'Autistic burnout' is increasingly conceptualised as an experience of severe exhaustion, increased sensory difficulties and need for solitude, resulting from not having needs met across contexts. We interviewed 20 autistic adults (eight diagnosed with autism in childhood) about their experiences of autistic burnout. In this reflexive thematic analysis, we focused on how burnout felt, comparing the experiences of those diagnosed in childhood versus adulthood. We created five themes. We understood burnout to be, at times, (1) a powering down and/or (2) the overactivation, of the mind and body, resulting in (3) a craving for sensory and social rest. For those diagnosed in adulthood, burnout seemed to be experienced as more chronic and confusing. Some participants diagnosed in adulthood (4) made the world more bearable by using substances, coping with the contributors to and effects of burnout. Especially affecting those diagnosed in adulthood, (5) not knowing why this was happening took a (sometimes dangerous) toll; for a few, it led to contemplating suicide. This study brings new insights into burnout experiences of adults diagnosed with autism at different life points.Lay abstract Some autistic people experience severe exhaustion as a result of not having their needs met that sometimes prevents them from being able to take part in daily life. Some people refer to this as 'autistic burnout'. In this study, we spoke to 20 autistic adults, eight of whom were diagnosed with autism in childhood. We analysed our participants' interviews through an approach called reflexive thematic analysis. Through this process, we created five themes around the question of how autistic burnout felt for these participants. We were also interested in how participants diagnosed with autism in childhood versus in adulthood described their burnout experiences. This is because research has shown that not having an autism diagnosis earlier in life could, indirectly, lead to not understanding one's own needs accurately and not having the right support from others. The five themes we created were (1) the powering down of the mind and body, (2) the overactivation of the mind and body, (3) craving social and sensory rest, (4) making the world more manageable by using substances and (5) not knowing why this is happening to you can take a (sometimes dangerous) toll. Themes 1, 2 and 3 seemed to be shared between participants regardless of age at autism diagnosis. However, these experiences seemed to be more disabling for participants diagnosed in adulthood. Themes 4 and 5 related particularly to those diagnosed with autism in adulthood. This study adds an important insight: perspectives on burnout experiences from adults diagnosed with autism at different life points.

Differences in visual sensory sensitivity/reactivity are documented in autism and ADHD. Measuring these differences could guide interventions and accommodations, improving quality of life. No current self-report questionnaires focus specifically on the range of affective and behavioural responses to visual stimuli reported in autism and ADHD. This study aimed to develop such a measure (ViPro-SR) for neurodivergent adults. Using online survey responses, psychometric properties of ViPro-SR were assessed, including factor structure, gender-related measurement invariance, internal consistency reliability and validity. An 11-item, stable 3-factor solution was derived, with factors representing: hypersensitivity to contrast, detail focus, and peripheral vision activation. Internal consistency reliability was satisfactory for the total scale (ω = 0.85) and each subscale (ω > 0.70). Evidence towards convergent validity of ViPro-SR was provided through highly significant, moderate to strong correlations with existing sensory measures. Discriminative validity was supported by significant differences in ViPro-SR total scores between autistic/ADHD groups and a not autistic/ADHD comparison group. ViPro-SR is a psychometrically sound instrument, currently recommended for subscale-level scoring, that could inform visual sensory accommodations and contribute to a research toolkit.

Adults often experience reduced social connectedness with increased age, and lack of social support can be associated with poorer quality of life. However, the social experiences and preferences of autistic adults in midlife and older age have not yet been qualitatively studied. A total of 33 autistic participants aged 40-78 years took part in our co-produced semi-structured interview study about their social preferences and experiences. Using thematic analysis, we created three themes. Themes 1 and 2, “The Impact of Ageing and Changes to Life Circumstances on Social Experiences” and "Consistency of Social Experiences Throughout Life”, directly contrasted. Theme 3 explored "Hopes and Concerns about the Present and Future”. These themes highlight the varied impact of ageing, resulting in the overarching sentiment that “one size does not fit all” when considering the social needs of autistic adults in midlife and older age. Although some aspects remained consistent, many reported reduced or more challenging social experiences with age, with many expressing concerns about the future. Motivations and barriers were also found to differ with age. These findings highlight targets for social support for older autistic adults, and the need for further research into specific age-related factors impacting their social experiences.

Sex/gender-related measurement bias in autism measures has been proposed as a factor contributing to the underdiagnosis of autistic women, yet research in this area remains limited. This study builds on the small but growing body of work addressing this gap by using a modified Delphi methodology to reach consensus among autistic women and academics/clinicians on the most relevant items from five measures of autistic traits: Autism Spectrum Quotient (AQ-50), Broad Autism Phenotype Questionnaire (BAPQ), Comprehensive Autistic Trait Inventory (CATI), Girls Questionnaire for Autism Spectrum Condition (GQ-ASC), and Ritvo Autism and Asperger Diagnostic Scale-14 (RAADS-14), and to evaluate each measure’s suitability for autistic women in their current form. Thirty-three autistic women and thirty-three academics/clinicians participated in the study. Each participant was asked to rate the relevance of individual items to the experiences of autistic women and to indicate whether each measure comprehensively captured experiences relevant to this group. Agreement on relevance was calculated separately for each group using the item-level content validity index (I-CVI) and the modified kappa statistic (k*), with scale-level content validity indices (S-CVI/Ave) derived for each measure. The findings showed broad consistency in relevance evaluations between the two groups. The RAADS-14 was rated as the most relevant measure for assessing autistic traits in women, followed by the CATI, while the remaining questionnaires were associated with lower perceived relevance. However, none fully captured experiences relevant to autistic women, indicating construct underrepresentation that warrants further investigation. Items assessing masking were identified as valuable for inclusion to enhance the relevance of autism measures for women. In contrast, items related to attention to detail and imagination appeared less useful for assessing autism more broadly or for capturing subtler presentations of autistic traits, or may not be suitably phrased for autistic women. The most relevant items identified across the five measures can be considered valid across clinical, academic, and lived-experience contexts, providing a foundation for refining existing scales to better capture the experiences of individuals with subtler presentations of autistic traits.

The pupillary light reflex (PLR), the automatic constriction of the pupil in response to increased luminance, is a candidate early intermediate phenotype associated with autism, with potential to help understand early neurodevelopmental differences because it is controlled by relatively simple neural circuitry. We conducted epigenome-wide association analyses of PLR onset latency and constriction amplitude at 9, 14, and 24 months, with 51 male infants enriched for familial autism likelihood (~ 80% with a first-degree autistic relative), using buccal DNA collected at 9 months. We identified four epigenome-wide differentially methylated probes (p < 2.4 × 10⁻⁷) significantly associated with PLR latency at 14 and 24 months, and 14- to 24-month developmental change in latency. Probes linked to PLR amplitude were identified at a discovery threshold (p < 5 × 10⁻⁵). Regional analyses revealed multiple differentially methylated regions associated with both latency and amplitude. Associated probes were enriched for neurodevelopmental processes and autism-associated genes, including NR4A2, HNRNPU, and NAV2. While the findings are most directly relevant to male infants in whom PLR variability may be associated with familial autism likelihood, they provide novel evidence that DNAm contributes to early variation in PLR. These insights into the biological underpinnings of this reflex support PLR as an early intermediate phenotype associated with autism.

Background There is growing awareness from qualitative research studies that menopause may be particularly challenging for autistic people. Research in the general population suggests that preexisting conditions may be a risk factor for negative experiences during menopause. However, there are limited studies examining variables associated with experiences of menopause symptoms for autistic people. Objectives To explore whether pre-existing depression and anxiety symptoms impact menopause symptoms for autistic and non-autistic people. Design The study design is classified as STROBE. Methods Autistic (n=52) and non-autistic (n=28) people assigned female at birth participated in the longitudinal AgeWellAutism (AWA) study. They reported self-report depression and anxiety symptoms at baseline and menopause symptoms (Greene Climacteric Scale) at follow-up after 4.5 years. Age, autism diagnosis and autism characteristics of mentalising difficulties, sensory reactivity, and social anxiety (subscales from the self-reported Ritvo Autism and Asperger Diagnostic Scale, RAADS) were recorded. Results Regression analyses were conducted with menopause symptoms as the dependent variable and as independent variables: Step 1, age; Step 2, baseline depression and anxiety symptoms, Step 3, autism diagnosis (alternative step 3, RAADS subscales). In the final regression model, younger age, higher baseline depression and autism diagnosis contributed significantly to explaining menopause symptom severity. In the alternative model (including subscales of the RAADS), younger age, higher baseline depression, mentalising difficulties and sensory reactivity contributed significantly to explaining menopause symptom severity. Conclusions Results align with research from the general population suggesting that a history of depression symptoms increases risk of negative experiences during menopause, furthermore, being autistic confers additional risk. Further studies examining the influence of lifetime experiences on menopause symptoms for neurodivergent people are required to better understand and mitigate risk during this critical time.

Background Despite increased recognition of autism in women and girls, their reproductive health remains underexplored. Understanding reproductive health burden and healthcare experiences is essential to identifying barriers and improving support for conditions that can impact quality of life. Objectives Investigate reproductive health and healthcare experiences among autistic compared to non-autistic individuals assigned female at birth (AFAB). Design We conducted a cross-sectional online survey in the UK (April 2024-July 2025) among individuals AFAB aged 18-40 years recruited via convenience-sampling from autism networks, social media, and Prolific. Methods In total, 311 participants were included (165 self-reported autistic [M=31.1 years, SD=6.2], 146 non-autistic [M=30.6 years, SD=5.5]). The survey, developed with input from autistic people, covered reproductive health conditions, knowledge and management of reproductive health, and reproductive healthcare experiences. Group differences were analysed using logistic regressions, chi-squared and Wilcoxon rank-sum tests. Healthcare inequality (HIE) scores were calculated overall and for five subdomains as composite of negative reproductive healthcare experiences. Associations between autism and HIE were examined using logistic regression. Results Autistic participants reported more reproductive health conditions (44% vs. 28%) and symptoms (95% vs. 84%) than non-autistic participants. Age-adjusted regression models indicated higher odds for any condition (OR=1.96[1.21-3.17], p <.01) and any symptom (OR=3.23[1.44-7.25], p <.01) with OR for specific conditions/symptoms ranging from OR=1.09[0.57-2.09], p=.799 to OR=3.97[2.43-6.50], p <.001. Adjusting for other neurodivergence attenuated estimates; however, the overall associations for any symptom remained statistically significant (p <.05). Autistic participants were more likely to report irregular menstrual cycles, menstrual cycle-related mental health and sensory experiences changes and poorer reproductive health knowledge and management (all p <.001). HIE scores overall and across subcategories were higher among autistic individuals. Autism diagnosis was associated with higher overall HIE scores (OR=2.86[2.37-3.45], p <.001) and domain specific HIE scores (ORrange = 1.81[1.49-2.22]-5.31[3.56-8.13], p <.001). Conclusion Autistic individuals AFAB face increased reproductive health burden, greater difficulty managing their reproductive health, and significant healthcare inequities. Tailored education and individualized service adjustments are essential for equitable reproductive care in autistic individuals AFAB.

Background: Autism spectrum disorder (ASD) and borderline personality disorder (BPD) share overlapping clinical features including social cognitive differences, interpersonal difficulties, emotional dysregulation, and alexithymia. The two conditions show different gender prevalence patterns, and it has been suggested that gender bias may exist in diagnostic patterns of ASD and BPD, with females being preferentially diagnosed with BPD instead of ASD. Methods: In this analysis of real-world clinical records from n = 417,752 adults receiving secondary mental health care, we use natural language processing methodology to assess the subsequent incidence of ASD in cohorts diagnosed with BPD and the incidence of BPD in cohorts diagnosed with ASD. To examine the possibility of gender-based diagnostic bias, we assess for an association between gender and the sequence and timing of diagnoses. Results: Results showed substantial rates of concurrent ASD and BPD; the 5-year cumulative incidence of later ASD diagnosis among people with BPD was 3.02% [95% CI: 2.62, 3.43] and of later BPD diagnosis among people with ASD was 3.84% [3.08, 4.60]. Consistent with predictions of unidirectional gender-based diagnostic bias, the typical association between male gender and ASD diagnosis was reduced in cohorts first diagnosed with BPD, whereas the association between female gender and BPD remained in those first diagnosed with ASD. In addition, the interaction between gender and diagnostic sequence was associated with the length of delay between diagnoses, such that women waited longer for an ASD diagnosis (relative to a BPD diagnosis) compared with men. Conclusion: Together, these results provide a number of avenues for future research and highlight the need for clinicians to consider neurodevelopmental assessment for patients diagnosed with BPD, particularly women, in order to investigate and address potential gender-based diagnostic bias.

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.

Movement differences in autism have attracted growing attention in recent years. Anecdotally, autistic movement has been likened to that of Parkinson’s Disease (PD). Given that PD assessments are primarily movement-based, it is important to ensure that autistic individuals are not scoring highly on PD diagnostic criteria due to autism-related movement differences. Quantifying overlap in movement profiles and identifying distinguishing features is essential, particularly given increased PD diagnosis rates in the autistic population. We conducted the first direct comparison study of autistic and parkinsonian movement. Autistic individuals (N = 31), individuals with PD (N = 32) and control participants (N = 31) completed a Shapes Tracing Task and a Reaction Time Task. Kinematic features were compared between groups and classification algorithms were run to distinguish between groups. Groups were distinguishable based on kinematic features. The autistic group differed from both PD and control groups in speed modulation and sub-movements, and from the PD group in reaction time. Classification algorithms for clinical (autism and PD) versus non-clinical groups, and for autism versus PD, were most accurate when combining kinematic and questionnaire data. There were no kinematic similarities between autism and PD that were also distinct from controls. Whilst kinematic features did not appear similar between autism and PD, they were informative for group classification. This proof-of-concept study highlights that movement-based metrics may aid in identifying whether someone belongs to a clinical group, and which one – suggesting potential for refining diagnostic approaches for both autism and PD.

The propensity to teach is vital to human cultural evolution and to our ecological dominance of the planet, but its cognitive foundations remain poorly understood. Traditional explanations argue that teaching hinges on particular cognitive pre-requisites, such as Theory of Mind. However, such explanations conflate the function of teaching-promoting learning in others-with how it is achieved, and overlook the role of comparatively simple mechanisms like the heuristics known to underpin teaching in some non-human animals. We propose a novel framework integrating evolutionary and psychological perspectives to understand the diversity of teaching by focusing on the cognitive requirements for flexibility and sensitivity to pupil needs. Synthesizing theory and evidence across disciplines, our framework evaluates the contributions of different mechanisms in determining who and what is taught, and how teaching is achieved. This allows us to understand the cognitive foundations of teaching across different species, in diverse human societies, and neurodiverse populations.

Visual imagery - the creation of images mentally without the corresponding sensory input - plays an important role in multiple cognitive processes. The lack of conscious visual imagery, known as aphantasia, has been linked to autistic traits. However, there is a lack of qualitative studies exploring the experiences of aphantasics, autistic or non-autistic. The current study aimed to investigate the experiences of autistic and non-autistic aphantasics qualitatively, exploring possible similarities and differences that might shed light on links or differential mechanisms. Qualitative framework analysis and quantifying methods were used to analyse data collected via an online survey. A total of 25 aphantasic adults with a clinical diagnosis of autism, and 25 age-matched non-autistic aphantasic comparison participants, completed a series of questionnaires and an open-ended question, providing data for the current analyses. Three themes were identified, each with four subthemes: imagery (auditory and other sensory imagery, inner speech, spatial and navigation, dreams), thinking (abstract thinking, thinking in words, creativity, memory), and emotions and socialization (own emotions, others' emotions, social relationship, feeling different). Significantly more non-autistic than autistic participants endorsed the subtheme concerning "auditory and other sensory imagery", while the opposite was the case for the subtheme "verbal thinking". This is the first study to explore the lived experience of autistic and non-autistic aphantasic adults through qualitative methods. We hope to promote wider public understanding and appreciation of the different, but certainly not deficient, experiences of aphantasia and its intersection with autism.

Retirement is a major life change affecting routines, finances and wellbeing. Autistic adults may face extra challenges during this transition due to employment barriers, limited support and planning difficulties. However, little is known about their retirement experiences compared to non-autistic adults. This mixed-methods study surveyed 517 adults from the United Kingdom (autistic n = 395), aged 40-90 years, about their retirement status, plans, experiences, employment history, income and financial security. Actual or expected retirement ages were similar across groups, but autistic adults were less likely to have made plans and more likely to have plans disrupted by financial, health or personal factors. They also reported lower rates of full-time work, reduced pensions and lower pre-retirement income. Many highlighted a lack of information about pensions and lifestyle planning. Concerns included isolation, loss of routine and financial worries, but some looked forward to more autonomy and time for self-care, leisure activities and interests. While there were many similarities between the autistic and non-autistic groups, our study found that autistic adults may reach retirement differently due to unique work histories, health needs and planning barriers. Tailored, accessible support is needed to help autistic adults plan for financial stability and meaningful post-retirement lives.Lay abstractRetirement is a major life change, but very little is known about how autistic adults experience this transition. This study explored retirement experiences/expectations of both autistic and non-autistic adults, finding that retirement happened or was expected to happen at similar ages across groups. However, autistic adults were less likely to plan for retirement and often had more difficulties with jobs, money, pensions and their health. Many felt unsure how to prepare for retirement and wanted clearer information. While some had concerns about isolation and changes to routine, others looked forward to more freedom and time for hobbies. The findings highlight the need for better support to help autistic people plan for retirement.

Clinical accounts and cohort studies suggest that Autistic people are disproportionately likely to be diagnosed with personality disorder. We conducted a cohort study of adults diagnosed Autistic drawn from the IQVIA Medical Research Database, with follow-up from 1 January 2000 to 16 January 2019. We included a comparison group without diagnosed autism, matched (1:10) by age, sex and primary care practice. We included 22,112 Autistic adults, of whom 6437 (29.1%) had a diagnosis of intellectual disability. Median age was 20.36 (interquartile range: 18.0-28.5), and 16,881 (76.3%) were men. The rate of new personality disorder diagnosis in Autistic people without intellectual disability was 4.8 (3.5-6.7) times higher for Autistic versus comparison men, and 4.6 (3.1-6.8) times higher for Autistic versus comparison women. For Autistic participants with intellectual disability, the rate was 2.0 (1.0-3.7) times higher for Autistic versus comparison men and 8.3 (4.0-17.2) times higher for Autistic versus comparison women. The estimated rate of new personality disorder diagnosis for Autistic people aged 20 increased from 14.67 (95% confidence interval: 10.4-20.8) per 10,000 person-years in 2009 to 22.43 (95% confidence interval: 13.9-36.3) in 2019. The findings indicate that personality disorder diagnoses are more common in Autistic people and increased overall in women from 2000 to 2019.Lay abstract Several research studies have suggested that Autistic people are more likely to be diagnosed with personality disorder than people who are not Autistic. We compared rates of personality disorder diagnoses between Autistic people and a comparison group of people not diagnosed Autistic using anonymised data collected by UK primary care practitioners for participants registered at a primary care (general practitioner) practice sometime between 1 January 2000 to 16 January 2019. The comparison group of people in the community who did not have an autism diagnosis were of the same age, sex and registered at the same primary care practice as their matched Autistic participant, with 10 times as many matched participants as Autistic participants. We included 22,112 Autistic adults, of whom 6437 (29.1%) had a diagnosis of intellectual disability. Median age was 20.36 years, and most, 16,881 (76.3%), were men. We included 221,120 comparison adults. New personality disorder diagnoses were more than four times as common for Autistic men and women without an intellectual disability compared to men and women in the comparison group. For Autistic participants with an intellectual disability, the rate was twice as high for Autistic versus comparison men and 8 times higher for Autistic versus comparison women. Between 2000 and 2019, there was an increase in the rate of new personality disorder diagnoses among Autistic people, and in women. The findings highlight the need for further investigation into reasons for this increase.

Psychological trauma and post-traumatic stress disorder (PTSD) are under-researched in autistic individuals. We explored the experience of trauma and PTSD symptoms in a sample of autistic adolescents (n = 30) aged 10-16 years (without a maltreatment history; 47% female), compared to a group of typically-developing (TD; n = 29) and a group of (non-autistic) maltreatment-exposed adolescents (n = 28), matched on key demographics. Caregiver reports indicated that a wide range of events were deemed traumatic to autistic adolescents, including those not meeting DSM-5's Criterion A for trauma for a PTSD diagnosis (e.g., bullying and bereavement). Caregiver- and self-reports converged to show more severe PTSD symptoms, and higher rates of probable PTSD, in autistic adolescents (43-57%) relative to the TD adolescents (7-32%). Symptom severity and rates of probable PTSD were comparable between the autistic and maltreatment-exposed adolescents (50-54%), except that, for autistic adolescents, the index trauma mostly did not match DSM-5 criteria, whereas it did for maltreatment-exposed adolescents. This short report's early findings supports the need for improved assessment of trauma exposure and PTSD symptoms in autistic adolescents. A flexible approach to how trauma is defined in this population may be needed, considering subjective experiences and autism-related processing differences.

Autistic individuals are at increased risk of developing mental health difficulties. Self-esteem has been found to be a significant indicator of mental health in the general population yet remains underexplored in autistic adolescents. This review aimed to explore rates of low self-esteem in autistic versus non-autistic adolescents (10-19 years of age) and examine the relationship between self-esteem and mental health symptomatology. A comprehensive literature search was conducted across four databases to identify relevant studies published until March 2025. The systematic review included 30 studies of self-esteem in autistic adolescents, including 15 studies with a non-autistic comparison group, and 16 studies with measures of both self-esteem and mental health. Autistic adolescents reported significantly lower levels of self-esteem compared with non-autistic adolescents, with a moderate weighted pooled effect size (g = -0.47). Group differences were maintained when considering measure variance in self-esteem tools but observed to be greater when using the Self-Perception Profile (g = -0.55) in contrast to the Rosenberg Self-Esteem Scale (g = -0.33). Lower self-esteem was associated with greater depressive symptomatology in autistic adolescents, with large effect (r = -.59). These findings highlight the need for targeted self-esteem interventions in autistic adolescents as a potential means to address co-occurring mental health difficulties.Lay AbstractAutistic adolescents are more likely to experience mental health difficulties than their non-autistic peers. One factor that may influence mental health is self-esteem, which refers to how positively or negatively a person views themselves. This review looked at how self-esteem differs between autistic and non-autistic adolescents, and whether low self-esteem is linked to mental health problems such as depression and anxiety. The review included 30 studies, some of which compared self-esteem levels between autistic and non-autistic adolescents and others explored how self-esteem relates to mental health symptoms. The findings showed that autistic adolescents tend to have lower self-esteem than non-autistic adolescents. In addition, lower self-esteem was linked to higher levels of depression in autistic adolescents. These results suggest that supporting self-esteem in autistic adolescents may be an important way to help improve mental health difficulties. The studies in this review included mainly male participants and used different ways to measure self-esteem and mental health, so more research is needed to better understand these relationships and how best to support a diverse range of autistic adolescents.

Psychological assessments play a significant role in both clinical decision-making and the interpretation of research findings, with the quality of these inferences depending on the validity of the measures used. Recent evidence suggests there are gender differences in the presentation of autism, raising concerns about the validity of existing autism tools to measure autistic traits in women and the subsequent implications for clinical inferences and research. This study explored the perspectives of autistic women on the relevance of existing autism questionnaires to their lived experience, alongside additional input from gender-diverse individuals assigned female at birth (AFAB). Through interviews, focus groups, and online surveys, 22 autistic women and AFAB gender-diverse individuals shared their experiences using and perspectives on the Autism Spectrum Quotient-10, 14-item Ritvo Autism & Asperger Diagnostic Scale, and Broad Autism Phenotype Questionnaire. The interview data were analysed using reflexive thematic analysis, identifying two overarching themes: (1) questionnaires measure only one way to be autistic, and not in an autism-friendly manner, and (2) enhancing questionnaires' relevance for autistic women and individuals socialised as female: key missing experiences to include. The findings suggest that some of the most frequently used autism measures may not fully capture the experiences of autistic women and AFAB gender diverse individuals. Significant gaps were identified, indicating that important aspects of the participants' lived experiences were missing. Furthermore, concerns were raised about the questionnaires' lack of relevance to the autistic population as a whole. The findings underscore the non-satisfactory content validity of these tools for measuring autism in autistic women and AFAB gender-diverse individuals. This highlights the need for their refinement to better reflect contemporary understandings of different presentations of autistic traits, particularly the impact of gendered experiences, in a way that avoids the introduction of possible new biases and remains relevant and accessible to autistic individuals.

Social isolation has detrimental effects on wellbeing. While isolation can occur at any age, its prevalence has been found to increase in older adulthood. Populations with social functioning differences, such as autistic people, have also been found to be at particular risk of isolation across the lifespan, including in older age. Despite the widespread impacts of isolation, little is known about the underlying factors that may contribute to social isolation in autistic people and the general populations. While social isolation has been linked to autistic traits and theory of mind (ToM), no study has yet considered their inter-relationship. Taking a dimensional approach to autistic traits, this study examined the association between autistic traits (assessed by the AQ-10), ToM (CarToM and Frith-Happé Triangles) and social isolation (Lubben Social Connectedness Scale) among 111 adults (n = 53 autistic, 58 non-autistic), aged 40-86 years. The study also assessed the putative mediating role of ToM in the association between autistic traits and isolation. Pearson correlational analyses showed middle-aged and older adults with higher social connectedness reported fewer autistic traits and showed better performance in ToM tasks, even when accounting for the effect of age and mental health symptoms. Mediation analyses suggested the association between autistic traits and social isolation was partially mediated by ToM when age and mental health symptoms were accounted for. These findings suggest one possible mechanism for the experience of social isolation. Additionally, the findings highlight that autistic people and people with high autistic traits may be particularly susceptible to social isolation in midlife and older age, and may benefit from additional support and possible interventions to maintain desired levels of social connectedness in later life.