William Mandy

Background: Autistic people experience substantially higher rates of mental health conditions and are overrepresented in mental health services. However, most interventions and service models have been developed for non-autistic people, and evidence is needed as to whether there are disparities in outcomes. This systematic review aimed to compare outcomes between autistic and non-autistic people receiving the same mental health interventions or services. Methods: We conducted a systematic review following PRISMA guidelines (PROSPERO: CRD420251021068). We searched academic databases (MEDLINE, Embase, PsycINFO, PubMed, CINAHL), a grey literature database (HMIC), a trial registry (ISRCTN), preprint servers (medRxiv and PsyArXiv), Google, and Google Scholar, to identify relevant papers published 01/01/1992-30/04/2026. We conducted backwards and forwards citation searching and contacted experts. Study quality was assessed using a modified Critical Appraisal Skills Programme Cohort Study Checklist and the Autism-Inclusive Research Assessment (AIRA). Data were synthesised narratively, with random effects meta-analyses where appropriate. Results: Thirty-nine studies were included, comprising 4787730 participants, assessing outcomes of psychological therapies (n = 17) and multi-component or service-level approaches (n = 22). Nearly half (46.2%) were UK-based, and under a quarter (23.1%) included people with intellectual disabilities. Ten studies (25.6%) were rated low quality, twenty-two (56.4%) medium quality, and seven (17.9%) high quality. AIRA ratings highlighted concerns about research inclusiveness for autistic people, including limited involvement of autistic people and lack of validated or adapted outcome measures. Findings varied by intervention: for some, multiple large, higher-quality studies showed less favourable outcomes for autistic people (e.g., less improvement in symptoms or functioning, or higher rates of restrictive practices or acute service use). For other interventions, comparable or mixed outcomes were found across studies, with interpretation often limited by small samples. Conclusions: Mental health treatment outcomes for autistic versus non-autistic people varied across interventions and outcome types. Where significant differences were observed, these usually showed poorer outcomes for autistic people, although they generally reflected smaller improvements rather than a lack of benefit. Action is needed to improve the accessibility and appropriateness of mental health care for autistic people, supported by more high-quality, co-produced research across a broader range of countries and service contexts.

Background: Emerging evidence suggests that attention-deficit hyperactivity disorder (ADHD) may be associated with increased likelihood of experiencing interpersonal harm, including from intimate partners. Aims: This study aims to test the long-term associations between ADHD traits in childhood and experiences of intimate partner violence (IPV) up to midlife (age 51 years). Method: Data were from the 1970 British Cohort Study, a nationally representative longitudinal study of people born during 1970. ADHD traits were assessed at age 10 years. Lifetime experience of five types of IPV was measured at age 51 years (harassment, economic abuse, physical violence, threats/coercive control, sexual violence). Regression models were used to test associations between childhood ADHD traits and midlife IPV, adjusting for gender, ethnicity and childhood social class. Results: Adjusted models showed that ADHD traits in childhood were associated with higher risk of experiencing any form of IPV, a greater number of different IPV experiences and all individual subtypes of IPV by age 51 years. Post-estimation showed that around one in seven men and one in four women without high ADHD traits experience some form of IPV by midlife. In people with high ADHD traits (4.40%), these estimates increase to approximately one in five men and one in three women. Conclusions: Higher levels of childhood ADHD traits are associated with an increased risk of experiencing IPV by middle age. These findings highlight that ADHD may be associated with increased vulnerability to interpersonal harm in relationships. Identifying people with ADHD at greatest risk, as well as addressing the needs of people with ADHD within IPV prevention and response systems is important for reducing harm and addressing inequalities faced by people with ADHD over the life course.

To adapt to social expectations and gain peer acceptance, autistic individuals may engage in compensatory behaviors, known as camouflaging, which has been associated with mental health outcomes including depression and anxiety. Instruments that accurately measure camouflaging in autistic individuals are therefore important. The Camouflaging Autistic Traits Questionnaire (CAT-Q) is widely used in literature and shows good psychometric properties. However, most non-English-speaking countries such as Brazil, lack validated instruments to assess camouflaging behaviours. The present study reports the adaptation of the CAT-Q for Brazil and examines the psychometric properties of its Brazilian version. The translation and cultural adaptation had independent translations and evaluation by expert judges, including autistic adults. A total of 923 autistic and 470 non-autistic adults from across Brazil completed the CAT-Q-BR and the Autism Quotient–Short Version (AQ-10). Confirmatory factor analyses tested the original three-factor structure of the CAT-Q-BR; Convergent validity was examined through associations with autistic traits on the AQ-10 and self-reported anxiety and depression diagnoses and known-groups validity (gender differences) were also analyzed. Results supported the original structure, with acceptable model fit (CFI = 0.964, TLI = 0.96, RMSEA = 0.076, SRMR = 0.066) and internal consistency for total score was good (α = 0.88). No significant association was found between CAT-Q-BR and the AQ-10. However, higher camouflaging scores were significantly associated with self-reported anxiety and depression. Gender-diverse participants reported higher camouflaging compared to cisgender men and women. Overall, findings provide initial evidence supporting the CAT-Q-BR as a reliable measure of camouflaging behaviors in Brazilian adults.

BackgroundAttending university may be associated with increases in reported mental health symptoms in young adults. The role autistic traits (ATs) play in this association remains unclear—despite those with high ATs facing heightened risk of co-occurring mental health problems. We aimed to compare depression symptom trajectories from ages 16 to 25 in young adults who did and did not attend university in the early 2010s, and by low and high ATs. MethodLongitudinal data were drawn from the Avon Longitudinal Study of Parents and Children population-based cohort. Depressive symptoms were measured using the Short Mood and Feeling Questionnaire. University attendance was derived from start, end and graduation dates. Autistic traits were assessed using the Social and Communication Difficulties Checklist. Mixed-effects growth curve models were applied to estimate depression trajectories. ResultsThe primary analysis included 3,563 individuals. Mean depression scores were lower among university attendees before entry compared to non-attendees. Scores increased over time in both groups, with no evidence that university attendance predicted differential increases. Depression scores were substantially higher before university in individuals with high ATs compared to individuals with low ATs. Those with high ATs who attended university showed marginal decreases in scores, whereas non-attendees saw increases over time. Sensitivity analyses supported primary findings, except when university attendance was defined by graduation at ages 24 and 25. ConclusionsYoung adults with high ATs show higher depression scores than the general population. University attendance appears to have population- and context- dependent associations with depression trajectories.

Background: There is growing awareness from qualitative research studies that menopause may be particularly challenging for autistic people. Research in the general population suggests that preexisting conditions may be a risk factor for negative experiences during menopause. However, there are limited studies examining variables associated with experiences of menopause symptoms for autistic people. Objectives: To explore whether pre-existing depression and anxiety symptoms impact menopause symptoms for autistic and non-autistic people. Design: The study design is classified as STROBE. Methods: Autistic (n=52) and non-autistic (n=28) people assigned female at birth participated in the longitudinal AgeWellAutism (AWA) study. They reported self-report depression and anxiety symptoms at baseline and menopause symptoms (Greene Climacteric Scale) at follow-up after 4.5 years. Age, autism diagnosis and autism characteristics of mentalising difficulties, sensory reactivity, and social anxiety (subscales from the self-reported Ritvo Autism and Asperger Diagnostic Scale, RAADS) were recorded. Results: Regression analyses were conducted with menopause symptoms as the dependent variable and as independent variables: Step 1, age; Step 2, baseline depression and anxiety symptoms, Step 3, autism diagnosis (alternative step 3, RAADS subscales). In the final regression model, younger age, higher baseline depression and autism diagnosis contributed significantly to explaining menopause symptom severity. In the alternative model (including subscales of the RAADS), younger age, higher baseline depression, mentalising difficulties and sensory reactivity contributed significantly to explaining menopause symptom severity. Conclusions: Results align with research from the general population suggesting that a history of depression symptoms increases risk of negative experiences during menopause, furthermore, being autistic confers additional risk. Further studies examining the influence of lifetime experiences on menopause symptoms for neurodivergent people are required to better understand and mitigate risk during this critical time.

Background: Avoidant Restrictive Food Intake Disorder (ARFID) is a relatively newly classified eating disorder which can significantly impact physical health and psychosocial function. This qualitative study aimed to explore the lived experience of ARFID caregivers in order to develop understanding of the condition and how it should be supported. Methods: Semi-structured interviews were conducted with the parents of sixteen children and young people with ARFID, who were recruited from an outpatient eating disorder service in the UK. Interview transcripts were analysed using Reflexive Thematic Analysis. Results: Qualitative analyses revealed four key themes: (1) From fussy eating to something more: The development of ARFID, (2) A fragile process: Factors that worsen and maintain ARFID (3), Developing a toolkit: Learning what helps, and (4) The weight of ARFID: The burden on the whole family. A conceptual model of ARFID development and maintenance is proposed, illustrating the relationships and interactions between the themes captured in the analysis. Conclusions: This study provides insight into the nature and course of ARFID, highlights the widespread impact on the individual and their family, and illustrates the critical role that parents play in managing this eating disorder.

Background Autistic adults report lower quality of life (QoL), but little is known about how social connectedness and ageing interact to shape QoL in middle-aged and older autistic populations. This study examined differences in QoL and social connectedness between autistic and non-autistic adults, and how age and gender influence these patterns. Methods 265 autistic adults and 167 non-autistic adults aged 40–93 completed self-report measures of social connectedness, QoL, and symptoms of poor mental health. Group and gender differences in QoL were analysed using 2x2 ANOVAs. Pearson correlations and Fisher’s r-to-z tests assessed associations between social connectedness and QoL. Post hoc analyses examined age group differences. Results When compared to the non-autistic group, the autistic group reported significantly lower social connectedness scores, as well as lower QoL across all domains. Social connectedness was positively associated with QoL in both groups but was significantly stronger for Psychological QoL and Social QoL in the autistic group. Gender and age moderated these associations, with autistic men having stronger associations compared to autistic women. Post-hoc analyses revealed interactions with autism group and age group on all four QoL domains, with autistic people in older age having significantly lower scores than autistic people in midlife, a pattern not observed in the non-autistic group. Conclusion Social connectedness may play a key role in shaping QoL for autistic adults as they age. Tailored, lifespan-focused support is needed to promote sustained social connection and foster wellbeing.

Background: Previous studies have reported differences in levels of mental wellbeing between autistic and non‐autistic adolescents and between girls and boys. However, it is unclear to what extent being autistic or a particular gender influences mental wellbeing in adolescence. The importance of social relationships for mental wellbeing is well established, but it is unknown to what extent this may differ between autistic and non‐autistic adolescents and between autistic girls and boys. Methods: Data from the Millennium Cohort Study were used. Measures of social experience included social support and social alienation at age 14 ( N = 11,056). Mental wellbeing was measured at age 17 ( N = 10,034). Moderated regression analyses after multiple imputation were used to determine (i) whether autism diagnosis moderates the effect of social experience on mental wellbeing and (ii) whether the interaction between gender and autism diagnosis moderates the effect of social experience on mental wellbeing ( N = 16,370). Results: In this nationally representative sample, levels of mental wellbeing are lower for autistic adolescents and for girls. Autistic girls had the lowest wellbeing, with large differences relative to non‐autistic boys (mean difference: −3.09; 95% CI: −4.565, −1.612) and non‐autistic girls (mean difference: −1.66; 95% CI: −3.13, −0.180). Autistic boys had lower wellbeing compared to non‐autistic boys (mean difference: −1.68; 95% CI: −2.54, −0.824) and non‐autistic girls (mean difference: −1.43; 95% CI: −1.69, −1.18). Autism does not moderate the effect of social experiences on mental wellbeing. No moderations were found on the effect of social experiences on mental wellbeing when all potential interactions are considered. Conclusion: Social support and social alienation during early adolescence equally impact the mental wellbeing of autistic and non‐autistic individuals at later adolescence. Considering the low mental wellbeing of autistic adolescents, there is a critical need to improve their social experiences.