Kristelle Hudry

Background: Eye-tracking could expedite autism identification/diagnosis through standardisation and objectivity. We tested whether Gazefinder autism assessment, with Classification Algorithm derived from gaze fixation durations, would have good accuracy (area under the curve [AUC] ≥ 0.80) to differentiate 2-4-year-old autistic from non-autistic children. Methods: Community sampling (March 2019-March 2021) of 2:00–4:11 year-olds included children recruited into a diagnosed Autism Group (‘cases’) and Non-Autism ‘Control’ Group (with likely undiagnosed autism minimised). We recruited well beyond minimum necessary sample size to ensure within-group heterogeneity and allow exploratory subgroup analysis. Alongside Gazefinder eye-tracking attempted with all recruited participants, we collected parent-report measures for all children, and clinical/behavioural measures with autistic children. Results: 102 autistic (81.4% male; M _age = 44mths; SD = 8.8) and 101 non-autistic children (57.4% male; M = 40; SD = 10.5) were recruited and eligible; the former slightly older, proportionately more male, and reflecting greater socio-demographic diversity. Gazefinder autism assessment was completed with 101 non-autistic children ( n = 1 returning minimal data), and attempted with 100- and completed with 96 autistic children ( n = 2 not attempted following adverse responses to clinical testing; n = 4 attempted but unable to calibrate). The Non-Autism Group returned significantly more overall tracking data. The final Classification Algorithm (range 0-100; threshold score = 28.6)—derived from n = 196 children’s fixation durations to elements of social/non-social scenes, human face presentations, and referential attention trials—had AUC = 0.82 (sensitivity = 0.82, specificity = 0.70). Compared to those correctly classified, autistic children misclassified as ‘controls’ showed greater overall tracking, and less pronounced autism features and developmental disability. Compared to correctly classified non-autistic children, those misclassified as ‘cases’ were older with lower overall tracking. Limitations: Our groups differed on socio-demographic characteristics and overall tracking (included within the Classification Algorithm). We used the ‘Scene 10A’ stimulus set as provided, without update/modification. Industry employees who developed the final Algorithm were non-blinded to child group, and considered only gaze fixation durations. Community sampling and ‘case-control’ design—comparing diagnosed autistic vs. non-autistic children—could be improved via future referral-based recruitment. Conclusions: Most children tolerated Gazefinder autism assessment, and our Classification Algorithm properties approached those reported from other Gazefinder use and established clinical assessments. Independent replication is required, and research informing the most suitable clinical application of this technology. Trial registration: ACTRN12619000317190

Feeding difficulties are associated with significant caregiver stress. Caregiver-mediated feeding programs in the family home may be appropriate for addressing the feeding challenges. However, very little literature reports on the feasibility and effectiveness of caregiver-mediated approaches for feeding difficulties. The aim of the study was to examine the feasibility and impact of the (EEP-Early Development (ED)-Telehealth for a young Autistic toddler assessing parent satisfaction, telehealth delivery mode, family-centric feeding goals, parental stress and perceived competence to improve his feeding outcomes, including his mealtime behaviors and increasing his food repertoire and equipping caregivers with strategies to manage challenging behaviors. A 28-month-old autistic toddler with feeding difficulties and his caregivers participated in the EEP-ED, delivered via telehealth. Feasibility was evaluated via parent satisfaction and telehealth delivery questionnaires pre- and post-intervention. The primary outcome was family-centred feeding goals measured using Goal-Attainment Scaling (GAS). Family-centric feeding goals were achieved, including increasing the child's dietary repertoire by 14 new foods and achieving independent drinking and eating. The mother reported high satisfaction, decreased parenting stress, and increased parenting competence. Caregiver-mediated interventions delivered via telehealth may be a feasible and effective approach to address mealtime and feeding challenges of young autistic children.

Many community–academic partnerships are established to conduct meaningful research and practice. Yet, little is written about their sustainability and what does exist suggests that effective partnerships are hard to sustain. In this study, we sought insights into what might support successful, enduring community–academic partnerships focused on early childhood autism service provision. We conducted semi-structured interviews and focus groups with 30 staff connected to a university-based early childhood service in education, allied health, management, and research roles, who had been involved in a decade-long community–academic partnership. We analysed the data using reflexive thematic analysis adopting an inductive approach. We identified three key themes. Staff shared strong values and commitments towards inclusive practice and evidence-based practice, which were embedded in the ethos of the partnership (Theme 1). They reported tangible, mutual benefits from working in partnership, with gains in learning and confidence supporting autistic children and families (Theme 2). Interviewees also highlighted the importance of strong equitable relationships, open communication, and fair processes, even if these were not always straightforward to achieve (Theme 3). These insights illustrate the value of ongoing monitoring of community–academic partnerships seeking to inform autism research programmes, policies and practices, while also building sustained community capacity. Lay When academic researchers work in partnership with community members, the research that gets done is usually more meaningful to people’s everyday lives. But these ‘community–academic partnerships’ can be difficult to set up, and even more difficult to keep going. In this project, we wanted to know what factors help to support the success of long-term community–academic partnerships, specifically for early childhood autism services. We spoke in depth to 30 staff connected to a university-based early childhood service, including early childhood educators, allied health professionals (psychologists, speech pathologists, occupational therapists), people managing the service and researchers. All had been involved in a community–research partnership that had been going on for a decade. Two researchers independent of the service led the interviews and analysis, looking for patterns in participants’ responses. We identified three main ideas or ‘themes’. Staff spoke of their strong values and commitments towards inclusive practice and evidence-based practice, which were shared among those within the partnership (Theme 1). They felt they had learned a lot from being involved in the partnership and had gained confidence supporting autistic children and families (Theme 2). Above all, though, they spoke of how the relationships within the partnership really mattered to making it a success. They emphasised the importance of trust, good communication and fair processes – but also noted that these things were not always achievable (Theme 3). These findings help us understand how researchers and community members can work effectively together to bring lasting benefits to autism research and services, and to the community more broadly.

Background and aims: Gathering Autistic young people's testimony is critical for understanding their lived experience of education and designing settings in which these students can thrive. Despite increasing knowledge in this field, we lack perspectives from a broad range of Autistic students which necessarily limits our ability to build inclusive, supportive environments for all. This study explored the educational experiences of preschool and school-aged Autistic students from diverse age groups, backgrounds, and educational settings. Methods: Thirty-six Autistic students (aged 4–18 years) from Chinese, Vietnamese, Somali, Lebanese, and White Australian backgrounds shared their thoughts and experiences of their education. Through semi-structured interviews, students told their stories using words and pictures. Interview transcripts were analyzed using reflexive thematic analysis. Results: Students described experiencing significant overwhelm within education settings, which led them to value access to safe spaces and having autonomy over decisions in their school day. A strong sense of fairness and justice was reported with students frustrated by inequitable application of school rules, as well as being discouraged by educators’ low expectations of them. Students preferred teachers who were clear and direct in their communication and genuinely cared about them as individuals. Students were mindful of others’ differences and perspectives, striving for mutual respect and friendship with their peers. Conclusions: Findings from this research indicate that to thrive academically, emotionally and socially, Autistic students need thoughtfully designed education settings with high expectations for every student, together with individualistic care from teachers. Implications: Our findings reinforce how classroom design and education practices must consider the needs of all students for Autistic students to thrive. From a practice perspective, promoting student autonomy around aspects of their educational environment—such as the ability to use headphones in class or provision of spaces in which to retreat to prevent or manage sensory/social overwhelm—could be “quick wins” for schools wanting to foster safer, more secure settings for Autistic learners. Broadly, educators should aim to embed as much certainty as possible into Autistic students’ educational environments to lay a solid foundation for learning. This foundation is likely to be most effective when educators are partners in discovery with each individual Autistic student, seeking to understand their unique strengths, needs, personalities and identities, and build trusting student–teacher relationships. While our research examined the perspectives of a diverse range of Autistic students, future research should attempt to elicit the educational experiences of both younger Autistic children (e.g., preschoolers) and non- or semi-speaking children, exploring methods suited to this purpose.

Emerging evidence suggests parenting supports implemented in the first 2 years of life may influence developmental outcomes for infants more likely to be Autistic. Yet questions remain about acceptability of these supports to the Autistic and autism communities. Through mixed-methods participatory research – co-designed and produced by Autistic and non-Autistic researchers – we sought diverse community perspectives on this topic, including to understand the relative acceptability of different support options. A total of 238 participants completed our online survey: 128 Autistic and 110 non-Autistic respondents, some of whom also self-identified as parents of Autistic, otherwise neurodivergent, and/or neurotypical children, and/or as health/education professionals and/or researchers. Most participants agreed that very-early-in-life approaches should help parents understand and support their children, and disagreed that these should seek to suppress autistic behaviour. Most agreed with the goal of respecting infant autonomy, and that parent education towards creating sensitive, accommodating environments could be appropriate, albeit with nuanced differences-of-opinion regarding the acceptability of specific therapeutic approaches. Participants generally endorsed the terms ‘support’ (vs ‘intervention’) and ‘early-in-life’ (vs ‘at-risk’/‘pre-emptive’). Engaging equal-power partnerships for the development, delivery of, and discourse around early-in-life autism supports will ensure end-user community values and needs are respected. Lay Most support programmes for Autistic children are available only after they are diagnosed. Research suggests that parenting supports may be helpful for parents and their infants, when provided in the first 2 years of life – before a formal diagnosis is given, but when information suggests an infant is more likely to be Autistic. However, we do not know how acceptable these types of supports might be to the Autistic and autism communities. We asked 238 Autistic and non-autistic people – some of whom were parents, and some of whom were professionals working in research, health and education – about their perspectives on very-early supports. People generally agreed that it could be acceptable to work with parents to help them understand and support their child’s specific needs and unique ways of communicating. People suggested a variety of support strategies could be acceptable, including parent education, changing the environment to meet an infant’s needs, and creating opportunities for infants’ to make choices and exercise control. People preferred respectful and accurate language – including the term ‘support’ (rather than ‘intervention’) and ‘early-in-life’ (rather than ‘at-risk’ of autism, or ‘pre-emptive’ when describing developmental stage). Continuing to work with community members will help to make sure autism support programmes are relevant and helpful.

We tested the potential for Gazefinder eye-tracking to support early autism identification, including feasible use with infants, and preliminary concurrent validity of trial-level gaze data against clinical assessment scores. We embedded the ~ 2-min ‘Scene 1S4’ protocol within a comprehensive clinical assessment for 54 consecutively-referred, clinically-indicated infants (prematurity-corrected age 9–14 months). Alongside % tracking rate as a broad indicator of feasible assessment/data capture, we report infant gaze data to pre-specified regions of interest (ROI) across four trial types and associations with scores on established clinical/behavioural tools. Most infants tolerated Gazefinder eye-tracking well, returning high overall % tracking rate. As a group, infants directed more gaze towards social vs. non-social (or more vs. less socially-salient) ROIs within trials. Behavioural autism features were correlated with increased gaze towards non-social/geometry (vs. social/people) scenes. No associations were found for gaze directed to ROIs within other stimulus types. Notably, there were no associations between developmental/cognitive ability or adaptive behaviour with gaze towards any ROI. Gazefinder assessment seems highly feasible with clinically-indicated infants, and the people vs. geometry stimuli show concurrent predictive validity for behavioural autism features. Aggregating data across the ~ 2-min autism identification protocol might plausibly offer greater utility than stimulus-level analysis alone.