Journal Articles

This study examined the presence of autistic traits in a sample of adult women diagnosed with different Eating Disorders (ED), and explored the concurrent role of autistic traits and sensory sensitivity in influencing both their eating disorder symptomatology and their autism-related eating behaviours. Seventy-five women with different ED (Anorexia Nervosa, Bulimia Nervosa, Binge-Eating Disorder, Other Specified Feeding or Eating Disorder) completed the Eating Attitude Test (EAT-26), the Autism Quotient (AQ), the Ritvo Autism Asperger Diagnostic Scale-Revised (RAADS-R), the Sensory Perception Quotient - Short Form 35 item (SPQ-SF35) and the Swedish Eating Assessment for Autism Spectrum Disorders (SWEAA). Twelve percent of participants scored above the cut-off on both the AQ and the RAADS-R, while 68% scored above the cut-off on the RAADS-R only. A mediation analysis revealed that the association between sensory sensitivity (SPQ-SFR35) and scores on both the EAT-26 and the SWEAA was significantly mediated by the presence of autistic traits (RAADS-R). These findings, first, confirm the presence of autistic traits in individuals with ED; second, they show that a lower sensory threshold (i.e., a higher sensory sensitivity) is associated with a higher presence of autistic traits which were, in turn, positively associated with dysfunctional eating behaviours typical of ED and ASD. This study ultimately highlights the importance of further research on autistic traits across all diagnostic categories of ED.

Voices of autistic women and girls have historically been absent from research. Even now, there is limited knowledge about the experiences of autistic girls and women, particularly in the school setting. To address this gap, this phenomenological study explored a broad range of school experiences for autistic women, from kindergarten through college. Interviews of 6 participants were conducted through a pilot study to inform the development of the interview protocol and process. A total of 14 autistic women participated in the full study, which also included the initial 6 from the pilot. Interviews were audio recorded and transcribed. Two researchers independently analyzed the data to identify themes using thematic analysis. Six themes were identified: (1) Accuracy of diagnosis matters; (2) Details matter; (3) Meaning of sensory and emotional experiences; (4) Invisibility/Not belonging; (5) Relationship and friendship challenges; (6) Layers of vulnerability. We identify recommendations for educators, administrators, counselors, and school social workers.

Rationale  Standard therapeutic approaches to reduce social anxiety in autistic adults have limited effectiveness. Since 3,4-methylenedioxymethamphetamine (MDMA)-assisted psychotherapy shows promise as a treatment for other anxiety disorders, a blinded, placebo-controlled pilot study was conducted. Objectives  To explore feasibility and safety of MDMA-assisted psychotherapy for reduction of social fear and avoidance that are common in the autistic population. Methods  Autistic adults with marked to very severe social anxiety were randomized to receive MDMA (75 to 125 mg, n = 8) or inactive placebo (0 mg, n = 4) during two 8-h psychotherapy sessions (experimental sessions) in a controlled clinical setting. Double-blinded experimental sessions were spaced approximately 1 month apart with 3 non-drug psychotherapy sessions following each.  The primary outcome was change in Leibowitz Social Anxiety Scale (LSAS) Total scores from Baseline to one month after the second experimental session.  Outcomes were measured again six months after the last experimental session.   Results  Improvement in LSAS scores from baseline to the primary endpoint was significantly greater for MDMA group compared to the placebo group (P = 0.037), and placebo-subtracted Cohen’s d effect size was very large (d = 1.4, CI − 0.074, 2.874).  Change in LSAS scores from baseline to 6-month follow-up showed similar positive results (P = 0.036), with a Cohen’s d effect size of 1.1 (CI − 0.307, 2.527).  Social anxiety remained the same or continued to improve slightly for most participants in the MDMA group after completing the active treatment phase. Conclusions  This pilot trial demonstrated rapid and durable improvement in social anxiety symptoms in autistic adults following MDMA-assisted psychotherapy.  Initial safety and efficacy outcomes support expansion of research into larger samples to further investigate this novel treatment for social anxiety.

Objective: Long-term effects of ADHD medication on cognitive functions are not well known. This study investigates development of cognitive functions and ADHD symptoms on well-controlled medication for 1 year in children and adolescents. Study design: This study is part of an ongoing open uncontrolled trial of long-term medication for ADHD in children and adolescents aged 6–18 years with any form of ADHD, and frequently comorbid autism spectrum disorder (ASD, 29%) or autistic traits (24%). Other comorbidities were oppositional defiant disorder, dyslexia/language disorder, borderline intellectual functioning, developmental coordination disorder. This analysis includes 87 participants (61 boys, 26 girls) who completed Wechsler tests at baseline and after 12 months. ADHD symptoms were investigator-rated on the ADHD Rating Scale-IV at the same time points. Results: The whole group of children and adolescents showed significant improvements in Wechsler Full Scale IQ (FSIQ, mean at baseline 92.6, at 12 months 97.95), and on the Index Scales Verbal Comprehension, Working Memory and Processing Speed, after one year of well-controlled ADHD medication. Comorbid dyslexia/language impairment predicted a larger rise in FSIQ, but not gender, ADHD presentation or comorbid ASD. Robust improvements in ADHD symptoms were observed (mean ADHD-Rating Scale score at baseline 34.6, and at 12 months 18.3). Conclusions: Cognitive test scores and ADHD symptoms were improved on well-controlled medication for 1 year in children and adolescents with ADHD, autism and other comorbidities. The main study limitation is the open uncontrolled trial design.

Research suggests that a disproportionate number of female individuals being treated for an eating disorder (ED) also have autism spectrum disorder (ASD). Alexithymia, or difficulty identifying and describing emotions, may mediate the relationship between ED and ASD. In this study, we explored the association of autistic traits with symptoms of alexithymia and eating pathology, as well as the potential mediating role of alexithymia. Two hundred and twenty‐eight female participants aged 18 and older were recruited from online ED support platforms to complete an anonymous online survey via Qualtrics. The survey included three questionnaires: the Toronto Alexithymia Scale‐20, the Autism‐Spectrum Quotient (AQ), and the 13‐item Eating Disorder Examination Questionnaire. More than half (54.8%) of participants met the clinical threshold on the AQ. Participants with a positive screen on the AQ scale also reported more symptoms of alexithymia (92.6% of individuals with a positive AQ vs. 79.8% of those without), B = 9.02, p < 0.001. A positive AQ screen was also associated with significantly greater disordered eating symptoms, B = 4.26, p = 0.031. Alexithymia mediated this association, a × b = 1.98, p

This article provides original insight into women’s experiences of adulthood diagnoses of attention deficit hyperactivity disorder (ADHD) and autism. Research exploring experiences of adulthood diagnoses of these conditions is emerging. Yet, there is no research about the gendered experiences of an adulthood combined ADHD and autism (AuDHD) diagnosis.  This article addresses this gap through interpretative phenomenological analysis of email interviews with six late-diagnosed AuDHD women revealing the complex interplay between late diagnosis, being a woman, and combined diagnoses of ADHD and autism.  It underscores how gender norms and stereotypes contribute to the oversight and dismissal of women’s neurodivergence.  Interpretative phenomenological analysis reveals the inextricability of femininity and neurotypicality, the gendered burden, discomfort, and adverse consequences of masking, along with the adverse outcomes of insufficient masking.  Being an undiagnosed AuDHD woman is a confusing and traumatising experience with profound and enduring repercussions.  The impact of female hormones exacerbated participants’ struggles with (peri)menopause often being a catalyst for seeking diagnosis after decades of trauma.  The epistemic injustice of not knowing they were neurodivergent compounded this trauma.  Diagnosis enabled participants to overcome epistemic injustice and moved them into a feminist standpoint from which they challenge gendered inequalities relating to neurodiversity.  This article aims to increase understanding and representation of late-diagnosed AuDHD women’s lived experiences.  The findings advocate for trauma-informed pre- and post-diagnosis support which addresses the gendered dimension of women’s experiences of being missed and dismissed as neurodivergent.  There needs to be better clinical and public understanding of how AuDHD presents in women to prevent epistemic injustice.

Thirty to 80% of children with autism spectrum disorder (ASD) also have symptoms of attention-deficit hyperactivity disorder (ADHD).  Many children with ASD and ADHD experience difficulties carrying out goal directed behaviors, particularly when it comes to inhibiting responses.  The aim of the current study was to better understand the relative strengths and weaknesses across different measures of inhibition in children with ASD, ADHD, ASD+ADHD, and children who are typically developing (TD).  Inhibition of distracting information, motor responses, response speed, and selections with the potential for greater loss was measured in 155 school-aged children across these four groups.  Results indicate that, for children with ASD+ADHD, inhibition varied across the different outcomes assessed.  Relative to TD children, children with ASD+ADHD showed greater difficulty inhibiting behavioral responses.  Conversely, inhibition of distracting information and strategic slowing of response speed differed between the children with ASD+ADHD and those with either ASD or ADHD.  Avoidance of potential losses did not significantly differ between the four groups.  The unique pattern of inhibition abilities shown in the ASD+ADHD group suggests the need for special consideration in the context of targeted intervention.

Introduction:  The medical and social definitions of neurodivergence have become a common topic of discussion in recent years, and the ways that we define, measure and report on conditions within the neurodivergent umbrella are changing. The objective of this study was to analyze differences in mental health symptom presentation at intake and compare treatment outcomes among three groups: clients with an affirming neurodivergent diagnosis, clients without an affirming diagnosis, and neurotypical clients. Methods:  Data were collected at intake and discharge. Clients self-reported neurodivergent identity, neurodivergent diagnoses, as well as the severity of depression symptoms, anxiety symptoms and self-harm frequency. One-way multivariate analysis of variance tests were run to assess differences in mental health symptoms at intake and discharge based on neurodivergent identity and corresponding diagnosis. When MANOVAs indicated significant differences, follow-up univariate one-way ANOVAs were conducted for each dependent variable. Results:  Neurodivergent clients reported significantly worse mental health symptoms at intake than neurotypical clients, regardless of diagnosis status. Additionally, clients who identified as neurodivergent but did not report an affirming medical diagnosis reported significantly worse mental health symptoms than those who did report an affirming medical diagnosis. By discharge from IOP treatment, no significant differences were found in symptom change scores between neurodivergent and neurotypical individuals, or neurodivergent individuals with an affirming diagnosis and those without. Discussion:  These findings highlight the importance of acknowledging client identity as a key component of mental health treatment. The act of validating symptoms and experiences, allowing accommodations when requested, and exploring identity formation regardless of diagnosis, allowed all clients who identified as neurodivergent to benefit from treatment.

The focus of mental health research in emerging fields should be driven by the priorities of people with relevant lived experience. Autism and ADHD are childhood-onset neurodevelopmental conditions that are associated with a range of health inequalities, including increased risk for eating disorders. The evidence base for how best to support neurodivergent individuals who experience disordered eating is still in its infancy, but research suggests that existing clinical approaches are not currently fit for purpose. In this Personal View, through community consultation with autistic people and people with ADHD who have experienced disordered eating, we present a comprehensive ranked list of research topics that people with lived experience prioritise. These priorities could be clustered into two areas: improving outcomes and identifying causal mechanisms. Within the theme of improving disordered eating outcomes, priorities are the improvement of treatment, the need for neurodiversity training in clinical services, and the identification and minimisation of unintended adverse effects of psychological intervention. Within the theme of identifying causal mechanisms, priorities are the identification of risk factors and a better understanding of the effect of autistic or ADHD neurocognitive profiles as potential contributors to eating disorder vulnerability. The final top ten research priorities are contextualised in terms of how they compare to the existing literature on the overlap between autism or ADHD and eating disorders, and concrete suggestions are made for how to implement these research priorities as testable hypotheses. Research informed by these priorities will build necessary understanding of the reasons behind the increased risk for eating disorders in neurodivergent people, and how to best support people who are affected by disordered eating to live positive and fulfilling lives

Cumulative exposure to psychosocial adversity at an early age has been shown to be a risk factor for attention-deficit hyperactivity disorder (ADHD) and autism that often co-occur. However, it is not clear if this association reflects a causal effect or familial confounding. We aimed to assess whether cumulative psychosocial adversity in the family increases the risk for ADHD and autism in offspring while accounting for unmeasured familial confounding. We used a population-based cohort of 1,877,901 individuals born in Sweden between 1990 and 2009. Participants were followed from the age of 3 until 2013, with a median follow up time of 13.8 years. We created a cumulative index based on 7 psychosocial adversity factors. We used Cox regression to estimate the hazard ratios (HRs) relating neurodevelopmental conditions to cumulative psychosocial adversity. To address familial confounding, the analyses were repeated in groups of relatives of different kinship: siblings and half-siblings and cousins. A dose-response relationship was observed between cumulative exposure to psychosocial adversity and ADHD at a general population level (covariate adjusted HRs (aHRs) with 95% confidence intervals ranged from 1.55 [one adversity; 1.53–1.58] to 2.65 [ ≥ 4 adversities; 1.98–3.54]). No clear dose-response relation was seen for autism (aHRs ranged from 1.04 [.59–1.84] to 1.37 [1.30–1.45]). HRs of ADHD and autism decreased with increasing level of kinship in the analysis of relatives. Cumulative exposure to psychosocial adversity was associated with both ADHD and autism in the general population, these associations were partly explained by unmeasured familial confounding between relatives. This highlights the need for using family-based designs in studies of psychosocial adversity and ADHD and autism.

The neurodiversity movement is a social movement that emerged among autistic self-advocates. It has since spread and has been joined by many with diagnoses of attention-deficit/hyperactivity disorder, dyslexia, and developmental coordination disorder among others.  By reconceptualizing neurodiversity as part of biodiversity, neurodiversity proponents emphasize the need to develop an ‘ecological’ society that supports the conservation of neurological minorities through the construction of ecological niches—that is, making space for all.  This is an alternative to the drive to eliminate diversity through attempts to ‘treat’ or ‘cure’ neurodivergence. So far, neurodiversity theory has not been formally adapted for psychotherapeutic frameworks, and it is not the role of the therapist to make systemic changes to societal organization.  Still, there is room for fruitfully drawing on a neurodiversity perspective for therapists working with neurodivergent people in clinical settings.  Here, we draw on the example of autism and synthesize three key themes to propose the concept of neurodivergence-informed therapy.  First, the reconceptualization of dysfunction as relational rather than individual.  Second, the importance of neurodivergence acceptance and pride, and disability community and culture to emancipate neurodivergent people from neuro-normativity.  Third, the need for therapists to cultivate a relational epistemic humility regarding different experiences of neurodivergence and disablement.

There has been a focus on autistic-led and participatory research in autism research, but minimal discussion about whether the field is hospitable to autistic involvement.  While the focus on participatory and/or autistic-led research is abundantly welcome, a wider conversation should also happen about how autistic people are treated in the process of knowledge creation.  As such, I present a critical reflection on my experiences of academia as an autistic autism researcher.  I open by questioning whether I am an academic, an activist, or an advocate before discussing my journey through academia, and my exposure to dehumanizing, objectifying, and violent accounts of autism.  I highlight how the construction of objectivity has resulted in a failure to question the validity of these dehumanizing accounts of autism, which are regarded as “scientifically-sound” by virtue of their perceived “objectivity.”  Furthermore, I discuss how the idea of objectivity is used to side-line autistic expertise in disingenuous ways, especially when this knowledge challenges the status-quo.  Despite claiming to be value-free, these dehumanizing accounts of autism embody social and cultural values, with a complete lack of transparency or acknowledgment.  I then discuss how these dehumanizing accounts and theories—entangled in values—reverberate into autistic people's lives and come to be ways of constituting us.  Following this, I discuss the rationality of the anger autistic people feel when encountering these accounts, and instead of urging people to distance themselves from these emotions, I discuss the value of “leaning-in” as a radical act of dissent in the face of research-based violence.  I then make a call to action urging all those who write or speak about autism to engage reflexively with how their values shape their understanding and construction of autistic people.  Lastly, I conclude by answering my opening question: I have emerged as an advocate, activist, and academic.  For me, belonging to the autistic community, acknowledging our marginalization, and recognizing our suffering within society means that hope for a better and just future has always, and will always underpin my work.