Autism in adulthood : challenges and management最新文献

Given the dearth of research on adulthood in autism prior to the last decade, we need methods to accelerate progress. One area of interest is mental health, but studies focusing on isolated methods or limited sets of constructs are unlikely to rapidly identify the many contributors to autistic adult mental health outcomes. We argue that adopting a multimethod, dimensional approach will more rapidly speed progress. One framework designed to encourage this approach is the National Institute of Mental Health (NIMH)'s Research Diagnostic Criterion initiative (RDoC). In this paper, we describe the utility of RDoC and considerations for the design of an RDoC-inspired autism study. We demonstrate this via an example focused on suicide because suicide is one serious and well-documented sequelae of poor mental health. This paper begins with a brief overview of the significance of suicide to autism. Then, the paper outlines key aspects of the RDoC, including consideration of the following: dimensional processes, development, different units of analysis (methods), content domains, and environmental influences. We describe the University of Pittsburgh Autism Center of Excellence (Pitt ACE) as project context; it adds an example of how RDoC can work and concepts to consider when designing an RDoC-inspired autism study. Specific methods and constructs are highlighted that may lead to improved understanding of suicide and mental health in autistic adults, and ultimately more tailored interventions and supports.

Background: Suicide is a leading cause of death for autistic people, but inadequately explained by theories derived in non-autistic populations. Autistic people's perceptions of the factors underpinning suicidal experiences are vital for guiding conceptual understanding, risk assessment, and policy and clinical practice towards preventing suicide.

Methods: We recruited 1369 autistic participants for an online survey designed through consultation with autistic people. Participants were 326 cisgender men, 718 cisgender women, and 325 transgender or gender-divergent individuals, ranging from 16-89 years old. We asked them to rate the importance of 19 contributing factors to their suicidal thoughts and feelings, and enter their own explanations of additional factors if desired. Alongside thematically analysing this qualitative data, we examined whether ratings of contributing factors differed by age and gender, and whether ratings statistically predicted levels of lifetime suicidality.

Results: Loneliness, feelings of worthlessness/failure, hopelessness and mental illness were the highest rated contributing factors to suicidal thoughts and feelings, particularly by autistic women and sex/gender minorities; ratings also differed by age. Qualitative responses indicated the complexity of suicidality, wherein autistic status influenced both the nature of the stressors (e.g. societal stigma) and cognitive-emotional states (e.g. feeling disconnected through feeling different to others) that participants identified. Greater perceived importance of bullying, difficulties accessing support and past trauma characterised participants with experience of suicide plans or attempts.

Conclusion: While some of the experiences and mental states identified by participants resembled those identified in non-autistic groups, the psychological profile of autistic participants and their experiences of marginalisation appeared to heavily contextualise expressions of hopelessness, burdensomeness, worthlessness, loneliness and entrapment. Autistic people vary with regards the factors perceived to underpin suicidality. However, associations between suicidality and the perceived importance of bullying, trauma, and inability to access support highlight the necessity of societal and systemic change to prevent suicide.

Background: The menopause transition commonly occurs between the ages of 45 and 55 years. In a general population, hormonal shifts result in a range of biological, psychological, and social changes. Recently, research has begun to focus on Autistic people's experiences of the menopause.

Methods: We undertook a prospectively registered (PROSPERO: CRD42023450736) systematic review of research and first-hand accounts from grey literature related to Autism and menopause. We utilised the Joanna Briggs Institute convergent integrated synthesis approach.

Results: Our search identified eight studies and seven pieces of grey literature, primarily comprising Autistic people. No studies evaluated interventions or provided data from those supporting Autistic people. We developed three themes. First, "knowledge of the menopause transition and peer support" focused on Autistic people's lack of knowledge of menopause symptoms, including differences for Autistic people, and the role of peer support in obtaining knowledge. Second, "Autistic people's experiences of menopausal symptoms" describes a broad range of negative symptoms which sometimes had significant impacts on mental health and daily activities. Limited quantitative evidence highlighted increased menopause symptom severity for Autistic people compared to non-Autistic comparison groups. Menopause symptoms impacted on work and relationships, and there was an inter-relationship between menopausal symptoms and Autistic identities. Third, "treatment of menopause symptoms" describes non-medical and medical approaches, including Hormone Replacement Therapy, to reduce symptom impacts. Most reports of medical treatment highlighted barriers to access, or negative experiences of appointments.

Conclusion: There is a clear need for better menopause supports for Autistic people. This should include Autism-friendly information to increase knowledge of menopause, and how it may impact Autistic people. Corresponding information should also be available for health professionals, with systemic barriers to healthcare also reduced to allow the best chance for Autistic people to receive menopause support. Autism-specific menopause peer support may be worthy of evaluation.

Autistic college students report that they experience difficulties in executive functioning (EF) and social interactions, which can impact their academic success and postcollege outcomes. Few programs exist that focus on both cognitive and social strategies, especially those developed with autistic partners. This study presents a community pilot of a curriculum designed to fill this gap: College SUCCESS. Autistic college students (N = 21) enrolled in College SUCCESS at their university/college through disability services. College SUCCESS is a 26-week group-based curriculum that autistic partners codeveloped; the first half focuses on EF, and the second half focuses on social cognition and communication, all within the context of succeeding at college. Thirteen students completed the curriculum. Students filled out questionnaires and completed task-based assessments before and after the program. Parents and group instructors also filled out questionnaires. Several areas of self-reported EF showed significant improvements from pre- to post-SUCCESS. Self-reported social communication and motivation also increased after the program. Students additionally demonstrated significant changes in social interaction in the context of role-play scenarios. Overall, students and their parents rated the program highly and commented that it had a positive impact. College SUCCESS represents one of the first programs for autistic college students that targets both cognitive and social cognitive skills and community partners codeveloped it. The curriculum could lead to better postsecondary and employment outcomes for autistic individuals. Researchers need more studies, particularly with larger samples, to understand how the College SUCCESS curriculum impacts autistic college students' long-term functioning and life outcomes.

Background: Participation rates for autistic young adults in higher education are increasing. However, academic outcomes and retention are lower than for neurotypical peers, and mental health and well-being concerns exist for these young people. Universities and colleges must provide inclusive supports that consider the needs of autistic young people and reflect neurodiverse affirming approaches. Our systematic review examined empirical studies of support initiatives for autistic young adults in higher education. We considered initiatives' impact in enhancing psychological well-being, academic achievement and retention, and the extent to which programs were coproduced and informed by an understanding of autistic culture and individual experiences.

Methods: Our review followed the Preferred Reporting Items for Systematic Reviews and Meta-analysis standards of systematic review. Studies conducted between 2013 and 2023 that investigated programs for autistic young adults in university and examined psychological well-being, academic achievement, or retention were eligible for inclusion. Sixteen studies met the inclusion criteria. We critically appraised those studies using the Joanna Briggs Institute tool and assessed the support initiatives for quality following the Australasian Society for Autism Research criteria.

Results: The most prevalent support programs for autistic young adults in higher education were mentoring initiatives. Multimodal interventions adopted a psychosocial focus, with primary aims of developing social, organizational, and empathic listening skills. Participants in mentoring programs demonstrated increases in well-being and academic outcomes, including participants' feelings of connection, belonging, and academic self-efficacy. Multimodal interventions showed reductions in areas such as anxiety and loneliness, and improvements in self-esteem.

Conclusion: The support programs we identified in this review demonstrated positive effects for autistic young people's well-being, academic achievement, and retention. Mentoring interventions were beneficial and focused on individual strengths, interests, and challenges of autistic individuals. Our recommendation for future research and support initiatives is to tailor programs to the individual needs of autistic university students, using codesign principles and focusing on environmental and systemic changes to enhance their full participation in higher education.

The applied science of Library and Information Science (LIS) has long emphasized understanding user behaviors in information-seeking processes, particularly in higher education environments where new information and research are generated. However, a notable gap exists in the literature regarding the information-seeking and information-use experiences of autistic and neurodivergent students and adults, impacting an interconnected network of relationships between researchers, librarians, LIS students, and postsecondary students seeking support and services. In LIS, research informs practice, and information-seeking is a cognitive and learning process, especially prescient in academic institutions. The failure to address the information needs of autistic, neurodivergent, and disabled people in LIS research and LIS curricula, which educates future librarians, impoverishes both practitioners and students. Drawing from personal experiences and empirical data, the author highlights the prevalence of neurodivergent students in higher education and investigates why, despite a growing awareness of neurodiversity, LIS research, scholarship, and program curricula largely overlook the specific needs of neurodivergent individuals. The article asks questions and proposes ideas for facing the consequences of an incomplete LIS education, addressing the necessity of introducing inclusive pedagogical practices in the academic library and getting honest about the field's cognitively biased scholarship because we cannot understand the information behavior landscape in all its neurobiological variations nor anticipate the future of information use and creation if we have bypassed neurodivergent and autistic minds.

Background: As autistic students enter postsecondary education, they must decide if and when to disclose their autistic identities. The existing literature on this topic either focuses on students with disabilities more broadly or is not the exclusive focus of the study. Given the need to disclose in order to receive accommodations and the inherent risk involved in disclosing a marginalized identity, it is imperative to understand what factors lead to an autistic college student's willingness to disclose.

Methods: After an extensive literature review on disclosure, we created a survey to better understand autistic college students' disclosure thoughts and behaviors. Researchers developed the survey and obtained feedback on item clarity and importance from autistic college students. We distributed the survey through national networks, resulting in a sample of 123. We analyzed the data using descriptive statistics, ordinal logistic regression, and Mann-Whitney U tests. We analyzed open-ended data using an inductive thematic approach.

Results: The sample was diverse in gender and sexuality, and the majority had co-occurring mental health conditions. Being autistic was an important part of the student's identity, but they expressed worries about negative perceptions or impacts from disclosure. Most students wished they could disclose without consequences. Willingness to disclose to a professor at the beginning of the semester was predicted by how safe a student felt it would be to disclose at their university and the necessity of accommodations. Cisgender, heterosexual students, and white students were more likely to disclose than LGBTQIA+ students and students of color, respectively. In open-ended responses, students discussed concerns about disclosure and when they feel safe to disclose.

Conclusion: We provide questions for students to consider when contemplating disclosure and recommendations for higher education professionals and future research.