Rachel Louise Moseley

Background: Menopause can be a challenging time for health and well-being. Research suggests that autistic people may experience menopause differently than non-autistic people, although explanatory mechanisms for this are under-investigated. Using a short-term repeated measures approach over 5 consecutive weeks, we examined whether menopause representations (thoughts, beliefs, and feelings about menopause) are associated with perceived menopause symptom severity, mental health (depressive and anxiety symptoms), and quality of life in autistic and non-autistic people. Methods: Over 5 weeks, we measured menopause representations, menopause symptom severity, quality of life, depression, and anxiety using self-report standardized scales in 476 autistic and 425 non-autistic participants aged 40–60 years. Using mediation analyses, we examined associations between menopause representations, and health and well-being outcomes (perceived menopause symptom severity, depression, anxiety, and quality of life) across all timepoints. Results: Autistic participants reported more severe menopause symptoms, greater depression and anxiety, and poorer quality of life, across all timepoints. Sense of control and sense of coherence, two aspects of menopause representations, were significant predictors of health outcomes over time. Feeling less in control and having a less coherent understanding of menopause mediated relationships between being autistic and increased menopause symptoms, depressive and anxiety symptoms, and reduced quality of life, across all timepoints. Conclusion: While requiring replication under more controlled conditions, our findings suggest that menopause representations may partially explain poorer health outcomes in autistic people who are peri- or postmenopausal. This partial mediation reflects that other mechanisms exist through which aspects of being autistic are associated with these poorer outcomes. Further investigation is needed to elucidate health inequalities during and after menopause, yet our findings suggest that feelings of control and coherence may be important for well-being during menopause, highlighting the importance of appropriate information and support to help autistic individuals confidently navigate this life stage.

Background: Autistic adults experience elevated interpersonal violence risk alongside mental health and functional challenges. However, how violence-related stress may accumulate over time and compare with non-autistic adults’ experiences remains unclear. Research often conceptualizes violence exposure, distress, and functioning as separate outcomes, rather than potentially interconnected processes across contexts and over time. We examined autistic and non-autistic adults’ narratives of violence-related stress, coping, challenges, and longer-term outcomes. Methods: Seventy-eight adults with interpersonal violence histories (27 diagnosed autistic, 21 self-identified autistic, 30 non-autistic; M _age = 31 years, standard deviation = 9.31) completed an online qualitative survey about violence experiences, coping, mental health, functioning, and changes in understanding these experiences. Using a critical realist approach, we conducted template analysis informed by reflexive thematic techniques, and initial coding was guided using broad domains of autism-related characteristics, environmental stressors, coping, challenges, longer-term outcomes, and perceived change over time, while remaining open to emergent insights. Results: Participants described cumulative and context-dependent stress processes rather than linear trajectories. Autistic accounts emphasized delayed harm recognition, sensory–emotional overwhelm, and self-protective strategies (e.g., camouflaging, suppression, withdrawal), particularly in ambiguous, invalidating, or unsafe environments. Across groups, participants described harassment, coercion, and perceived failures of protection in relational and institutional contexts, reportedly reducing trust in support pathways. Participants described coping strategies as initially protective but increasingly costly, contributing to restricted participation, reduced support access, and later functional difficulties. Non-autistic accounts reflected cumulative stress processes but were less consistently organized around autism-related characteristics. Participants identified turning points, including harm recognition, therapy, supportive intervention, and tangible exits from harmful contexts. Conclusions: Interpersonal violence may contribute to cumulative stress processes affecting mental health, functioning, and well-being, particularly where autism-related characteristics combine with threat, invalidation, conformity pressure, and inadequate support. Findings highlight the importance of recognizing cumulative stress processes, earlier harm recognition, and needs-led, responsive support in disrupting stress cycles. Community Brief: Why is this an important issue?: Autistic adults experience high rates of bullying, coercion, abuse, and other harmful interpersonal experiences, which may contribute to later mental health and daily functioning difficulties. We do not yet understand how these experiences build up over time or compare with those of non-autistic adults. Harm may arise not only from violence itself but also from coping and other people’s responses. What was the purpose of this study?: We explored how autistic and non-autistic adults describe stress, coping, challenges, and life after violence, including how these experiences may build up over time. What did the researchers do?: Seventy-eight adults with experience of interpersonal violence completed an open-ended online survey. Participants included diagnosed and self-identified autistic adults and non-autistic adults. They described their experiences of violence, coping, longer-term effects, and change over time. We analyzed responses to identify patterns and turning points. What were the results and conclusions of the study?: Participants rarely described a simple path to recovery. Many described stress, coping, and later difficulties as connected over time. Autistic participants described difficulty recognizing unclear or hidden harm, managing overwhelm, and trying to stay safe through camouflaging, self-silencing, withdrawal, or monitoring threat. Participants reported these strategies felt protective short term but exhausting and linked with reduced functioning, burnout, or isolation. Participants also described schools, workplaces, services, or authorities minimizing their experiences or failing to respond, reducing trust and making help-seeking harder. Described turning points included recognizing harm, therapy, supportive relationships, leaving unsafe situations, and developing greater self-trust. What is new or controversial about these findings?: Rather than viewing violence as a single event, participants described how stress can build over time through ongoing experiences, coping efforts, and responses from others. Comparing autistic and non-autistic accounts helped clarify how some processes were more closely linked to autism-related characteristics. Participants reported that strategies appearing effective in the moment, such as camouflaging or over-performing, were associated with longer-term strain, reduced participation, and exhaustion. Responses from schools, workplaces, services, or authorities could reportedly either reduce harm or worsen it when they minimized experiences, discouraged disclosure, or failed to provide protection. These findings challenge the assumption that appearing to cope or function means a person is safe or well. What are potential weaknesses in the study?: We used a one-time online survey with written responses. The study may underrepresent people from lower socioeconomic status groups, non-Western countries, racially minoritized communities, without internet access, or who prefer other communication methods. Participants described past events from memory, and we could not ask follow-up questions or track changes over time. How will these findings help autistic adults now or in the future?: Our findings suggest that services should not focus only on changing autistic people’s behavior or improving visible coping. Camouflaging, withdrawal, or burnout may indicate high strain rather than resilience. Earlier recognition of harm, consistent responses to reports of violence, and support based on individual needs rather than diagnosis alone may support longer-term mental health, participation, and well-being.

BackgroundAutistic young people are twice as likely to die by suicide than their non-autistic peers, but mechanisms driving this remain undefined. This study explored factors contributing to suicidal thoughts in adolescence (aged 11-15), alongside processes of coping and recovery. MethodsWe conducted reflexive thematic analysis of semi-structured interviews with nine autistic young people (mean age=21.1) to produce conceptual models of: (i) suicide risk; and (ii) recovery. FindingsAn over-arching theme described adolescent suicidal thoughts as omnipresent, fluctuating, and unpredictably building to crisis. Self-exploration uncovered multiple meanings and functions of suicidal thoughts. Nested sub-theme 1 described the development of autistic identity. Early experiences of rejection and de-humanisation resulted in existential questioning; self-discovery, neuroaffirming resources, and neurodivergent communities enabled agency and a protective autistic identity. Nested sub-theme 2 described marginalisation and social identity. Harmful school environments, pressure to mask autistic traits and invalidation in health services resulted in suicidal distress and crisis. Critical consciousness and leaving education enabled autonomy, purposeful coping and pursuit of life goals. Living well as an autistic person offered greatest protection, but recurrent setbacks and others’ lack of understanding hindered progress. InterpretationSuicidal thoughts and feelings were shaped by interactions between autistic young people and their environment and marked by epistemic injustice. Findings resonate with the Integrated Motivational-Volitional model’s emphasis on defeat and entrapment; however, defeat was experienced early, and was pervasive and entrenched, while fluctuations in risk were shaped by harmful environments and neuronormative pressures. Findings further support the COURAGE model of suicide recovery, particularly domains for optimising identity, self-understanding, and meaning in life; however, domains dependent on social acceptance and empowerment were less well-supported, suggesting that opportunities were constrained by broader social and structural barriers. Across both models’ structural factors increased risk and constrained the conditions necessary for autistic people to live meaningful and sustainable lives. Clinicians should prioritise neuroaffirming approaches and resources, but lasting reductions in suicide risk in autistic young people will require structural change, including greater equality of opportunity and an urgent action to reduce the distress of educational environments.

Differences in emotion-related processes and experiences impact ADHD people’s wellbeing, but have historically been framed through a deficit-based lens, without sufficient recognition of interpersonal and environmental influences. We explored positive and challenging aspects of ADHD emotions, how these emotions were perceived by others and their impacts on relationships, eliciting perspectives from 15 ADHD people and 15 non-ADHD people (with ADHD loved ones) through semi-structured interviews and the Grid Elaboration Method respectively. Data were analysed using interpretative phenomenological analysis and Reflexive Thematic Analysis respectively. Both groups reported that ADHD emotions co-existed as disabling and sustaining, strength and weakness. Societal pressures appeared to shape both how ADHD people experienced and expressed their emotions, which added to dysregulation; and how they were perceived by non-ADHD people, contributing to frustration. Emotion-related differences in ADHD impact the lives of ADHD and non-ADHD people, and are influenced by societal and systemic inequalities, though the extent to which this is the case is not yet fully understood.

Where global prevalence of autism and ADHD is assumed stable, increasing incidence of referrals, referral requests and recorded diagnoses have evoked concerns that autism and ADHD are overdiagnosed, i.e. that diagnoses are bestowed without sufficient justification to individuals who might be incentivised to seek diagnosis. While there is presently little evidence to support these assertions, methodological limitations demonstrably contribute to the systematic under-detection of certain sub-groups, like older adults, marginalized minorities and people assigned female at birth, within these diagnostic categories. As such, rising demand for autism and ADHD diagnosis can be understood in light of historic underdiagnosis. While strains on diagnostic systems require urgent solutions, failure to diagnose legitimate cases precludes provision of appropriate support and has severe individual and socioeconomic repercussions. Given the limitations which underlie current prevalence estimates, we draw attention to the equally problematic issue of underdiagnosis and the accompanying individual and societal costs this brings.

BackgroundNon-suicidal self-injury (NSSI) is relatively common among autistic people. While studies indicate relationships between NSSI and suicidal thoughts and behaviour (STB), it is unclear whether specific NSSI behaviours co-occur in meaningful ways with differential relevance to STB, and if this differs between autistic and non-autistic people.MethodsTo understand the clinical relevance of specific NSSI behaviours to STB and related constructs, we pooled data from 327 autistic and 260 non-autistic participants from two online surveys. We used network analyses to separately visualise and compare the NSSI networks of autistic and non-autistic people, controlling for age differences between groups. Thereafter, using data provided by autistic people across two time-points one year apart, we examined zero-order correlations and used LASSO regression to assess links between NSSI behaviours at the first time-point and STB-related variables at the second.ResultsOur first analyses revealed differences between autistic and non-autistic people in the co-occurrence of NSSI behaviours and their relationships to STB-related constructs. Three NSSI clusters emerged for autistic people and one for non-autistic people. In both groups, some NSSI behaviours were only indirectly linked to STB via relationships to other NSSI behaviours; cutting and ingesting dangerous substances/sharp objects were most strongly related to suicide attempts. Our second analyses, focusing on autistic people, revealed initial correlations between cutting, self-burning, self-hitting and skin-tearing and STB-related outcomes, although these disappeared after controlling for STB at time-point one. Self-biting, breaking bones and fighting to get hurt remained significant predictors of STB-related outcomes. ConclusionWhile requiring replication in better matched samples, our findings corroborate differences in how autistic and non-autistic people engage in NSSI, as well as differential relevance of specific behaviours to STB. Future research must explore direct and indirect pathways between NSSI behaviours and STB, and the functional needs that different behaviours serve.

Background: Many autistic people experience difficulties seeking help from mainstream mental health services and some turn to alternative methods of support to manage suicidal thoughts and behaviours (STB). Despite the existence of many self-help apps—some designed for autistic people—research has yet to explore how autistic people use these. Methods: We conducted a secondary analysis of online survey data from autistic people in the UK (N=1266; median age=33; age range=16-100). Chi-square tests and binomi

Purpose of review: We asked the following research questions: (1) What evidence exists that describes specific warning signs of suicide in autistic people? and (2) What gaps exist related to research on warning signs of suicide among autistic people? Recent findings: Following the six-step approach for scoping reviews, we identified 15 sources that described potential warning signs of suicide in autistic people. The majority of sources were published between 2020 and 2025, and most sources were books or book chapters. Only one source explicitly defined ‘warning signs’. Robust research on warning signs of suicide in autistic people is lacking. Summary: Most evidence on warning signs of suicide in autistic people exists from first-person narratives and fictional case examples. Two important next steps to advance the science and practice of suicide prevention include adopting a clear definition of warning signs consistently used by researchers and practitioners, and systematically evaluating warning signs of suicide in autistic people.

BackgroundMenopause can be a challenging time for health and wellbeing. Research suggests that autistic people may experience menopause differently to non-autistic people, although no explanatory mechanisms for this have been examined. Using a longitudinal approach, we examined whether menopause representations (i.e. thoughts, beliefs and feelings about menopause) are associated with the severity of menopause symptoms, poorer mental health (depressive and anxiety symptoms) and quality of life over time in autistic and non-autistic people.MethodsWe measured menopause representations, menopause symptom severity, quality of life, depressive and anxiety symptoms using self-report standardised scales in 476 autistic and 425 non-autistic participants aged 40-60 years. We collected data over five consecutive weeks. Using mediation analyses, we examined associations between menopause representations and health and wellbeing outcomes (perceived menopause symptom severity, anxiety, depression and quality of life) across all timepoints. ResultsAutistic participants reported more severe menopause symptoms, greater anxiety and depression, and poorer quality of life, across all timepoints. Sense of control and sense of coherence in relation to menopause, two aspects of menopause representations, were significant predictors of health outcomes over time. Feeling less in control and having a less coherent understanding of menopause mediated relationships between being autistic and increased menopause symptoms, depressive and anxiety symptoms, and reduced quality of life, across all timepoints.ConclusionFindings suggest that menopause representations partially explain poorer health outcomes in autistic people who are peri- or postmenopausal, and acknowledge that other mechanisms exist through which aspects of being autistic are associated with these poorer outcomes. While further investigation is needed to identify the mechanisms of health inequalities during and after menopause, our findings suggest that feelings of control and coherence are important for wellbeing during menopause, highlighting the importance of appropriate information and support to help autistic individuals navigate this life stage confidently.

Menopause is a time of hormone fluctuation and change. Menopause can be seen also as a neurological transition which affects cognition, emotion, and the regulation of brain and bodily processes (e....