Background: Autistic adults report differences in how they use and interpret nonverbal communication. These differences can support communication, regulation, and connection, but they can become barriers when people judge them against conventional social norms. Gender may add to these barriers because people often expect social expression to look and sound a certain way and may respond negatively when communication does not match those expectations. Prior research has described communication barriers in health care, employment, relationships, and leisure, but less is known about whether these barriers differ by gender across everyday contexts. We examined whether gender was associated with self-reported nonverbal communication barriers across these contexts. We also examined whether age, autistic traits, and self-reported communication ability were associated with these barriers. Methods: Autistic adults (N = 356) completed measures assessing nonverbal communication barriers across health care, employment, relationships, and leisure. Participants also reported their gender, age, autistic traits, and self-reported communication ability. We used principal component analyses to create context-specific composite scores. We examined gender group differences using analyses of variance and assessed associations among gender, age, autistic traits, self-reported communication ability, and nonverbal communication barriers using hierarchical linear regressions. Results: Transgender and gender-diverse adults reported the highest nonverbal communication barriers across contexts, followed by cisgender women and then cisgender men. Gender group differences were largest in relationships and health care. Barriers showed moderate to strong correlations across contexts. Gender remained significantly associated with barriers after we accounted for age, autistic traits, and self-reported communication ability. Conclusions: These findings support a relational understanding of autistic communication barriers because gender differences remained after we accounted for autistic traits and self-reported communication ability. Barriers may reflect how other people interpret and respond to autistic communication, rather than communication ability alone. The results also support the need to examine how gendered expectations influence autistic adults' communication experiences across contexts.
Background: The overlap between autism and gender diversity has attracted increasing attention. Although recent research has begun to examine the lived experiences of autistic gender-diverse people, most studies have been conducted in Western countries. In Japan, where stigma toward autism is stronger and LGBTQ+ rights are less protected, the existing literature remains limited and often interprets autistic people's gender diversity through pathologizing frameworks. Methods: To explore the lived experiences of autistic gender-diverse adults from their own perspectives, I used an online open-ended questionnaire covering different aspects of life: identity, discrimination and prejudice, everyday life, care needs and experiences, and community. Forty-four autistic gender-diverse adults (aged 19-62 years) who mainly lived in Japan participated in the study. I analyzed the data using reflexive thematic analysis. Results: I identified three main themes. Theme 1: Authenticity versus conformity, where participants aspired to live authentically but felt compelled to hide their autistic traits and gender identities because of social pressure to conform. Theme 2: Belonging nowhere, where participants reported a strong sense of isolation in an unaccommodating society. Theme 3: Personal-political ambivalence, where participants adopted two conflicting orientations to make sense of their experiences-self-blaming and yearning for social change. Conclusion: Japanese autistic gender-diverse adults experienced social and structural barriers across multiple settings, including workplaces, clinical services, and communities. The findings largely aligned with previous research conducted in Western contexts, while suggesting that isolation and internalized stigma may be particularly acute in Japanese society. These findings call for greater awareness and structural change, and the intersectional experiences of autistic gender-diverse people may position them as agents of such change.
Autistic adults live in social environments structured around neurotypical norms, within which difficulties in social participation are often framed as individual deficits. Early adulthood represents a critical developmental period characterized by transitions into adult educational, occupational, and social roles. During this period, individuals face increasing demands for participation while navigating discontinuities between child-centered support systems and adult-oriented social contexts. Support approaches for autistic adults in early adulthood have traditionally relied on normalization-oriented interventions, including social skills training and serious games, which typically prioritize behavioral normalization. However, comparatively little attention has been paid to the underlying value assumptions of these approaches or to their potential role in reinforcing masking and psychological burden. Gamification, defined as the application of game design elements to non-game contexts to enhance motivation and sustained engagement, is reconsidered in this conceptual commentary as a neurodiversity-aligned approach to supporting social participation. Rather than emphasizing behavioral normalization, this perspective argues that gamification grounded in neurodiversity principles prioritizes comfort, self-determination, and subjective well-being, making it more closely aligned with the lived experiences and preferences of autistic adults. By redefining intervention outcomes in terms of psychological safety and lived participation experiences, this article offers a conceptual framework for understanding social participation support in early adulthood. Reconsidering social participation support from this perspective may encourage researchers and support providers to critically re-evaluate normalization-oriented intervention frameworks. It may also facilitate a shift toward more ethical practices that prioritize meaningful social participation as defined by autistic individuals navigating the transition into adulthood. Community Brief Why is this topic important? Autistic adults in early adulthood face increasing expectations for social participation, while support often shifts abruptly from child-focused services to adult-oriented environments. Many support programs focus on helping autistic people behave in ways that appear more “normal.” This article suggests a different approach. It argues that support should respect natural differences between people and help autistic adults participate in ways that feel comfortable, enjoyable, and meaningful to them. What is the purpose of this article? This article explores different ways that games and game-like activities can be used to support autistic adults. It asks whether these approaches are mainly helping people fit social expectations or helping them participate in ways that feel comfortable and meaningful to them. Drawing on existing research, including reviews of social skills training and game-based interventions, the paper examines how support can encourage safe participation, personal choice, and confidence, rather than focusing only on changing behavior. What personal or professional perspectives do the authors bring to this topic? The author is a non-autistic researcher and nurse with professional and research experience in pediatric and adolescent health care, including supporting young people as they transition into adulthood. The author does not have lived experience of autism and does not intend to represent the full range of perspectives within the autistic community. These professional experiences inform the author’s interest in how support can promote autonomy, well-being, and meaningful participation during the transition to adulthood. What is already known about this topic? Previous research has shown that autistic adults in early adulthood are more likely to experience social exclusion, difficulties expressing their needs and boundaries, and persistent inequalities in access to education, employment, and social participation. Game-based approaches have become increasingly popular because they can make activities more interesting and enjoyable by using goals, rewards, feedback, and play. However, simply adding game elements does not always lead to better support. Researchers have questioned whether some approaches place too much emphasis on changing behavior rather than improving people’s everyday experiences and well-being. Games and game-like activities can also be designed with different goals. Some approaches focus on helping people behave in ways that others expect, while others focus on helping people feel comfortable, confident, and able to make their own choices. What do the authors recommend? This paper does not suggest that simply adding game elements will improve support. Instead, it argues that support should respect each person’s preferences, choices, and experiences rather than trying to make everyone behave in the same way. From this perspective, game-based approaches should help autistic adults participate in everyday life while supporting their well-being, comfort, and independence. Success should therefore not be judged only by the number of new skills someone learns. It should also consider whether people felt safe, comfortable, and able to participate in ways that were meaningful to them. How will these recommendations help autistic adults now or in the future? Game-like activities should not replace real social interaction. Instead, they can be used as one way of helping autistic adults participate at their own pace and in ways that suit their preferences. For example, they may help people take part in work, education, or community activities with greater confidence and less stress. This approach also recognizes that change should not be expected only from autistic people. Families, supporters, workplaces, and community organizations also play an important role in creating environments where autistic adults feel safe, respected, and able to participate in meaningful ways.
Autistic adults experience substantially higher rates of obesity compared with neurotypical peers, contributing to markedly increased all-cause mortality. Despite these disparities being independent of intellectual ability, gender, or support needs, existing literature disproportionately concentrates on children and/or individuals with intellectual disability. Consequently, obesity management in autistic adults as a whole remains an under-addressed topic. This clinical review explores the intersection of autism and obesity through a biological, pharmacologic, and experiential lens. We review neuropsychiatric factors that influence eating and physical activity, including sensory processing differences, executive dysfunction, and stress response. We also examine physiological differences relevant to obesity risk, including circadian differences, gut microbiome, and inflammation. In addressing intervention, we highlight high-prevalence co-occurring conditions, including sleep disorders, gastrointestinal disorders, allergies/asthma, and hypermobility syndromes, as modifiable obesity risk factors. Given high rates of psychotropic use in autistic adults, we discuss their role in both obesity risk and treatment, as well as interactions between psychotropics and obesity pharmacotherapy. We then outline autism-specific considerations for optimizing both psychotropic and obesity pharmacotherapy. Finally, we emphasize a neurodiversity-affirming approach to lifestyle modification, prioritizing collaboration, sensory and executive-function accommodations, flexible dietary strategies focused on macronutrient ratios and micronutrient sufficiency, and individualized physical activity that accounts for motor, sensory, and social barriers. We argue that applying an autism-specific, neurodiversity-informed lens can improve engagement, mitigate risk, and enhance the effectiveness of obesity management for autistic adults.
Background: While the Autistic community widely perceives stimming—or repetitive behaviors—as serving a self-regulatory function, it is unclear whether the academic literature aligns with this perspective. Academic sources have sometimes framed stimming negatively (e.g., as purposeless or in need of suppression), though empirical support for this remains unclear. Clarifying the potential functions of stimming has practical implications for Autistic people, including for clinical practice. Methods: We conducted a scoping review of the published literature on stimming in Autistic adults between 2013 and 2024 to identify potential functions of stimming and examine how it has been conceptualized in the literature to date, using search terms such as “stimming” and “repetitive behaviors.” A comprehensive search yielded nine studies which met eligibility criteria and were retained for data charting. Results: The nine retained studies, predominantly from the United Kingdom, variously utilized quantitative, qualitative, and mixed-methods designs. The studies highlighted the self-regulatory or positive role of stimming for Autistic adults. However, only two studies explicitly set out to investigate the function of stimming, highlighting a significant gap in the current understanding. We identified limitations such as variability in the key terms used to refer to stimming ( n = 13) within the academic literature on Autistic adults to date. Conclusions: Currently, the academic literature on stimming in Autistic adults provides emerging evidence for the functions of this behavior from the perspective of Autistic people. To strengthen our understanding of stimming, future studies should establish a precise, widely accepted conceptualization, including clarifying the relationship between stimming, higher-order repetitive behaviors, and sensory-seeking behaviors (e.g., whether these constructs are truly distinct or share common functions). A clearer understanding of the potential functions of stimming may inform more appropriate and neuroaffirming supports, including recognizing and accommodating stimming as a meaningful self-regulatory and communicative behavior, rather than trying to extinguish or suppress stimming in the absence of harm.
