The Psychological Impact of the COVID-19 Lockdown: A Comparison between Caregivers of Autistic and Non-Autistic Individuals in Italy

The COVID-19 outbreak has disrupted the daily routine of the population worldwide, including autistic people and their caregivers, with severe consequences on mental health. On one hand, the reduced social contacts and the interruption of outpatient and daycare services during the lockdown have represented a real challenge for autistic people and their caregivers. On the other hand, confinement has allowed individuals to spend more time pursuing their interests and stay home with their family members without feeling the pressure of social expectations. The present study aimed to compare the levels of personal wellbeing, family distress, insomnia, and resilience between caregivers of autistic people and caregivers of people with other neurodevelopmental, psychiatric, or relational disabilities. A web survey was completed by 383 participants, of which 141 were primary caregivers of autistic people. We did not find any significant difference between caregivers of autistic and non-autistic people in any of the considered psychological variables. Lower age of the autistic family member and lower resilience levels were significantly associated with higher individual distress in the group of caregivers of autistic people. Our findings do not corroborate the hypothesis that caregivers of autistic individuals have had more severe consequences than other caregivers during the lockdown. However, they confirm the importance of promoting resilient coping strategies in autistic people and their caregivers.

Moral Foundations Theory Among Autistic and Neurotypical Children

Morality can help guide behavior and facilitate relationships. Although moral judgments by autistic people are similar to neurotypical individuals, many researchers argue that subtle differences signify deficits in autistic individuals. Moral foundation theory describes moral judgments in terms of differences rather than deficits. The current research, aimed at assessing autistic individuals’ moral inclinations using Haidt’s framework, was co-designed with autistic community members. Our aim was to describe autistic moral thinking from a strengths-based perspective while acknowledging differences that may pose interpersonal challenges among autistic youth. We assessed 25 autistic and 23 neurotypical children’s moral judgments using the Moral Foundations Questionnaire for Kids. We used semi-structured interviews and qualitative analysis with a subset of participants to describe children’s moral reasoning. Analyses suggested that autistic and neurotypical children make similar judgments about moral transgressions across all five moral foundations. General linear mixed modeling showed that the greatest predictor of recommending punishment was how bad children deemed moral transgressions to be. We also found a trend that autistic children were more likely to recommend punishment for harmless norms violations than were neurotypical children. Future research could use longitudinal methods to understand the development of moral judgments among autistic and neurotypical children.

Dimensions of Self-Reported Driving Difficulty in Autistic and Non-Autistic Adults and their Relationship with Autistic Traits

A survey asked autistic and non-autistic people about the driving difficulties they experience and their autistic traits. Principle components analysis was used to identify how reported difficulties clustered together in each group, and regression was used to determine which subscales of the Autism Spectrum Quotient predict these factors. For autistic drivers three factors of driving difficulty emerged: a Driving Executive factor, predicted by Attention Switching; a Driving Understanding factor, predicted by Communication; and a Driving Social Interaction factor, predicted by Attention Switching. For non-autistic drivers only one Driving General factor emerged, predicted by Communication. This suggests autistic people may experience at least three distinct domains of difficulty when driving which may relate to their particular profile of autistic features.

Cardiovascular risk and association with depression in middle-aged and older autistic adults

Cardiovascular risk factors (CVRF) increase during later-life and are associated with depression symptoms and difficulties with executive function among non-autistic older people. Few studies have examined CVRF among autistic people. Using data from the Simons Foundation Powering Autism Research for Knowledge research match, this study examined the frequency of CVRF and associations between CVRF, depression symptoms and executive function in 387 middle-aged and older autistic people (aged 40-83 years). Individuals provided demographic and health information to assess the number of CVRF (presence of hypertension, high cholesterol, diabetes, obesity). Participants also self-reported their depression symptoms and executive functions in the domains of inhibitory control and emotional regulation. CVRF were common among autistic middle-aged and older people, with 28.9% reporting two and 23.2% reporting three or more CVRF. Regression analyses explored the variables associated with depression symptoms. After accounting for the effects of age and sex assigned at birth, CVRF contributed a small but significant amount to the model. A regression model examined the impact of executive function. Emotional regulation (but not inhibitory control), CVRF and age were significantly associated with depression symptoms in middle-aged and older autistic people. In conclusion, CVRF was significantly associated with depression symptoms, and depression symptoms, in turn, were primarily associated with emotional regulation. CVRF occur at high rates in middle-aged and older autistic people but may not be as important a mechanism for depression symptoms as among non-autistic older people.

“You Feel Like You Kind of Walk Between the Two Worlds”: A Participatory Study Exploring How Technology Can Support Emotion Regulation for Autistic People

An increasing amount of technological solutions aiming to support emotion regulation are being developed for Autistic people. However, there remains a lack of understanding of user needs, and design factors which has led to poor usability and varied success. Furthermore, studies assessing the feasibility of emotion regulation technology via physiological signals for autistic people are increasingly showing promise, yet to date there has been no exploration of views from the autistic community on the benefits/challenges such technology may present in practice. Focus groups with autistic people and their allies were conducted to gain insight into experiences and expectations of technological supports aimed at supporting emotion regulation. Reflexive thematic analysis generated three themes: (1) communication challenges (2) views on emotion regulation technology (3) ‘how’ technology is implemented. Results provide meaningful insight into the socio-emotional communication challenges faced by autistic people, and explore the expectations of technology aimed at supporting emotion regulation.

Healthy Relationships on the Autism Spectrum (HEARTS): A feasibility test of an online class co-designed and co-taught with autistic people

This study tested the feasibility and preliminary efficacy of a six-session online class on healthy relationships for autistic individuals ages 18–44 years old ( N = 55). The content of the Healthy Relationships on the Autism Spectrum class was informed by formative research with 25 autistic individuals, and developed collaboratively by two non-autistic professionals and seven autistic self-advocates. Fifty-five autistic people participated in Healthy Relationships on the Autism Spectrum and completed pre- and post-surveys. The study found that it was feasible to deliver Healthy Relationships on the Autism Spectrum online. Pairing an autistic and non-autistic person to co-teach was well-received. Participants decreased hostile automatic thoughts ( p < 0.05), involvement in dating abuse in intimate relationships ( p < 0.05), fight-or-flight response ( p < 0.05), and rejection sensitivity ( p < 0.001). Participants experienced improved flourishing ( p < 0.001), coping with rejection and jealousy ( p < 0.001), motivation to engage with others for socializing ( p < 0.05), self-compassion ( p < 0.05), and positive thinking ( p < 0.05). Scores on a measure of interpersonal competence did not change, and loneliness did not decrease. The majority of participants reported high satisfaction with the class. Healthy Relationships on the Autism Spectrum is a promising healthy relationships promotion class that should be evaluated through a randomized controlled trial. Lay abstract The Healthy Relationships on the Autism Spectrum class is unique because autistic people helped to develop it and co-taught it. It is an online, six-session class. The class was piloted in 2020–2021 with 55 autistic people who were ages 18–44 years old. This feasibility study found that most people who took the class liked it. Surveys filled out by the students before and after the class showed that they became less sensitive to rejection, used more positive thinking skills, and were more interested in being social. However, the class may not have made them feel less lonely. The team that invented the class is using the feedback to improve it. The class holds promise for improving the quality of friendships and dating relationships for autistic adults and should be tested further.

Exploring Autistic Adults’ Psychosocial Experiences Affecting Beginnings, Continuity, and Change in Camouflaging Over Time- A Qualitative Study

Many autistic people develop camouflaging strategies to mask or compensate for their underlying autism-related differences in order to get by in predominantly non-autistic societies. Autistic adults have described camouflaging as a “lifetime of conditioning to act normal”, suggesting that camouflaging develops over the autistic person’s lifespan. Yet, very little is so far known about the course of camouflaging motivations and behaviours over time or the psychosocial factors that may influence autistic people’s camouflaging trajectories. In an exploratory qualitative study within an Asian sociocultural context, we interviewed 11 Singaporean autistic adults in depth about their camouflaging experiences throughout their lives. We aimed to better understand the beginnings, continuity and changes in their camouflaging motivations and strategies over time, and related psychosocial influences. Interviews were transcribed verbatim and thematically analysed. Twenty-six themes were identified, and were organised across four phases - pre-camouflaging, beginnings, continuity, and change over time. The earliest camouflaging motivations were predominantly relational, linked to a negative self-identity shaped by adverse social experiences. Strategies were increasingly complex and better integrated into one’s sense of self over time, or more selectively engaged in. Our findings highlight the role of psychosocial pressures precipitating camouflaging. They also emphasise the need for both individual psychological and societal-level changes to move from pathologizing autistic differences to acceptance, understanding, and inclusion, so as to reduce psychosocial pressures on autistic people of all ages to camouflage.