Meng-Chuan Lai

Few studies have examined the reproductive health of autistic girls and women. We undertook a descriptive retrospective population-based cohort study in Ontario, Canada, 2004 to 2023. Among first pregnancies, we (a) estimated the proportion occurring in autistic individuals, (b) examined the distribution of autism diagnoses before, during and after pregnancy and (c) described the preconception characteristics of childbearing autistic individuals based on timing of diagnosis. Autism was identified using a validated algorithm before, during and after pregnancy, the latter until 2024. Preconception socio-demographic and clinical characteristics were compared in each autism diagnosis timing group with nonautistic individuals using descriptive statistics. There were 1,148,470 first pregnancies, of which 1,086 (0.09%) were to autistic individuals. Among autistic individuals, 64.3% had their first diagnosis recorded before conception, 3.3% during pregnancy and 32.4% after delivery. Compared with nonautistic individuals, autistic individuals, regardless of the timing of diagnosis, were younger and more likely to live in low-income neighbourhoods, be long-term Canadian residents and experience co-occurring conditions, violence and high health care use preconception, with the highest rates of these factors among those with pre-pregnancy autism diagnoses. Findings show the importance of addressing preconception health needs of autistic individuals, including those awaiting a diagnosis, and autism training for health care providers. Lay Most autism research is focused on boys and men. We know less about autistic girls and women, including how many experience pregnancy and what their pregnancy-related needs are. We looked at how many first pregnancies occurred among autistic people, and how many people are diagnosed as autistic before, during and after pregnancy. We also looked at the demographic, social and health characteristics of autistic people before pregnancy, based on when they got their autism diagnosis. To do this, we studied all first pregnancies that happened in Ontario, Canada between 2004 and 2023. We identified autism diagnoses in health care records before, during and after individuals’ pregnancies, up until 2024. We then described autistic and nonautistic people according to their age, neighbourhood-level income, rurality, immigration status, co-occurring conditions (like diabetes and depression), violence and health care access before their pregnancy. We found 1,148,470 first pregnancies in Ontario from 2004 to 2023; of these pregnancies, 1,086 (0.09%) were to autistic people. Among autistic people, 698 (64.3%) got their autism diagnosis before pregnancy, 36 (3.3%) during pregnancy and 352 (32.4%) after delivery. Compared with nonautistic people, autistic people were younger, more likely to live in low-income neighbourhoods and more likely to have lived in Canada long-term. They also had more co-occurring conditions; were more likely to experience violence; and used more health care services, including hospital services, before pregnancy. People who were diagnosed as autistic before pregnancy had even more co-occurring conditions, violence and health care use than people who were diagnosed as autistic after pregnancy. Our study shows that it is important to support the pre-pregnancy health of autistic people, including those who are waiting for a diagnosis. Our study also shows that health care providers need training to understand the needs of autistic girls and women.

Although many autistic adults become parents, quantitative evidence on their parenting support needs remains lacking, and it is unknown whether professionals accurately recognize these needs. This study aimed to identify autistic parents' support needs and examine the extent to which they align with professionals' perceptions, to better inform professional training and support provision. Potential support needs were first characterized through a participatory process involving two autistic mothers active in major autism advocacy organizations. These needs were subsequently assessed using a co-designed questionnaire completed by 124 autistic adults and 977 professionals from healthcare, education, social, and judicial fields. The results showed that autistic adults reported significantly greater needs for practical and material support than those perceived by professionals, including in-home assistance, flexible working arrangements, administrative support, and peer mentoring. In contrast, professionals showed greater endorsement of child-protection-related interventions than autistic adults, although endorsement remained low overall. The findings suggest that the current support systems may not adequately address the everyday challenges faced by autistic parents. Greater autism-specific training for professionals and policies promoting more individualized and practical support provision may help improve the appropriateness of support provision and better align support systems with autistic parents’ expressed needs.

Flow is a state of optimal engagement. Autistic individuals and individuals with attention-deficit/hyperactivity disorder (ADHD) might have variations in flow-like experiences, such as hyperfocus, autistic inertia, and monotropism, that diverge from traditional or typical definitions. Following the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) guidelines, we systematically reviewed 43 publications, including empirical studies, reviews, and other literature, to examine these constructs. Results showed that attentional experiences associated with neurodivergence overlap with, but also differ notably from, typical flow. Autistic inertia hinders task initiation and transitions, in contrast to flow’s seamless engagement. Monotropism involves rigid, directed focus and repetitive, tenacious engagement, whereas flow allows for flexible adaptations to challenges. Hyperfocus is like flow regarding intense concentration and immersion but is often involuntary, lacks clear goals, and is associated with emotional dysregulation. Although commonalities exist across these attentional experiences, the greatest overlap occurs within autistic inertia, monotropism, and hyperfocus. Attention in autistic and ADHD individuals might be more dynamic than previously believed, with potential for transitions between these experiences. This fluidity can enhance focus and productivity but may also lead to negative outcomes, such as overly rigid fixation or difficulty engaging with and disengaging from tasks. Clarifying these differences and overlaps can inform tailored interventions and supports, helping neurodivergent individuals manage focus, reduce task-related stress, and optimize productivity.

Antipsychotic medications can cause serious metabolic adverse effects, including type 2 diabetes, with females disproportionally more affected than males. Recently, brain insulin resistance (IR) has been posited as a potential determinant of these effects. Currently there are no direct methods to investigate brain IR, but physiological response to intranasal insulin (INI) can be used as a surrogate marker. INI reliably suppresses endogenous glucose production and modulates resting-state brain activity in humans; however, the current literature has been heavily focused on males. Recently, it has been reported that hormonal fluctuations throughout the menstrual cycle may influence brain insulin sensitivity. Brain insulin sensitivity is greatest in lean females during the follicular phase, matching that of lean males, but decreases during the luteal phase. This study aims to investigate brain insulin action in females across different phases of the menstrual cycle, and to determine how a metabolically high-risk antipsychotic medication, olanzapine, may disrupt these effects. In a single-blind, crossover design, fifteen female participants aged 18–35 years will undergo a neuroimaging-based assay of brain insulin action with oral olanzapine (or placebo) and intranasal insulin (or placebo) as pharmacological challenges. All treatment conditions will be administered once in each menstrual phase, meaning that each participant receives every condition twice over the course of the study. Two visits will take place during the follicular phase of the menstrual cycle (i.e., cycle days 3–11), and another two visits during the luteal phase (i.e., cycle days 18–25). During each study period, participants will receive either oral olanzapine (OLA) or oral placebo (PL) at doses of 5 mg on Day 0 and 10 mg on Day 1. On Day 2, participants will undergo two MRI scans, the first following intranasal placebo (INP) administration and the second following intranasal insulin (INI). It is hypothesized that INI, but not INP, will modulate resting state brain activity during the follicular menstrual cycle phase but not luteal phase. Oral OLA will subsequently inhibit all INI-induced effects, relative to oral PL, during the follicular phase; OLA will have no apparent effect in the luteal phase given pre-existing brain IR. This is the first study to explore the effect of menstrual cycle phases on the anti-insulin action of antipsychotics. This investigation is necessary for the development of suitable treatment options to minimize the metabolic impact of antipsychotics in females. Trial registration: ClinicalTrials.gov Registration: NCT06251635

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.

Background: Autistic people can and do become parents, yet they often feel misunderstood. They fear being judged on their parenting abilities by professionals from health care, social care, and even judicial systems, including the risk of unwarranted and disproportionate child protection investigations or interventions. Despite these concerns being frequently reported qualitatively, they have not been investigated with quantitative data. Methods: Using a participatory research framework, we co-constructed a clinical vignette and a set of questionnaire items in collaboration with autistic parents to ensure that the materials reflected their lived concerns and priorities. Professionals from health care, social, educational, judicial, and allied health fields, as well as autistic adults, were invited to complete the survey. We compared their perceptions of a fictional autistic mother, before and after diagnostic disclosure, as well as their views on professional competency regarding autism. Results: Although professionals do not hold overtly negative views, their perspectives diverge from those of autistic adults. Professionals perceived the fictional mother with high autistic traits more negatively than did autistic adults before knowing the diagnosis. In addition, judicial, medical, and paramedical professionals were less likely to identify autism than autistic adults. However, participants reported that diagnostic disclosure was somewhat reassuring and decreased their concerns about the mother’s psychological needs. Professionals rated their own competency in autism higher than autistic adults did when evaluating the professionals, although most professionals reported needing further training. Conclusion: These results provide support for autistic parents’ concerns about stigma. Divergent perspectives between professionals and autistic adults may be partly explained by a “double empathy problem,” where autistic and non-autistic individuals do not share the same reference frame for behavior. The findings underscore the importance of targeted training on autistic parenthood for all professionals, particularly those with minimal prior autism-specific training, to reduce bias and improve understanding.

Background:Autistic people can and do become parents, yet they often feel misunderstood. They fear being judged on their parenting abilities by professionals from healthcare, social-care, and even judicial systems, including the risk of unwarranted and disproportionate child protection investigations or interventions. Despite these concerns being frequently reported qualitatively, they have not been investigated with quantitative data.Methods:Using a participatory research framework, we co-constructed a clinical vignette and a set of questionnaire items in collaboration with autistic parents to ensure that the materials reflected their lived concerns and priorities. Professionals from healthcare, social, educational, judicial, and allied health fields as well as autistic adults were invited to complete the survey. We compared their perceptions of a fictional autistic mother, before and after diagnostic disclosure, as well as their views on professional competency regarding autism.Results:Although professionals do not hold overtly negative views, their perspectives diverge from those of autistic adults. Professionals perceived the fictional mother with high autistic traits more negatively than did autistic adults before knowing the diagnosis. In addition, judicial, medical, and paramedical professionals were less likely to identify autism than autistic adults. However, participants reported that diagnostic disclosure was somewhat reassuring and decreased their concerns about the mother’s psychological needs. Professionals rated their own competency in autism higher than autistic adults did when evaluating the professionals, although most professionals reported needing further training.Conclusion:These results provide support for autistic parents’ concerns about stigma. Divergent perspectives between professionals and autistic adults may be partly explained by a “double empathy problem,” where autistic and non-autistic individuals do not share the same reference frame for behavior. The findings underscore the importance of targeted training on autistic parenthood for all professionals, particularly those with minimal prior autism-specific training, to reduce bias and improve understanding.

Receiving an autism diagnosis can significantly contribute to adolescent identity formation via different processes, such as coping with stigmatization and/or reframing the diagnosis as a foundation for self-understanding and self-acceptance. Despite the presumed importance of cultural context in this regard, little is known about how autistic adolescents experience their autism diagnoses in non-Western countries. We aimed to understand the experiences of Taiwanese autistic adolescents receiving autism diagnoses in a relationship-oriented, non-Western culture. Eight autistic adolescents aged 14–18 years (three assigned-male, five assigned-female) participated in in-depth individual interviews, with data analyzed by reflexive thematic analysis. These Taiwanese autistic adolescents used their autism diagnoses to gain self-understanding and guide social interactions, specifically, (a) to explain past experiences in relation to both positive and negative stereotypes about autism; (b) as a guide to autism knowledge and to provide a framework for modifying one’s own behaviors; (c) to seek connections with autistic peers and to be understood by non-autistic people; and (d) to negotiate with the Taiwanese educational system in meeting their needs. This study offers a qualitative, in-depth perspective on how autistic adolescents in a relationship-oriented, non-Western society experience and navigate their autism diagnoses—as a resource for identity construction and social position. Lay Receiving an autism diagnosis can come with different emotional and cognitive responses, such as feeling stigmatized and/or reframing this experience as a foundation for self-understanding and self-acceptance. This process is especially impactful during the teenage years, when young people typically begin to actively explore who they are. Because most previous research has been conducted in Western countries, we know very little about the experiences receiving an autism diagnosis in non-Western, relationship-oriented cultures, where fitting in with the group is often valued more than standing out. In this study, we interviewed eight autistic adolescents in Taiwan, aged 14–18 years, to understand how they experienced their autism diagnoses. We found that these Taiwanese autistic adolescents used their diagnoses to better understand themselves and guide their interactions with other people. Some used it to explain their past experiences and relieve themselves of guilt. Some said it helped them understand more about their own behavioral tendency and adjust their behavior accordingly. The diagnosis also helped them connect with their autistic peers, communicate effectively with non-autistic people, and ask for support within the school system. This study highlights the voices of Taiwanese autistic teenagers about their experiences of receiving an autism diagnosis. It shows how autism diagnoses can promote self-understanding and social coping.

Some autistic individuals camouflage their behavioral differences, a phenomenon that overlaps with general impression management (IM). Few studies have examined IM in autistic people, particularly outside English‐speaking countries. This study delineated the shared facets of camouflaging and IM, and used this conceptual clarification to address two knowledge gaps: (1) the respective roles of assigned‐sex, gender identity, and gender role expression in explaining IM facet differences, and (2) how these facets relate to autism features across life stages. French autistic adults ( N = 291) completed self‐report measures of camouflaging, concern for appropriateness, self‐monitoring, and gender role expression. The Autism Diagnostic Interview‐Revised (ADI‐R) and the Autism Diagnostic Observation Schedule Second Edition (ADOS‐2) measured childhood and adulthood autism features, respectively. Joint exploratory factor analysis extracted latent facets of camouflaging and IM measures. Hierarchical and elastic‐net regressions examined how IM facets were associated with assigned‐sex, gender identity, and gender role expression. Multiple regressions tested whether IM facets moderated the relationship between childhood and adulthood autism profiles. The results highlighted the multi‐faceted nature of IM (as inclusive of camouflaging) and unveiled nuances beyond previously documented sex/gender differences in autistic camouflaging. We found two IM facets: “intentional use” (purposeful IM use) and “self‐efficacy” (self‐perceived IM capability). IM intentional use was greater in autistic women and gender‐diverse adults than men. Greater IM self‐efficacy was most strongly associated with higher communion traits (i.e., qualities of being caring and cooperative). In autistic assigned‐males, greater IM self‐efficacy was linked with lower adulthood autistic social communication features. The findings confer new insights into sex‐related, gender‐related, and potential developmental links between IM and autism profiles.