Andrew D. R. Surtees

To navigate social interactions, we rely on understanding others’ behaviours, with respect to their underlying thoughts and feelings, an ability known as mentalising. Children’s mentalising ability...

Introduction/Objectives: Intersectoral collaboration between education and mental health services is central to the care of autistic children and adolescents. However, recent literature indicates that evidence remains limited regarding how these collaborative arrangements are implemented in routine public services, particularly in low- and middle-income countries (LMICs). This study aimed to assess the intersectoral collaboration between Brazilian educational and mental health services for autistic children and adolescents and to examine the frequency and type of intersectoral contact. Methods: An exploratory cross-sectional study was conducted in the municipal public education system of Niterói, a city in the Southeast region of Brazil. Participants included parents of 123 autistic children and adolescents, 49 teachers from mainstream education and specialized educational services (SES), and 24 health professionals. Data were collected using structured questionnaires with multi-informant reports. The instruments were specifically developed for the study and submitted to expert content-validation procedures. Analyses included descriptive statistics and, in a subsample of 51 matched cases with paired responses from teachers and health professionals, Cohen’s kappa to assess agreement between reports. Results: Low levels of intersectoral collaboration were observed, characterized by infrequent contact, limited information exchange, and slight agreement between reports from teachers and health professionals (κ = 0.25; p = 0.01). Teachers were more likely to know where care was provided than to know which specialists were involved, while more than half of health professionals did not know which school the child attended. Conclusions: In the investigated municipal network, care appeared fragmented, highlighting difficulties in translating intersectoral recommendations from public policies into routine collaborative practices.

Purpose: Anxiety prevalence is higher for autistic adults than the general population, yet there is no consensus on whether self-report questionnaires provide internally consistent measurements. This review aimed to identify and narratively compare the internal consistency of all available self-report anxiety measures for autistic adults, and meta-analyse the measures with enough studies. Methods: Six databases were searched to identify relevant literature. After eligibility criteria were applied, 27 articles were retained. Included papers were evaluated for risk of bias using bespoke criteria. Results: The Generalised Anxiety Disorder seven-item questionnaire, Liebowitz Social Anxiety Scale, and Depression Anxiety Stress Scale (21-item – anxiety subscale [DASS-21]) were meta-analysed as they were examined in sufficient numbers of studies. Pooled Cronbach’s of 0.91 (CI 0.91–0.92), 0.97 (0.96–0.97), and 0.87 (0.83–0.92), respectively, were identified. Acceptable heterogeneity was found for all measures except the DASS-21 (I ² = 95.4%). Pooled internal consistency was comparable to equivalent measures used with general population samples. A complementary narrative review revealed that internal consistency across all 27 studies ranged from good to excellent. Conclusion: Published data suggest self-report anxiety measures have excellent internal consistency when completed by autistic adults. Future studies should explore complementary psychometric properties and include autistic samples with intellectual disabilities to replicate the findings.

Theory of mind is an important skill to function in society. There is evidence that anxiety can impair the ability to use this skill effectively; however, current research is inconclusive, uses heterogeneous measures of theory of mind, and lacks distinction between anxiety types, despite these being known to present differently in clinical populations. False belief tasks are standard practice for assessing theory of mind in children and autistic participants and have also been found to adequately detect theory of mind differences in neurotypical adults yet are not systematically used throughout the current literature. Given that egocentrism reflects difficulty inhibiting one’s own perspective, a core component of theory of mind, the present study examined egocentric bias using a false belief task. One hundred and sixty-eight participants completed the Generalised Anxiety Disorder-7 (GAD-7) and the Social Phobia Inventory (SPIN) prior to being randomly allocated to a general anxiety, social anxiety, or neutral mood condition. Following mood manipulation, participants completed a false belief task with either privileged knowledge or no knowledge. A 3 × 2 ANOVA found no significant main or interaction effects of general or social anxiety and false belief knowledge on performance, despite a reported increase of anxiety in the anxiety groups. There were also no significant correlations between trait general or social anxiety on theory of mind. The findings from this study do not support the previous evidence that anxiety increases egocentrism. Future studies should continue to distinguish systematically between state, trait, general, and social anxiety, and use reliable theory of mind measures.

Existing evidence about the way anxiety impacts empathy is mixed, highlighting the complexity of empathy as a construct. The impact of state anxiety on affective and cognitive empathy in women was tested. Seventy-five women underwent an anxiety or relaxation induction, prior to completing measures of affective and cognitive empathy, and trait anxiety. Robust positive correlations were found between trait cognitive and trait affective empathy, and trait and performance affective empathy. Induced anxiety impaired affective empathy performance when controlling for trait empathy, however, was not observed to impact cognitive empathy performance. Trait anxiety and empathy did not moderate the influence of induced anxiety on affective empathy performance. Irrespective of trait levels of anxiety and empathy, women are less affectively empathic when anxious, but do not vary in their cognitive empathy.

Autistic people experience high rates of mental health conditions and resultant inpatient psychiatric admissions. Best practice guidance suggests that generic inpatient units are poorly suited to many autistic patients. This meta-analysis synthesised the highly variable empirical literature reporting the prevalence of autistic people in such settings. Systematic searches of three databases were conducted, with eighteen studies included in the final review. The pooled estimated prevalence was 10% (95% confidence interval: 6–14%), compared to a 1% prevalence of autism in the general population. Significantly higher prevalence was estimated for children (13%) vs. adults (4%). A structured risk of bias assessment suggested that the quality of studies was highly variable. High levels of heterogeneity were explored statistically. Despite best practice guidelines stating that many autistic people would have their needs best met in specialty units, autistic people are over-represented in generic psychiatric inpatient settings.

Joint attention is crucial for the development of social cognition, but whether the type of relationship (i.e. cooperative or competitive) or interaction (e.g. addressed or witnessed) modulates joint attention is unclear. This study investigated these factors in 96 neurotypical adults using a video object-choice task. Here, participants chose between cups based on an actor’s pointing cue, either while being addressed or witnessing an interaction between two actors. Participants were primed about the actor’s cooperative or competitive intent. Experiment 1 found no significant interaction between these factors. However, Experiment 2, considering spatial attention (cue direction), revealed nuanced effects. In addressed interactions, more social cues led to faster responses, especially during spatially congruent cooperative trials. In witnessed interactions, responses were faster to spatially incongruent cues in cooperative trials and vice versa in competitive trials. These findings suggest that joint attention is not solely a passive response to social cues, but is actively shaped by the social context and spatial configuration, highlighting how individuals actively interpret and adapt to others’ attentional cues.

Joint attention is crucial for the development of social cognition, but whether the type ofrelationship (i.e., cooperative or competitive) or interaction (e.g., addressed or witnessed)modulates joint attention is unclear. This study investigated these factors in 96 neurotypicaladults using a video object-choice task. Here, participants chose between cups based on anactor's pointing cue, either while being addressed or witnessing an interaction between twoactors. Participants were primed about the actor's cooperative or competitive intent.Experiment 1 found no significant interaction between these factors. However, Experiment 2,considering spatial attention (cue direction), revealed nuanced effects. In addressedinteractions, more social cues led to faster responses, especially during spatially congruentcooperative trials. In witnessed interactions, responses were faster to spatially incongruentcues in cooperative trials and vice versa in competitive trials. These findings suggest thatjoint attention is not solely a passive response to social cues, but is actively shaped by thesocial context and spatial configuration, highlighting how individuals actively interpret andadapt to others attentional cues.

Purpose With growing frequency, young people are referred for autism assessment following the onset of mental health difficulties, such as anxiety and depression. Understanding the nature of these difficulties and how they change through the assessment process may be crucial in providing effective support; this study provided the first longitudinal assessment of that. Method Twenty-seven young people and their parents/carers completed questionnaire measures of mental health, wellbeing and quality of life while waiting for an autism assessment, at the point of assessment and three months after receiving their diagnostic outcome. Results A range of clinically-significant mental health presentations were reported. Young people commonly reported more severe symptoms than their parents, while parents reported a more significant impact. Mental health symptoms were correlated with quality of life. There was not evidence that the potentially stressful experience of waiting for and completing an assessment negatively impacted young people’s mental health or wellbeing. Conclusion Young people waiting for autism assessment experience varied, enduring and impactful difficulties with mental health: comprehensive assessment is required to meet their needs. At a group-level, there is no good reason to delay autism assessment for fear of worsening mental health symptoms.

Autism diagnostic criteria relate to difficulties in functioning across multiple developmental domains, that often impact on a person’s independence. There are different ways to conceptualise and exercise independence, but no previous studies have questioned how autistic adults do so. This qualitative study aimed to understand how autistic adults define and experience independence. It was designed to further our understanding of how autistic adults account for and use coping strategies to overcome barriers to independent living and navigate their way to their desired level of independence. Twelve semi-structured interviews were conducted with autistic adults living in the United Kingdom. The data were analysed using reflexive thematic analysis. The researchers generated three major themes. The first theme ‘Independence is “not a one-size-fits-all”’ highlights that there is no one definition or concept of independence for autistic people; these are relative and uniquely individual. The second theme ‘“Being autistic has its setbacks” in a neurotypical world’ describes the obstacles encountered by autistic adults seeking independence within a society that favours neurotypical norms. The third theme ‘Finding ways of making it work’ captures strategies autistic adults use in achieving or maintaining independence. The findings from this study provide a foundation for future research exploring domains of independence for autistic adults. The perceived desirability of achieving different degrees of in(ter)dependence and the fluctuating nature of self-sufficiency are explored through lived experience. Increasing understanding of barriers and challenges to independence has the potential to empower autistic adults and improve services and support.