Autism最新文献

Autism is heterogenic in core and co-occurring characteristics. Subtyping autism in a longitudinal manner aids the understanding of autism development throughout life and thus enhances personalized support. In this systematic review, we summarized the literature on latent core autism characteristics trajectories and trajectories of other functional domains in autistic individuals and identified predictors of trajectory assignment. We searched Embase, Medline, PsycINFO, Cochrane Central, Web of Science, and Google Scholar until April 22, 2025. We included longitudinal observational studies that applied statistical subtyping methods on core autism characteristics or other functional domains in autistic individuals. A total of 30 eligible analyses were included. The included analyses investigated core autism characteristics (10), adaptive behavior (10), behavioral problems (7), adverse childhood experiences (1), cognitive development (1), and feeding problems (1). For each domain, we found differing numbers and shapes of trajectories. Cognitive development was predictive of core autism symptom trajectory classifications, where cognitive development was generally lower in more severely affected core autism symptom trajectories. We found mixed results for other predictors. Future studies should focus on understudied outcome domains, such as motor coordination or sleep problems. In addition, more research is needed to understand when and why individuals deviate from their subgroup trajectory.Lay abstractAutistic people can have very different characteristics. Investigating groups based on their characteristics over time can improve our understanding of how autistic people develop and why development can differ between people. We reviewed studies that group autistic individuals based on their development of autistic features and other characteristics. We included 30 analyses and summarized their findings. The studies show that there are different ways autistic individuals develop based on core autistic characteristics (social difficulties and focused, intense and repetitive behaviors, interests and activities), as well as for adaptive behavior, behavioral problems, cognitive development, and feeding problems. For core characteristics, lower cognitive abilities seemed to be related to less favorable developmental pathways. This review showed that autistic people may show distinct patterns of development in core characteristics and other domains. We also highlight that some domains of functioning, such as motor coordination and sleeping problems, are not studied in the literature and future studies should focus on these domains as well since these are difficulties that autistic people often face. Identifying distinct developmental patterns in autistic children can help to predict the outcome of autistic people and may aid in offering personalized support.

With growing numbers of adults seeking and receiving autism diagnoses, understanding subjective experiences of this process is crucial for sensitive policy and practice. The route to diagnosis can be long and circuitous, yet most evidence on adults' experiences of diagnosis relies on retrospective reports collected at a single point in time. The current study explores lived experiences of the diagnostic journey through serial qualitative interviews conducted in the weeks before and after adults' autism diagnosis. Fourteen adults participated in online interviews over videoconferencing or email. Thematic analysis of the data suggested the diagnostic process could be characterised according to three themes. Journey to Self-Discovery identified the pursuit of diagnosis as rooted in a drive for self-understanding, propelled by anticipated benefits that were partially realised, and emotionally complex at all stages. Challenges with Navigating the Diagnostic Process highlighted how the process of acquiring and adjusting to a diagnosis was shaped by issues of resource access, system deficiencies, social inequalities and cognitive overwhelm. Isolation to Advocacy revealed how journeys that began in independent self-initiative evolved over time into community participation and advocacy. Providing original evidence of how lived experiences of adult autism diagnosis evolve across time, the current study offers valuable context for adults pursuing assessment, professionals performing assessments and policy-makers designing adult autism services.Lay abstractIncreasing numbers of people are receiving autism diagnoses in adulthood. Understanding their firsthand experience of diagnosis is crucial for improving supports for adults undergoing autism assessment. This study conducted interviews with adults at two time-points: one interview during the six weeks before their assessment, and a second interview within six weeks after their assessment. Fourteen people volunteered to participate in the study through videocall or email. The interview transcripts were analysed using a process called thematic analysis, with specialist software used to find patterns across people's experiences. The analysis suggested that adults appreciated the role of diagnosis in helping develop a better understanding of themselves. Nevertheless, people had mixed emotions both leading up to the assessment and after their autism diagnosis. Adults experienced many challenges in arranging and undergoing the autism assessment. However, the process of getting a diagnosis helped many to move from feeling isolated to feeling part of a wider community. These findings will be useful to adults at different stages of the diagnosis process, and for professionals and policy-makers developing adult autism services.

Linguistic alignment reflects shared linguistic behaviors (e.g. syntax and lexicon) between interlocutors. Recent work has examined whether autistic children align to the same degree as their non-autistic peers, with current findings inconclusive. This study took an in-depth approach to investigating factors contributing to variation in linguistic alignment among autistic individuals. Eighteen school-age and adolescent autistic male participants, 14 males with fragile X syndrome + autism, and their mothers participated in the study. Dyads engaged in an unstructured conversation for ~12 min. Using Bayesian linear mixed-effect models, we assessed the relationships between alignment and within-individual factors of the participants. Lexical and syntactic alignment were uniquely influenced by within-participant factors. Maternal lexical and syntactic alignment were differentially associated with participant cognitive and expressive language abilities, and according to etiology (fragile X syndrome + autism vs idiopathic autism). This study highlights the complexity of alignment in autistic individuals and their mothers. Results suggest that alignment is a dynamic process that is motivated in part by within-individual traits of their children. Consequently, characterizing alignment in autism requires a highly nuanced and thoughtful approach that accounts for the heterogeneity of the population.

This study examined differences in referral and diagnosis based on sex recorded at birth (hereafter, 'sex'), using case notes from 408 individuals diagnosed by 30 multidisciplinary teams across Scotland. Analyses focused on male-to-female ratios and median ages at referral and diagnosis across attention-deficit/hyperactivity disorder, autism and intellectual disability. The lifespan male-to-female ratio across all diagnoses was 1.31, varying by category and age. In autism, the male-to-female ratio was 2.21 for children under 10 years, but there were more females in adolescence (male-to-female ratio = 0.79) and adulthood (male-to-female ratio = 0.94). Across the lifespan, combining all diagnoses, females were referred later (median ages: 14.4 vs 19.7 years; p < 0.001) and diagnosed later (median ages: 15.2 vs 20.2 years; p < 0.001), indicating a 5-year delay. Among autistic children and adolescents, females were referred later (median age: 7.5 vs 10.5 years; p = 0.002) and diagnosed later (median age: 9.3 vs 11.9 years; p = 0.003). However, no significant differences were found in age of referral or diagnosis for autistic adults. Overall, the results indicate increasing balance in sex ratios with age, greater asymmetry in younger age groups, and consistent delays in referral and diagnosis ages for females.Lay abstractThis article looks at how males and females are diagnosed with neurodevelopmental differences including autism, attention-deficit/hyperactivity disorder (ADHD) and intellectual disabilities. It studies the case notes of 408 people (adults and children) assessed by 30 different teams during their diagnosis process. The results show overall that more males were diagnosed with neurodevelopmental differences and that males are diagnosed at younger ages compared to females. The increased diagnosis of males compared to females is most common in younger ages, but and as people get older, the number of males and females diagnosed becomes more equal, showing that more women are coming forward for and being diagnosed, for example with autism and ADHD. This research shows that although there are increasing amounts of females diagnosed, that girls and women are still missed when they are young, with more boys gaining a diagnosis as children. It seems there is a pattern of females being diagnosed at later ages (meaning less access to support and self-understanding). The study calls for better diagnostic practices and more research to address these gender differences.

Friendship has been identified as an important way to support autistic adolescents' social, emotional and cognitive development. However, research examining autistic adolescents' friendships has tended to use methodologies inaccessible to children with complex communication and learning needs. We examined the friendship experiences of 12 autistic adolescents (aged 12-15 years) with complex communication and learning needs who attended a specialist school. Using reflexive thematic analysis, we identified two themes. Within the first theme of 'reconceptualising friendship', the adolescents identified friends who evoked strong emotions and connection, without distinguishing between positive or negative interactions, or the standard boundaries of friendship. 'Friendships' with adults were also highlighted. Within the second theme of 'the context dependent nature of connection', the adolescents' descriptions of friendship communicated a preference for engagement via physical play in spaces that facilitated such interaction. Our findings underscore the importance of directly eliciting the views of autistic adolescents with complex communication and learning needs. They also highlight the value of facilitating opportunities to build social connection with peers and adults through physical play and activities that provoke strong emotions within a safe and contained context.Lay abstractFriendship plays a key role in helping autistic young people develop: socially, emotionally and cognitively. However, much of the research on friendships among autistic children and young people has overlooked those with complex communication and learning needs, using methods that are not accessible to them. As a result, their views on friendship have often been underreported. We investigated the friendship experiences of 12 autistic adolescents, aged between 12 and 15 years, who have complex communication and learning needs and attend a specialist school. By using methods that were adapted including visual resources, the children were able to share their views on friendship. Our two main findings were (1) children identified friends who evoked strong emotions and connection, without distinguishing between positive and negative interactions or the standard boundaries of friendship; and (2) children's descriptions of friendship communicated a preference for physical play in spaces that facilitated this. They also identified the need for space within structured settings. Our research gave the children the opportunity to identify their friends and express their preferences, offering important insights for future studies. These results highlight the value of supporting autistic children to build social connections by providing opportunities for active play and exploration of strong emotions within safe and familiar settings.

Evidence supporting the association between breastfeeding patterns and autism is inconsistent. This study examined sociodemographic and birth factors related to breastfeeding duration and subsequent autism spectrum disorder (autism) diagnosis according to the Diagnostic and Statistical Manual of Mental Disorders, 5^th Edition, compared to a neurotypically developing cohort, based on electronic health records. Demographics, feeding preferences, and breastfeeding duration as reported by parents during routine baby wellness visits were analyzed for a cohort of 11,766 (1.9%) children with autism spectrum disorder diagnosis and a random subsample of 12,000 (2.03%) neurotypically developing children. Autism spectrum disorder diagnosis was based on a national autism registry and assigned after electronic health records were completed. Preterm, very low birth weight, multiple births, and complex medical comorbidities were excluded. Infants subsequently diagnosed with autism were breastfed for an average of 5.0 months, 1.5 months shorter than neurotypically developing. Fewer autism spectrum disorder infants were exclusively breastfed in the first year of life. Two-way analysis of variance indicated a significant effect of socioeconomic status and autism spectrum disorder on breastfeeding duration, and a significant interaction of socioeconomic status with autism spectrum disorder. Shorter breastfeeding duration among infants with subsequent autism spectrum disorder was confirmed, calling for closer monitoring for autism traits in infants with breastfeeding difficulties. These challenges were independent of birth parameters; however, they were influenced by socioeconomic factors.Lay AbstractThis study found that infants later diagnosed with autism were breastfed for a shorter duration than their typically developing peers, with differences influenced by socioeconomic status. These findings highlight the importance of monitoring breastfeeding challenges as a potential early indicator of autism, particularly in families of mid-range socioeconomic status.