often requires autism-informed interpretation, attention to baseline change, and consideration of additional indicators. Findings support the need for clearer clinical guidance, targeted clinician training, and development of assessment tools that better reflect autistic adults’ experiences.
Background: Autism is a neurodevelopmental disability characterized by differences in communication, social interaction, and behavior. Cognitive behavioral therapy (CBT) is a promising intervention for autistic people, yet research mainly focuses on children. Objective: To assess the effects of CBT in autistic adults. Methods: We performed a systematic review. We conducted searches in PubMed/MEDLINE, Embase, Cochrane Central Register of Controlled Trials, and ClinicalTrials.gov. We included randomized controlled trials (RCTs) evaluating CBT in autistic adults (≥16 years). We performed study selection, data extraction, and risk of bias assessment in duplicate. We conducted meta-analyses using random-effects models. We determined the certainty of evidence using the Grading of Recommendations, Assessment, Development, and Evaluation methodology. Results: We included 10 RCTs ( n = 537). Most RCTs had small sample sizes and a high risk of bias, and most meta-analyses showed heterogeneity. For alexithymia, CBT probably caused an important reduction (1 RCT; MD: −5.30 points; 95% confidence intervals: –10.87 to + 0.27; moderate certainty of the evidence) at less than 6 months post-treatment. Regarding other outcomes at less than 6 months, CBT may reduce depression and anxiety and improve quality of life; however, it may have little to no effect on social anxiety, functioning, obsessive-compulsive symptoms, mental health symptom severity, and all-cause discontinuation. For autistic traits, CBT may lead to an increase in scores. The evidence for these latter outcomes remains very uncertain (very low certainty of the evidence). Conclusion: CBT showed very uncertain effects across most outcomes in autistic adults. CBT probably reduced alexithymia at less than 6 months post-treatment. These findings are limited by methodological issues in the included RCTs, such as small sample sizes and high risk of bias. Overall, evidence on the effect of CBT in autistic adults remains limited, highlighting the need for more rigorous research to inform clinical practice.
Background: Growing numbers of adults are being diagnosed as autistic or having ADHD later in life, leading to a range of emotional responses and queries around identity. This review explores the process of identity reconstruction in late-diagnosed autistic and ADHD adults, examining both shared and distinct aspects of identity in each group, to better understand how diagnosis affects self-perception and to guide future post-diagnostic support. Methods: Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) and Joanna Briggs Institute (JBI) guidelines, we entered search terms relevant to autism, ADHD, delayed diagnosis, and identity into multiple databases. After screening titles and abstracts, two raters reviewed full-text articles to determine their inclusion with substantial inter-rater reliability. We extracted and coded qualitative data, with themes identified through thematic analysis. Results: The search strategy identified a total of 6894 articles, of which 5470 were duplicates. Reviewers screened 1423 articles. A final set of 25 articles was identified, with 12 articles exploring ADHD diagnoses and 13 articles exploring autism diagnoses. Our thematic analysis of the articles suggests that individuals experience a profound reevaluation of their identity following diagnosis in adulthood. Three overarching themes were identified, reflecting experiences shared across autism and ADHD, as well as distinctions unique to each condition: 1. Reconfiguring the self; 2. Finding the self through others; and 3. Emotional integration of the self. Participants grappled with confusion, reinterpretation of past experiences, and developed a more authentic sense of self, a process that was facilitated through finding belonging among neurodivergent peers. Emotionally, this process required navigating grief, internalized stigma, and negative self-perceptions. Diagnosis was transformative, offering validation and empowerment to participants. Overall, the process of diagnosis appears to foster growth toward a more integrated identity. Conclusions: Findings from this review highlight both shared and condition-specific impacts on identity, highlighting a need for post-diagnostic support that acknowledges the identity-related impacts of diagnosis in both autism and ADHD. Current evidence largely reflects majority populations, highlighting a gap in understanding of how underserved groups, such as ethnic minorities, experience and negotiate identity after diagnosis. Clinicians should be aware of the need for community connection, self-acceptance, and informed decision-making about disclosure, and provide affirming, tailored care following diagnosis.
Background: Positive sibling relationships have important implications for the well-being of autistic adults. Yet past research finds that individuals with autistic siblings report lower levels of sibling relationship quality. The research in this area, however, relies on the perspective of non-autistic family members and focuses on families where one sibling has a clinical autism spectrum disorder (ASD) diagnosis. The current study addressed these limitations by assessing whether autistic young adults also report poorer sibling relationship quality than non-autistic young adults and whether patterns differ by what it means to be autistic. Methods: Participants included a total of 964 18- to 29-year-olds ( M age = 24.61, SD = 2.90; 45% female; 58% White) from across the United States who completed an online survey. Participants were assigned to one of four groups: those diagnosed with autism or in the process ( n = 97), those who identify as autistic but have not been diagnosed and are not seeking diagnosis ( n = 80), those high in autistic traits but do not identify as autistic and have not been diagnosed ( n = 67), and the non-autistic ( n = 720). Results: Results show that young adults in the three autism groups reported poorer relationship quality than the non-autistic group in terms of closeness, conflict, ill-wishes, and parent-mediated relationships. Furthermore, autistic young adults reported greater heterogeneity in sibling relationship quality experiences (except for parent-mediated relationships) than non-autistic young adults. There were no mean or heterogeneity differences among the three autism groups on any relationship quality dimension. Conclusions: The findings suggested that autistic young adults report poorer sibling relationship quality than non-autistic young adults and that it does not matter if an individual has been clinically diagnosed with ASD; autistic traits are likely the driver of social experiences, not a diagnosis.
Background: While there is growing interest in the relationship between social media (SM) use and psychosocial well-being, little is known about this relationship in neurodivergent people. We undertook a systematic review to synthesize findings from studies exploring links between social (dis)connectedness and SM use in Autistic people and/or people with attention-deficit/hyperactivity disorder (ADHD), with the aim of exploring commonalities and differences in their experiences. Methods: We conducted systematic searches of four databases, retaining reports if they included SM-related measures and measures of social connectedness and/or disconnectedness in Autistic and/or ADHD populations. Two of us independently screened, coded, and assessed all records for methodological quality, with another of us screening just under 15% of records. Results: Our search yielded findings from 21 reports based on data from 18 studies. A narrative synthesis we undertook suggested that SM may be linked to greater social connectedness for Autistic people and greater social disconnectedness for those with ADHD. The literature was characterized by a predominance of cross-sectional research and the quality assessment highlighted measurement issues. Conclusion: Our findings suggest that SM may differentially support and hinder social connectedness for Autistic and ADHD SM user groups, respectively, although we discuss potential challenges to this conclusion, including potential biases in the way studies are framed and key constructs are operationalized across the different literatures. Our review highlights the need for further longitudinal and experimental research to establish underlying directions of causality and the robustness of our findings.
Background: Autistic adults report lower quality of life (QoL), but little is known about how social connectedness and aging interact to shape QoL in middle-aged and older autistic populations. This is important as autistic people themselves have identified improving QoL and social well-being as top research priorities. To address this gap, this study examined differences in QoL and social connectedness between autistic and non-autistic adults, and how age and gender influence these patterns. Methods: Two hundred sixty-five autistic adults and 167 non-autistic adults aged 40–93 completed self-report measures of social connectedness, QoL, and symptoms of poor mental health. 2 × 2 analyses of variance (ANOVAs) analyzed group and gender differences in QoL. Pearson correlations and Fisher’s r -to- z tests assessed associations between social connectedness and QoL. Post hoc analyses examined age group differences. Results: Compared with the non-autistic group, the autistic group reported significantly lower social connectedness scores, as well as lower QoL across all domains. Social connectedness positively correlated with QoL in both groups but showed a significantly stronger association with Psychological QoL and Social QoL in the autistic group. Gender and age moderated these associations, with autistic men having stronger associations than autistic women. Post hoc analyses revealed interactions between autism group and age group across all four QoL domains, with autistic people in older age having significantly lower scores than autistic people in midlife, a pattern not observed in the non-autistic group. Conclusion: Social connectedness may play a key role in shaping QoL for autistic adults as they age. Tailored, lifespan-focused support is needed to promote sustained social connection and foster well-being.
More autistic individuals are entering universities and the workforce than ever before. Yet, autistic university students experience social difficulties when transitioning to college such as social anxiety and social exclusion from their peers, and autistic adults are unemployed or underemployed. One reason for these negative experiences is the attitudes others hold toward autistic individuals. In this narrative review, we summarize the literature on explicit and implicit attitudes toward autistic individuals. Our review suggests that, while explicit attitudes toward autistic individuals as a group generally are positive, willingness to engage with autistic individuals, particularly in close proximity, may be more negative. Regarding implicit attitudes, most of which are assessed via reaction-time based methods, the findings are less nuanced. That is, regardless of the measure used, implicit attitudes toward autistic people tend to be negative in children, college students, and adults, including those who work with autistic populations. This article also considers factors that moderate these attitudes including previous contact with autistic individuals, knowledge of autism, and providing a label for autistic individuals. We review interventions designed to improve attitudes toward autistic individuals, which generally suggest that educational materials can have positive effects on explicit attitudes, but the effects of trainings on implicit attitudes are more variable. Regarding training, best practices include providing facts about autism that include the challenges and strengths associated with autism as well as providing perspectives from autistic people themselves. Finally, we provide suggestions for future directions.
