Adam John Guastella

Diagnostic and developmental assessment reports communicate outcomes and recommendations for children with neurodevelopmental conditions (NDCs), supporting access to interventions, funding and educational accommodations. However, little is known about caregivers' perceptions of the clarity, usefulness and applicability of these recommendations. Methods: This qualitative study explored caregiver experiences of recommendations following comprehensive developmental assessments at a publicly funded tertiary paediatric service in Sydney, Australia. Thirteen semi‐structured interviews involving 14 caregivers of children aged 2–13 years were conducted between January and July 2025. Participants represented diverse cultural, linguistic and educational backgrounds. Interviews explored the clarity, usefulness and relevance of report recommendations. Data were analysed using the Framework Method. Results: Five themes were identified: quality of recommendations, practical considerations, access to funding, access to information and broader service‐related issues. Caregivers generally described recommendations as clear, practical, comprehensive and consistent with verbal feedback. Reports supported disability funding applications, educational planning and communication with schools and service providers. Areas for improvement included more personalised, child‐centred recommendations; clearer explanations of diagnostic terminology and funding pathways; greater detail about available services and practical implementation guidance. Caregivers also reported difficulties navigating funding systems, accessing services and prioritising recommendations alongside family demands. Conclusions: While recommendations were viewed positively overall, findings identified opportunities to improve relevance, accessibility and implementation. Child‐centred recommendations, structured follow‐up and care coordination may strengthen report impact and better support families to navigate services and interventions.

Mutual eye contact is a clinically relevant behavioral marker in social engagement assessments. Existing clinical tools often rely on manual observation, which may introduce subjective biases. No validated video-derived algorithm currently exists for objectively recognizing clinically defined eye contact behaviors in multi-individual free play settings. This study introduced a novel multi-view deep learning framework for automated recognition of clinically defined eye contact behaviors between children and assessors during free play. We investigated whether multi-view video recordings and spatial-temporal behavioral patterns improved recognition performance. The study included video recordings from 103 children diagnosed with autism (mean age = 6.96 years) and 33 typically developing children (mean age = 7.63 years). Mutual eye contact behaviors between children and assessors were analyzed during five-minute free play sessions, with caregivers present in the assessment room. The framework was trained using sparsely sampled spatial- and temporal-domain images from multiple fixed cameras capturing complementary views of the assessment environment. The fused single-view model achieved F1 scores of 0.85 [0.83, 0.88] for eye contact behavior and 0.90 [0.89, 0.91] for non-eye-contact behavior. Multi-view fusion improved performance to 0.92 [0.89, 0.95] and 0.94 [0.93, 0.96], respectively. These findings suggest that multi-view video analysis can objectively identify clinically defined eye contact behaviors among multiple individuals during clinical free play assessments. The framework may support scalable behavioral coding and quantitative assessment of clinically relevant social behaviors consistent with established criteria.

Social anxiety (SA) is highly prevalent among autistic adults, yet little is known about how autistic people respond to common therapeutic strategies, such as exposure tasks. This study examined responses to a structured speech exposure task embedded within an 8‐week modified cognitive–behavioral therapy (M‐CBT) program. Thirty‐two autistic adults with co‐occurring SA completed pre‐ and post‐task assessments of anxiety and related cognitive appraisals, including self‐focused attention, perceived performance, appearance concerns, and threat appraisals. Participants reported appropriate engagement with the task, characterized by elevated anticipatory anxiety followed by reductions in anxiety during the speech. Responses were largely consistent with CBT models of social anxiety and with reports by those in a social anxiety disorder reference group. Participants overestimated anticipatory anxiety (predicted fear) relative to experienced peak fear during the task. Higher anxiety was associated with greater self‐focused attention and stronger threat appraisals, although anxiety correlated positively with self‐rated performance. Importantly, the extinction of fear during the speech task was associated with post‐treatment response to CBT. Among participants classified as high‐extinction, 59% showed clinically significant improvement on the Liebowitz Social Anxiety Scale, Self‐Report (LSAS‐SR), compared with 25% of those in the low‐extinction group. A parallel pattern was observed in a social anxiety disorder comparison group, indicating that the extinction–outcome relationship was similar across autistic and non‐autistic adults. This study provides evidence that autistic individuals report fear and anxiety responses in a manner largely consistent with CBT models and that extinction‐based processes during exposure are meaningfully associated with treatment response. Further studies employing randomized controlled trials and objective measures of fear are now needed.

Cognitive-behaviour therapy (CBT) is an evidence-based treatment for social anxiety. However, despite the high prevalence of social anxiety among autistic adults, much less is known about how autistic people experience each CBT component used in treatment. This qualitative study explores autistic adults’ perspectives on a modified cognitive-behaviour therapy group programme for social anxiety, focusing on the perceived effectiveness of CBT components and the identification of needed modifications. Twenty-seven participants who completed the intervention took part in semi-structured interviews. Thematic analysis identified core themes related to therapeutic impact (application of CBT group strategies) and participant experiences (suggestions for future iterations of social groups). Overall, exposure tasks were viewed as helpful in reducing anxiety, particularly when structured and predictable. Cognitive restructuring was often experienced as effective; however, its impact was sometimes limited by persistent and deeply held core beliefs and past negative experiences. Social strategies and anxiety management skills were appreciated for their structured format and educational elements, but generalizability was sometimes raised as a limitation. Participants also recommended additional adaptations, including flexibility in content delivery and modifications to the physical environment. Findings highlight overall support of cognitive-therapy components for reducing social anxiety in adults, but also benefit to tailoring CBT approaches to theneeds of autistic adults. Results from this study offer practical guidance from autistic people to enhance the acceptability and effectiveness of future CBT interventions. Lay Many autistic adults experience social anxiety, making everyday interactions feel stressful or overwhelming. To help with this, clinical researchers developed a group therapy programme based on cognitive-behaviour therapy adapted for autistic adults. While cognitive-behaviour therapy is commonly used to treat anxiety, there has been relatively little research into how autistic people experience group-based versions of this therapy. This study aimed to understand how participants felt about the programme and how it could be improved. The intervention included eight group sessions where participants learned about social anxiety and autism, social strategies and took part in guided activities to build confidence. The programme encouraged a supportive environment where autistic individuals could safely try out new ways of connecting with others without feeling pressure to hide who they are. To understand how helpful the programme was, researchers interviewed participants about their experiences. Many said the programme helped them feel more confident and less anxious in social situations. For example, they found role-playing in a safe group setting especially useful. Participants also appreciated that the therapy was adapted to suit their needs. However, the study also highlighted some areas for improvement. Some participants found parts of the programme challenging, especially unstructured activities or settings. Others suggested the programme could be more flexible, offer clearer instructions or be better prepared for people who had past negative experiences with therapy. These early findings suggest that cognitive-behaviour therapy can be effective when thoughtfully adapted for autistic adults. This work helps lay the foundation for more inclusive, autism-informed mental health services that support social confidence in a way that feels safe and empowering.

It has been proposed that autistic individuals adopt camouflaging strategies to mask their autistic traits and conform to social norms, and that these camouflaging strategies have been linked to adverse mental health outcomes. This study examined whether camouflaging, measured by the Camouflaging Autistic Traits Questionnaire (CAT‐Q), predicted functioning, distress, and quality of life beyond standard clinical measures of social responsiveness and social anxiety. We analysed data from 113 autistic adults experiencing social anxiety who expressed interest in anxiety interventions. Hierarchical regression analyses assessed the unique contribution of camouflaging after accounting for social responsiveness and social anxiety. Results indicated that social responsiveness and social anxiety significantly predicted depression, psychological distress, and disability, whereas camouflaging did not explain additional variance in these outcomes. Although camouflaging correlated with poorer mental health and reduced quality of life, it did not independently predict these outcomes beyond social anxiety and responsiveness. These findings suggest current camouflaging measures may capture overlapping constructs, highlighting the need for more precise conceptualization and measurement tools.

Children with autism spectrum disorder (ASD) and their families report diverse challenges in adaptive functioning. Artificial intelligence (AI)-assistive devices can offer innovative solutions to support adaptive functioning by offering real time assistance and capacity to adapt to heterogenous needs. Objective: This qualitative study utilised an AI-assistive device, the Pixi Home-Hub, to explore caregiver perspectives, experiences and needs related to the broader potential of AI to support adaptive functioning in their daily lives. Methods: Criterion purposive sampling recruited 10 caregivers of children with ASD. Two focus groups were conducted to discuss how an AI-assistive device, the Pixi Home-Hub, could support their child and families adaptive functioning. Content analysis was utilised to interpret the data. Independent coding by a second reviewer, analytical memos and peer review were employed to promote rigour. Results: Three key themes emerged from the data: (1) Caregiver experiences of their child's adaptive functioning in daily activities and areas for growth, (2) Caregiver experiences of balancing their child's support needs with their own, and (3) Access and barriers to integrating AI technology into everyday use. Conclusion: Caregivers believed that AI-technology can play a role in supporting their family's adaptive functioning activities and proposed using AI-assistive devices as a digital support navigator to facilitate greater access to health and government supports.

Background: The placebo effect is established in clinical trials, but for paediatric research, questions remain about how to best manage its influence. Within the autism field, data on these issues is sparse. This is particularly important in the oxytocin field where placebo responses are thought to play an important role. This study reports on data from the single‐blind, placebo lead‐in phase of a randomised controlled trial (RCT) to investigate the placebo response and its relationship to treatment response in autistic children. Methods: Eighty‐seven autistic children aged 3–12 years ( M = 7.27; SD = 2.69; 85.1% male) were consecutively recruited into a multi‐site RCT evaluating the efficacy of oxytocin for improving social responsiveness. Participants underwent a 3‐week, single‐blind placebo lead‐in before randomisation into a 12‐week double‐blind treatment phase (oxytocin, n = 45; placebo, n = 42). The Social Responsiveness Scale, 2nd Edition (SRS‐2) Total Raw Score was used to measure change from baseline to post‐placebo lead‐in. A ≥10‐point improvement defined placebo responders. Results: Nearly half the sample ( n = 42, 48.3%) were identified as placebo responders during the lead‐in phase, showing a clinically significant degree of change on the SRS‐2. Caregiver treatment guess did not significantly impact the placebo response ( p = .534). Placebo response was associated with greater symptom severity ( r 's > −.23; p ‐values < .037 ) and higher cognitive ability ( r = −.35, p = .004). Smaller placebo responses during the lead‐in phase were associated with larger responses during active treatment in participants receiving oxytocin ( r = −.36, p = .017). Placebo responses during the lead‐in phase were observed across all caregiver‐reported measures (Cohen's d = .19–.65). Conclusions: This study provides important information about placebo effects and placebo lead‐in designs for clinical trials in the autism field. We show widespread clinically significant improvement during placebo lead‐in, utility of identifying placebo responders for informing clinical trial analyses, similarities in symptom measure effect sizes for placebo effects, and a lack of influence of caregiver beliefs on placebo responses.

The oxytocin/oxytocin receptor (OT/OTR) signalling system is involved in socioemotional behaviours, garnering interest as a therapeutic target across multiple clinical conditions. Despite its potential, our limited understanding of how to optimally target it and the scarcity of molecular tools for in vivo studies hinder therapeutic development. Molecular imaging techniques, such as Positron Emission Tomography (PET), can bridge this gap by furnishing direct insights into ligand biodistribution, receptor visualisation and ligand-receptor engagement. Here, we report the design, synthesis and biochemical and pharmacological characterisation of five OT-like peptides as novel PET tracers for investigating the OT/OTR signalling system. dOTK ⁸ [SFB] emerged as the most promising OT-like lead. The radioactive version [ ¹⁸ F]dOTK ⁸ [SFB] was produced using a microfluidic reaction approach and validated by preclinical PET imaging of healthy rats after intravenous ligand administration. [ ¹⁸ F]dOTK ⁸ [SFB] exhibited specific accumulation in OTR-rich tissues, affirming OTR-specificity and suitability as a new OT-like PET radiotracer for investigating OT/OTR biodistribution in humans.

Background: Psilocybin-assisted psychotherapy (PAP) has gained attention as a promising intervention for conditions including depression, anxiety and post-traumatic stress disorder, but understanding of its side-effects is limited. This review evaluates the quality of side-effects reporting in PAP trials, to guide treatment, policy and research. Aims: To assess side-effects reporting quality in PAP trials for psychiatric conditions, comparing published articles and ClinicalTrials.gov records. Method: A PROSPERO-registered review (no. CRD42023458960) included English-language PAP trials (2005–2024) identified via Embase, CENTRAL, PubMed and reference searches. Reporting quality was assessed using the CONSORT Harms extension, categorised as either high (17–21), moderate (12–16), low (7–11) or very low (0–6). Randomised controlled trials underwent risk of bias analysis, and descriptive statistics compared side-effects across sources. Results: Twenty-four trials were included. Reporting quality was high in six studies, moderate in four, low in nine and very low in five. All randomised controlled trials ( n = 9) showed high risk of bias for side-effects outcomes. Variability in reporting hindered comparisons between articles and ClinicalTrials.gov, underscoring the need for standardisation. Overall, there was no evidence of systematic underreporting of side-effects in published articles compared with trial registers. Conclusions: Side-effects reporting in PAP trials is inconsistent but is improving over time. Existing evidence has a high risk of bias. Future trials should align with best-practice guidelines for side-effects reporting. Discussions with patients should prioritise findings from high-quality studies and emphasise the current uncertainty regarding PAP side-effects.