Gael I. Orsmond

Purpose Autistic youth experience high rates of adverse childhood experiences (ACEs), yet little is known about how different ACEs are associated with mental and physical health outcomes. The aims of this study were to identify latent classes of ACEs in autistic youth and examine how ACEs, measured via cumulative risk or latent class approaches, were associated with mental and physical health outcomes in autistic youth. Methods We conducted a secondary analysis of the 2021–2022 National Survey of Children’s Health, a U.S. cross-sectional dataset. The sample included 1,332 autistic youth aged 12–17. A latent class analysis (LCA) of 12 ACE indicators was conducted. Logistic regressions examined associations between ACEs and mental health (anxiety or depression diagnosis) and physical health (poor/fair vs. good/excellent health), controlling for youth characteristics. For each outcome, two regressions were conducted: one using cumulative ACE count (0–12) and one using latent class membership. Results A 3-class LCA model best fit the data: (1) Low ACEs, (2) Bullying and Discrimination, and (3) Household Disruption and Community Violence. For each outcome, cumulative ACE count and latent classes predicted similar variability. Compared to the Low ACEs class, youth in Class 2 and Class 3 were > 120% more likely to have a diagnosis of anxiety or depression; youth in Class 2 were > 75% more likely to have poor physical health. Conclusion Findings highlight distinct patterns of ACEs among autistic youth and their links to health outcomes. Tailoring supports to specific types of adversities experienced by youth may foster resilience and promote well-being.

Autistic youth often face challenges with transitioning to adulthood. Although autistic students working toward a traditional diploma likely have unique educational and transition needs, little is known about special education services offered to this population. In this descriptive study, we used content analysis to analyze Individualized Education Programs (IEPs) of 48 traditional diploma-seeking autistic high school students from 11 states across geographic regions in the United States, focusing on annual goals, accommodations, and related services. Individualized Education Programs commonly included social, emotional, and behavioral and executive functioning goals; fewer than half had employment, postsecondary education, or independent living annual goals. The most included accommodations were for academic support and support for learning and processing styles. Implications for school-based transition services are discussed.

The aim of the present longitudinal study was to identify malleable factors during the last year of high school that predicted post-school outcomes in autistic youth one year after high school graduation. We then explored whether depressive symptoms in high school mediated the associations between other malleable factors and post-school outcomes. Thirty-two autistic youth and a parent completed surveys during the youth's final year of high school (T1) and one-year post-high school graduation (T2). Malleable factors measured at T1 included social communication skills, executive functions, responsibility for daily tasks, and depressive symptoms. The T2 young adult outcome measure included both objective and subjective indicators of productivity, social well-being, and autonomy in living situation. All malleable factors except social communication skills were significantly correlated with young adult outcomes. T1 executive functions, responsibility for daily tasks, and depressive symptoms jointly predicted 40.2% of the variance in young adult outcomes. Only depressive symptoms explained a significant amount of unique variance in young adult outcomes. In addition, depressive symptoms mediated the predictive association between executive functioning and young adult outcomes. The findings suggest that depressive symptoms may be a key intervention target for autistic high school students. Adapting cognitive behavioral approaches to comprehensively address multiple transdiagnostic factors such as executive functions, responsibility for daily tasks, and mental health may be a promising avenue to promote positive post-school outcomes in this population.

Purpose Research documents poor outcomes for autistic adults in the domains of employment, independent living, and social relationships. Measurement and sample limitations in prior studies may have amplified past estimates of poor outcomes. The goal of the current study was to improve upon past approaches and to create and describe a measurement approach to capture adult outcomes that reflected the context of young adulthood and the perspectives of autistic individuals, pairing objective outcome indicators with subjective satisfaction indicators. Methods Thirty-six autistic young adults (mean age 19.8 years) and a parent completed self-report surveys. Using these data, we defined an objective and subjective (i.e., satisfaction) outcome indicator in each of three domains: productivity (employment or post-secondary education), social well-being (frequency of contact with friends), and living situation (autonomy). Results Three-quarters of young adults experienced at least 5 out of 6 positive outcomes. Over 90% were engaged in school, work, or a structured transition program, and an equal percentage were satisfied with their productivity activity. Over three-quarters of adults had a good amount of contact with friends and were satisfied with their social life. Most young adults had a moderate level of autonomy in their daily lives, and all were satisfied with their living situation. Conclusion Tailoring outcome measurement approaches specifically for autistic young adults provided a more optimistic portrayal of outcomes than previously noted in the literature. The approach used better reflects a neurodiversity approach and may be useful for evaluating the effectiveness of transition services or interventions.

There is a growing need to provide appropriate services to help students with autism spectrum disorder (ASD) transition to employment. Limited research has investigated what aspects of support should be prioritized when preparing youth with ASD for employment. By conducting structural equation modeling using a nationally-representative dataset on high school students receiving special education services (NLTS-2), this study examined the malleable predictors of employment during the transition and developed a model to examine the relationships between predictors and employment outcomes. The findings suggested two pathways for youth with ASD. For youth with higher daily functioning skills (DFS), academic performance mediated the relationship between parent participation and employment. For youth with lower DFS, school-based transition supports was the key mediator.

Siblings often oversee the well-being of an adult with autism spectrum disorder (ASD). The current study contributes to the literature by examining correlates of support provided to siblings in young adulthood in the context of the broader autism phenotype (BAP). Young adults (n = 866; M_age = 25.43, SD = 2.54; 55% female) reported on support provided to and the BAP characteristics of 1198 different siblings (M_age = 28.56, SD = 8.87; 50% female). Findings showed that young adults provided more emotional and practical support to sisters that they perceived to be higher in BAP characteristics. These findings suggest that sisters who have characteristics associated with ASD may be at an advantage in receiving support.

Prior research on the sibling relationship in the context of autism spectrum disorder (ASD) has included only one sibling per family. We used multi-level modeling to examine aspects of the sibling relationship in 207 adults who have a brother or sister with ASD from 125 families, investigating variability in sibling relationship quality and pessimism within and between families. We found that there was greater variability in aspects of the sibling relationship with the brother or sister with ASD within families than between families. Sibling individual-level factors were associated with positive affect in the sibling relationship, while family-level factors were associated with the sibling’s pessimism about their brother or sister’s future. The findings illustrate the unique experiences of siblings within families.

Objective: Participation restriction, common among people with knee osteoarthritis (OA), may be influenced by affect. We examined the risk of incident participation restriction over 84 months conferred by positive and negative affect among people with knee OA.Methods: Participants were from the Multicenter Osteoarthritis Study and had or were at high risk of knee OA. Participation restriction was measured using the Instrumental Role Limitation subscale of the Late‐Life Disability Index, and affect was measured using the positive affect and depressed mood subscales of the Center for Epidemiologic Studies Depression Scale. Robust Poisson regression was used to calculate the risk of incident participation restriction over 84 months conferred by combinations of low and high positive and negative affect, adjusting for covariates.Results: Of 1,810 baseline participants (mean age 62.1 years, 56% female), 470 (26%) had incident participation restriction over 84 months. Participants with low positive affect had 20% greater risk of incident participation restriction than those with high positive affect; participants with high negative affect had 50% greater risk of incident participation restriction compared to those with low negative affect. Participants with both low positive and high negative affect had 80% greater risk of incident participation restriction compared to other combinations of positive and negative affect.Conclusion: Low positive and high negative affect, both alone and in combination, increase the risk of participation restriction among adults with knee OA. Efforts aimed at preventing participation restriction in this population should consider these mood states.

Objective: Older adults with knee osteoarthritis (OA) who live in environments with mobility barriers may be at greater risk of developing participation restrictions, defined as difficulties in engagement in life situations. We investigated the risk of participation restriction over 5 years due to self‐reported environmental features among older adults with knee OA.Methods: Participants from the Multicenter Osteoarthritis (MOST) Study self‐reported participation at baseline, 30 months, and 60 months using the instrumental role subscale of the Late Life Disability Index (LLDI). Data on self‐reported environmental features were from the Home and Community Environment questionnaire administered in the MOST Knee Pain and Disability study, an ancillary study of MOST. The relative risks (RRs) of developing participation restriction at 60 months, indicated by an LLDI score <67.6 out of a possible 100, due to reported high community mobility barriers and high transportation facilitators, were calculated using robust Poisson regression, adjusting for covariates.Results: Sixty‐nine of the 322 participants (27%) developed participation restriction by 60 months. Participants reporting high community mobility barriers at baseline had 1.8 times the risk (95% confidence interval [95% CI] 1.2–2.7) of participation restriction at 60 months, after adjusting for covariates. Self‐report of high transportation facilitators at baseline resulted in a reduced but statistically nonsignificant risk of participation restriction at 60 months (RR 0.7, 95% CI 0.4–1.1).Conclusion: Higher perceived environmental barriers impact the risk of long‐term participation restriction among older adults with or at risk of knee OA. Approaches aimed at reducing the development of participation restrictions in this population should consider decreasing environmental barriers.

In this article, we highlight the distinctive features of a feasibility study, identify the main objectives and guiding questions of a feasibility study, and illustrate the use of these objectives. We synthesized the research methods literature related to feasibility studies to identify five overarching objectives of feasibility studies that focus on social and behavioral interventions. Feasibility studies are designed to answer the overarching question: Can it work? The main objectives of feasibility include the assessment of recruitment capability and resulting sample characteristics, data collection procedures and outcome measures, acceptability of the intervention and study procedures, resources and ability to manage and implement the study and intervention, and preliminary evaluation of participant responses to the intervention. For each objective, we identified follow-up questions designed to assist the researchers to understand barriers to the ultimate success of the research.