Autism

Autistic people sometimes camouflage their behaviour to appear non-autistic. This meta-analysis rigorously tests the relationship between autistic traits and camouflaging, examining contributing person- and study-level variables. Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, we searched PubMED, PsycINFO, Web of Science, and ProQuest Dissertations in April 2025. All quantitative designs examining autistic traits and camouflaging on a continuum were included. Fifty papers (N = 16,895; ages 10–90) contributed to a three-level meta-analysis (accounting for dependent effect sizes). Study quality was medium to high with no evidence of publication bias. Results revealed a moderate association between autistic traits and camouflaging (r = 0.34, 95% CI: 0.30–0.39), comparable across sexes. Depression, but not anxiety or social anxiety, moderated the relationship. Age was not a moderator, but the association was stronger in general population samples (vs diagnosed), with self-reported autism measures (vs observational), and when using the discrepancy method for camouflaging (vs self-report). Among camouflaging subdomains, assimilation showed the strongest effect, followed by compensation and masking. Limited sample diversity constrains inferences across the full spectrum. This meta-analysis provides a clearer understanding of when, why, and how autistic traits are related to camouflaging, with important research and clinical implications. No funding was obtained for this study. Registration: https://osf.io/uswtr/?view_only=277aec07cdfc402dae75f4900f291253

Autistic individuals, family members, and professionals often hold differing perspectives on the goals and outcomes of supports for autistic children under 12 years. While traditional approaches prioritise the acquisition of neurotypical behaviours, emerging frameworks emphasise autonomy, self-determination, and well-being. This systematic review synthesised findings from 15 studies using qualitative, quantitative, and mixed-methods designs, which were assessed for methodological quality using the Joanna Briggs Institute checklists. Communication, social inclusion, and child well-being emerged as shared priorities. Notable differences were observed; professionals tended to focus on normative developmental goals such as skill acquisition and behavioural compliance, while autistic individuals and family members more often valued flexibility, self-advocacy, and strengths-based approaches. Tensions persist between medicalised and neurodiversity-affirming paradigms. To ensure supports align with what matters to autistic people, future research should prioritise co-design with autistic individuals and families, embrace cultural responsiveness, and develop tools that can flexibly but consistently assess neurodiversity-affirming outcomes. These steps will support more ethical, inclusive, and meaningful goal-setting practices in autism research and support.

Understanding the causes of autism in sub-Saharan Africa remains limited, contributing to stigma and delayed identification. This multi-site qualitative study examined community explanatory models of autism and related help-seeking practices in Northern Uganda. Data were generated through 25 semi-structured interviews and 4 focus group discussions (N = 64) across 1 urban and 2 rural districts in the Acholi sub-region. Participants included autistic young people, caregivers, health and education professionals, community, cultural and religious leaders, and government representatives. Data were analysed inductively. Four interrelated themes were identified: unknown causes, supernatural explanations, biopsychosocial attributions, and help-seeking pathways. Autism was frequently misunderstood and conflated with ‘mental illness’ or general learning difficulties. Supernatural accounts, such as witchcraft, curses, and divine punishment, were prevalent and often gendered, with mothers disproportionately blamed. Biopsychosocial explanations included contraceptive use, obstetric complications, genetic factors, and post-conflict trauma. These causal beliefs shaped different help-seeking trajectories, typically prioritising religious and traditional interventions before biomedical care. Stigmatising interpretations were linked to social exclusion, neglect, physical abuse, and, in extreme cases, infanticide. Findings highlight the entanglement of cultural, spiritual, and biomedical models in a post-conflict, low-resource context. Interventions addressing misconceptions and maternal blame may reduce stigma, support earlier identification, and prevent avoidable harms.

Fall-related injuries are a major public health issue for older adults, contributing to mortality, morbidity, decreased functional ability, loss of independence, and increased healthcare costs. Autistic older adults may be at greater risk for falls due to motor coordination difficulties and antipsychotic medication use. This cohort study used multivariable logistic regression to compare the odds of falling and negative binomial regression to compare the rate of fall-related injuries. Data from Medicare Standard Analytical Files (2013–2021) for autistic and non-autistic older adults aged 65+ were analyzed. The sample included 13,732 autistic and 25,497 matched non-autistic older adults. Our dependent variables were (1) falls, (2) unique fall-related injuries, and (3) fall-related hospitalizations. Overall, 47.4% of autistic older adults had a fall compared to 31.5% of non-autistic older adults. Autistic older adults also had more fall-related injuries and hospitalizations. Accounting for duration of observation, autistic older adults had significantly higher odds of any fall (odds ratio = 1.99; 95% confidence interval = 1.89–2.08), rate of fall-related injuries (incidence rate ratio = 1.93; 95% confidence interval = 1.86–2.01), and rate of fall-related hospitalizations (incidence rate ratio = 1.43; 95% confidence interval = 1.35–1.51) than non-autistic older adults. These findings highlight the need for targeted fall prevention strategies for autistic older adults to reduce morbidity and mortality.

Camouflaging refers to strategies used by autistic individuals to mask traits and adapt to neurotypical norms. Beyond socio-cognitive abilities, recent work suggests that camouflaging is also shaped by psychosocial factors. This study tested an integrative, prediction-oriented model of camouflaging. We hypothesized that higher levels of camouflaging would be associated with socio-cognitive functioning, perceived social misfit, mental health, and lower autism acceptance, and that an integrative model combining these factors would predict individual differences in camouflaging. Participants were 120 autistic adults (M = 37.4 years, SD = 10.4), mostly officially diagnosed and predominantly assigned female at birth. Self-report measures assessed camouflaging, executive functioning, perceived social-cognition differences, autism acceptance, social support, and mental health. Partial least squares structural equation modeling was used to estimate the contribution of each predictor to camouflaging. The final model explained a moderate proportion of variance in camouflaging (R² = 0.27; standardized root mean squared residual = 0.05). Executive dysfunction, perceived social-cognition differences, and personal acceptance showed positive associations with camouflaging, whereas intellectual functioning, perceived acceptance, and social support did not contribute meaningfully. Camouflaging reflects a dynamic interplay between perceived social misfit, executive demands, and identity-related processes rather than a fixed cognitive ability, highlighting the importance of affirming social environments.

Despite a wealth of research on autism and interoception, there is not a clear consensus about which dimensions of interoception (if any) are related to autism. This study explored whether self-reported interoceptive accuracy, attention and evaluation are related to autism diagnosis and autistic traits. We analysed questionnaire responses from 519 participants, including 232 autistic participants. We found that people with an autism diagnosis had more negative interpretations of their bodily signals than people without an autism diagnosis, and increasing autistic traits in a general population sample were associated with higher interoceptive attention, lower interoceptive accuracy and higher negative interoceptive evaluation. Our findings suggest that interoceptive evaluation should be a priority for future research.

Autism is the fastest growing neurodevelopmental condition in Canada. Caregiver-mediated interventions, such as the Social ABCs, improve early social communication and caregiver empowerment. To enhance accessibility, Social ABCs was adapted into a condensed, group-based model. This study evaluated its implementation and sustainability at a large pediatric hospital, examining child and caregiver outcomes across multiple coach training pathways and French-language delivery. A retrospective chart review included 361 families (children 12–42 months with suspected or confirmed autism) who completed six weekly group sessions and nine individual caregiver coaching sessions between 2020 and 2024. Coaches were trained via expert-led, hybrid, or site-led pathways. Caregiver implementation fidelity improved from 33.6% to 70.0% (p < 0.001), with similar gains in English and French. Child vocal responsivity increased from 5.7% to 43.2% (p < 0.001), and post-intervention caregiver fidelity correlated with child responsivity (r = 0.25, p < 0.001). Fidelity and responsivity outcomes did not differ by training pathway, supporting site-led training. Multiple pathways expanded clinician capacity, increasing children served by ~86% within 2 years. These findings suggest that group-based Social ABCs may improve caregiver and child outcomes, increase service capacity, and enhance accessibility for French‑speaking families, supporting feasibility of multi‑pathway training models for scaling early autism interventions.

Whether and to what extent sociodemographic disparities in school-based autism identification have been occurring in U.S. elementary schools is currently unclear. We investigated for disparities attributable to race, ethnicity, biological sex, family income, and language use by analyzing repeated cross-sectional data collected on very large samples of U.S. fourth graders participating in the National Assessment of Educational Progress from 2003 to 2022 (ns = 103,150–205,860). Multivariable logistic regression models accounting for potential confounds including student-level academic achievement and school-level resources repeatedly indicated that students of color, females, students from low-income families, and multilingual learners (MLs) are less likely to be identified with autism while attending U.S. elementary schools. These disparities have been largely stable over time, particularly for Black students, females, and MLs. Health and educational policies that ensure equal access to autism supports and services in U.S. elementary schools including by students from historically marginalized communities are warranted.

Students of Color, Females, Students from Low-income Families, and Multilingual Learners Are Less Likely to be Identified with Autism While Attending U.S. Elementary Schools

Whether students who are Black or Hispanic, females, from low-income families, or who are multilingual learners have been less likely to be identified with autism while attending U.S. elementary schools is currently unclear. Prior work reports conflicting findings and has often been unable to approximate contrasts between similarly situated students including those displaying the same levels of academic achievement and who are attending the same schools. Such contrasts of similarly situated students are necessary to better evaluate for the possibility of differential treatment due to biased or discriminatory practices. We used statistical methods to account for potential alternative explanatory factors (e.g. differences in family income, language use, or academic achievement) to better approximate contrasts between similarly situated students. Doing so provides stronger evidence of disparities in school-based autism identification attributable to race, ethnicity, biological sex, family income, and language use and not instead to alternative explanatory factors. To investigate how these disparities have changed across time, we analyzed very large cross-sectional samples of fourth-grade students from 2003 to 2022. These analyses repeatedly indicated that students who are White, boys, those from higher-income families, or students who are English-speaking are more likely to be identified with autism than students of color, females, those from low-income families, or students who are multilingual learners including among those who are displaying similar levels of academic achievement and who are attending the same schools. Although autism prevalence rates have increased for students from historically marginalized communities, students from these communities are still less likely to be identified with autism while attending U.S. elementary schools. Efforts are needed to ensure equal access to autism services and supports among students attending U.S. elementary schools.

Our understanding of autistic socialization using social network analysis has focused on autistic children and understanding support systems. The purpose of this study is to examine autistic friendship networks in adulthood without focusing on support systems. We broadly recruited autistic and nonautistic college students (n = 592 students). Students provided ego-network information, including demographics, satisfaction with their social relationships, and perceptions of their friends (e.g. perceived neurotype and demographics). Autistic college students reported similar network structure metrics (e.g. density, number of friends) as nonautistic college students. Participants of all neurotypes reported similar friendship closeness, social satisfaction, and close mixed-neurotype friendships. However, on average, autistic college students had a higher proportion of autistic and neurodivergent friends than nonautistic college students. To a lesser extent, nonautistic students reported a greater preference for neurotypical friendships. These quantitative results suggest that autistic college students prefer building friendships with other autistic or neurodivergent peers (i.e. autistic or neurodivergent homophily). This preference suggests that authentically autistic (social) spaces and the availability of neurodivergent peers would be beneficial for autistic college students. Overall, these findings contradict the pathologizing “lack of interest in friendships” narrative surrounding autism.

Autistic burnout is typically defined as chronic exhaustion with functional impacts on everyday life. It appears common across work, study, and relationships, yet its emotional and relational dimensions remain underexamined. To document lived experiences of autistic burnout among autistic adults and to identify emotional and relational processes (e.g. shame and masking) that may shape onset, maintenance, and recovery. Eleven autistic adults participated in semi-structured interviews or written responses conducted online between July 2023 and November 2024. Data were analysed using template analysis, combining a priori codes from prior research with inductive coding. Participants described profound exhaustion, sensory overload, and executive dysfunction that disrupted daily life. A prominent emergent theme was shame, which shaped interpretations of functional limits, masking efforts, and help-seeking. Many reported dual-masking, concealing both autistic traits and signs of burnout, which intensified strain, delayed recognition, and undermined recovery. Withdrawal and “gentle re-engagement” through low-demand, people-adjacent activities were described as recovery strategies. Autistic burnout involves physical and cognitive challenges alongside relational and emotional processes that can precipitate and sustain it and complicate recovery. Shame and masking shape how burnout is interpreted and disclosed, underscoring the need for shame-aware, low-demand supports.

Autistic people’s minority status makes them more vulnerable to minority stressors, such as stigmatization and victimization, which are linked to greater stress and lower life satisfaction. The Psychological Mediation Framework (PMF) proposes that cognitive, affective, and social-psychological processes help explain the relationships between these stressors and adverse outcomes. This cross-sectional study tested the PMF in autistic adults by examining how two of its key processes, internalized stigma and loneliness, are associated with stress and life satisfaction. Using self-report survey data from 831 autistic participants enrolled in the Netherlands Autism Register (NAR), aged 18–87 years (M_age = 47.5; SD = 12.5; 408 women, 309 men, and 114 gender-diverse individuals), multiple regression analyses showed that internalized autism-related stigma, emotional loneliness, and social loneliness were each positively associated with stress and negatively associated with life satisfaction. Mediation analyses indicated that both types of loneliness partially mediated the relationship between internalized autism-related stigma and these outcomes. Supporting the PMF, the findings suggest that autism-related stigmas may become internalized and be associated with loneliness, which is linked to greater stress and lower life satisfaction. Future studies should build upon the PMF and explore strategies to mitigate underlying minority stressors.

Social support is positively associated with quality of life (QoL) in autistic people, yet almost all evidence is cross-sectional and focused on younger adults. We examined 2-year longitudinal survey data from 209 autistic adults aged ⩾40 years living in the United States, all recruited via the Research Match service of Simons Powering Autism Research for Knowledge. Participants self-reported their general QoL, autism-specific QoL, and social support (subjective support, instrumental support, and social interaction). Cross-lagged panel models tested bidirectional associations. Mean scores increased from Time 1 to Time 2 for the general QoL and autism-specific QoL, while social support was mostly stable. Higher baseline general QoL predicted greater subjective support later, whereas baseline subjective support did not predict later general QoL. A reciprocal relationship emerged between autism-specific QoL and subjective support. Unexpectedly, baseline instrumental support predicted lower subsequent general QoL. Among autistic adults in mid-to-later life, QoL appears to drive subsequent social support more strongly than support drives QoL, with the clearest reciprocity observed for autism-specific QoL and subjective support. Future multiwave studies with more diverse samples are needed to chart long-term trajectories and determine how tailored support can optimize aging outcomes in individuals with autism.

Families face long waits for their child to undergo a diagnostic assessment for possible autism. This study explored the experiences of parents and children/young people (CYP) accessing and professionals providing autism diagnostic assessments in the United Kingdom. This realist evaluation was conducted in three phases: (1) interviews and focus groups with parents, CYP and professionals from six U.K. National Health Service (NHS) childhood autism assessment and diagnosis services; (2) resulting qualitative data were analysed, and programme theories (PTs) explaining how, why and in what contexts childhood autism assessment and diagnosis pathways work well were tested and refined; and (3) recommendations for change were developed by the research team and presented to delegates at six dissemination events including 250 clinicians, managers, parents/carers, commissioners and academics involved in autism assessment and diagnosis. Delegates were invited to select and rank the most important recommendations. There were 121 participants in Phase 1 (18 CYP, 34 parents, 69 professionals). In Phase 2, both families and clinicians confirmed challenges in the assessment and diagnostic process, including increased demand for assessments and insufficient numbers of specialist multidisciplinary team (MDT) practitioners to provide adequately skilled workforces. The need to support families across the whole assessment and diagnostic process was seen as key to providing a quality service but was often not possible. Steps taken to improve the process were identified, and seven PTs covered: improving recognition of children needing referral, referral processes, service organisation, professional skill mix, assessment, feedback/report writing and training/service evaluation. In Phase 3, during consultation, 12 recommendations were selected as most important for change. Several strategies for improving services were identified that may reduce waiting times and increase acceptability and quality of childhood autism assessment and diagnosis services.

Elevated depressive symptoms among parents of autistic children are well documented and associated with poorer mental health. Mindfulness has been identified as a protective factor against mental health difficulties, but its day-to-day associations with depressive symptoms in this population remain unclear. A total of 210 Chinese parents of autistic children participated in this 15-day diary study, during which they completed daily measures of mindfulness and depressive symptoms. The data were analysed using dynamic structural equation modelling. Results indicated that (1) parents’ daily mindfulness and depressive symptoms exhibited autoregressive stability and showed significant negative reciprocal cross-lagged associations at the within-person level. At the between-person level, (2) higher perceived social support was associated with lower mean depressive symptoms and higher mean mindfulness, and it strengthened the negative cross-lagged effect of daily mindfulness on next-day depressive symptoms; and (3) child externalising problems were positively associated with parents’ overall mean depressive symptoms and negatively associated with both parents’ overall mean daily mindfulness and the autoregressive effects of daily mindfulness and depressive symptoms. Findings underscore the importance of fostering daily mindfulness within a supportive resource context and highlight the need to maintain the day-to-day persistence of mindfulness in families of autistic children with higher externalising problems.

Traditional self-report autism measures are often constructed from an “outside view” by non-autistic researchers rather than reflecting authentic autistic experiences. Predictive processing theory offers a framework for understanding autism, but comprehensive tools assessing the subjective manifestations of predictive processing differences and associated challenges have been lacking. This study aimed to develop and validate the Introspective Predictive Processing Inventory (IPPI), a self-report measure assessing predictive processing characteristics and their subjective consequences in everyday life. Through community-led, participatory research, we developed an initial 65-item version in German and English, and employed a five-stage validation approach across three samples (N = 790). We used network-based item optimization, exploratory and confirmatory factor analyses, measurement invariance testing, and convergent validity assessment. Network optimization reduced the scale to 18 items while maintaining excellent reliability and improved discriminative power. Exploratory factor analysis revealed a stable two-factor structure: “Prediction Integration and Interpretation” and “Prediction Error Sensitivity and Stability Needs”. The IPPI demonstrated exceptional discriminative validity (area under the curve >0.97), strong convergent validity with established measures, measurement invariance across groups, and independence from general cognitive abilities. It provides a tool for assessing predictive processing experiences and their daily consequences, advancing autism research that bridges predictive processing theory with lived experiences.

Autistic girls are often diagnosed late, missed, or misdiagnosed, which can negatively impact quality of life and mental health. Although research shows the social profiles of autistic girls differ from boys in systematic ways that might explain gaps in diagnosis, little is known about how autistic girls’ social language compares to their same-sex non-autistic peers. This study investigated social words—words that make reference to other people—produced by 138 age- and IQ-matched autistic and non-autistic youth (ages 6–15) during one Autism Diagnostic Observation Schedule, Second Edition task. Girls used significantly more social words than boys across both diagnostic groups. There was a larger gap in social word production between autistic girls and non-autistic girls than autistic boys and non-autistic boys, with non-autistic girls using the most social words. Non-autistic girls’ social language behavior—including their social word production—sets an especially high bar for autistic girls, who often report trying to blend in with other girls. Growing evidence of the distinct social language profiles of autistic and non-autistic girls versus boys should guide researchers and clinicians to assess autism in ways that are sensitive to sex-associated differences and develop interventions that consider the norms of youth’s target social circles.

Eating difficulties are highly prevalent among autistic children and are linked to negative health consequences. While many mechanisms are thought to underly these behaviors, we know less about how internalizing and externalizing behaviors relate to eating difficulties in autism. The purpose of this study was to examine how internalizing and externalizing behaviors differ between autistic children (3–6 years of age) with parent-reported picky eating (n = 80) and without picky eating (n = 30). Data was drawn from intake paperwork and assessments completed as part of an autism diagnostic evaluation at a large medical center. Results suggested that picky eaters, when compared to non-picky eaters, had significantly more difficulties with aggression and withdrawal. Our study findings suggest that understanding the behavioral profiles associated with picky eating may be particularly useful when devising treatment plans. Furthermore, diagnosticians who may be the first to gather both eating and behavioral symptom data can initiate referrals to feeding specialists to help prevent some of the negative health consequences associated with these eating behaviors.

Self-injurious behaviors in autistic youth vary widely in their form, intensity, and potential for physical injury. This study explored predictors of two categories of self-injurious behaviors that were delineated based on their potential for physical injury (self-injurious behavior-High Likelihood and self-injurious behavior-Low Likelihood), with a focus on the role of distress linked to a strong preference for routines (otherwise known as insistence on sameness). The sample included 1892 autistic youth (M_age = 10.82, SD_age = 4.14; 22% females) across the United States. Distress associated with insistence on sameness was the strongest predictor of total self-injurious behavior scores, self-injurious behavior-Low Likelihood, and self-injurious behavior-High Likelihood, after controlling for demographic factors and speech level, and remained a unique predictor after accounting for variance explained by other restricted and repetitive behaviors. Sensory hypersensitivity and sensory-seeking were strong unique predictors of all self-injurious behaviors, while hyposensitivity was a weaker predictor of self-injurious behavior total and self-injurious behavior-Low Likelihood, and a non-significant predictor of self-injurious behavior-High Likelihood. Among demographic factors, lower household income was the strongest predictor of all self-injurious behaviors. Higher speech level was a positive predictor of self-injurious behavior-Low Likelihood but a negative predictor of self-injurious behavior-High Likelihood. These findings demonstrate the role of distress associated with insistence on sameness in manifestations of self-injurious behaviors and highlight the importance of exploring predictors at a more granular level to inform targeted interventions and support.

The term virtual autism has recently been used to describe autism-like behaviors in young children following prolonged exposure to screens. The use of the word autism in this context raises conceptual and ethical concerns by reinforcing outdated ideas about parental blame, misrepresenting the nature of autism as we currently understand it, and causing misunderstanding about autism among the general public. We call for more precise and responsible language and advocate for an alternative term that better reflects the environmental basis of the phenomenon, such as screen-related developmental delay.

Post-diagnostic support is a critical yet underdeveloped aspect of dementia care, especially for autistic adults who present with distinct cognitive, sensory, and communication needs. Although interventions such as medication management, psychosocial support, environmental modifications, and carer training are known to improve outcomes, their relevance and accessibility for autistic individuals remain poorly understood. As part of the Second International Summit on Intellectual Disability and Dementia, an international working group examined the intersection of autism and dementia with a focus on post-diagnostic care. Drawing on interdisciplinary expertise, the group identified key barriers and opportunities in clinical practice, caregiving, and service delivery. Recommendations are organized across seven areas, including models of post-diagnostic support, caregiving contexts, pharmacological and non-pharmacological interventions, environmental adaptations, and care planning. The discussion emphasizes the complex needs of autistic adults—many of whom have co-occurring intellectual disabilities, psychiatric conditions, or chronic health issues—and the need for individualized approaches that account for sensory sensitivities and communication differences. Existing dementia care frameworks often fail to address these complexities, resulting in significant service gaps. The report calls for urgent investment in research, workforce training, and policy reform to promote equitable, autism-informed post-diagnostic support and improve quality of life for this underserved population.