A Systematic Review of Self-Reported Stress Questionnaires in People on the Autism Spectrum.

Background: The goal of this systematic review was to provide an overview of self-report measures of stress in populations on the autism spectrum. In addition, information regarding psychometric properties was discussed as well. Methods: Four databases were systematically searched following the PRISMA guidelines and using strict eligibility criteria. Risk of bias assessment was performed using the COSMIN checklist. Results: Eight questionnaires were previously used in populations on the autism spectrum, reported over 31 studies. Discussion: Future research should focus more on examining psychometric properties of these self-report measures in this population as current evidence is scarce. In addition, it is important to consider which concept of stress one aims to measure as not all questionnaires cover the same aspects of stress. Supplementary Information: The online version contains supplementary material available at 10.1007/s40489-021-00293-4.

Impact of the COVID-19 Pandemic on Daily Life: Diverse Experiences for Autistic Adults.

Using a mixed methods design, this study aimed to examine the impact of the COVID-19 pandemic on autistic and non-autistic adults. We conducted an online survey with 196 autistic and 228 non-autistic adults from Belgium, the Netherlands and the United Kingdom focusing on their experiences during the first period of the pandemic. Our results indicate rather diverse experiences within the group of autistic participants across all domains of life. In comparison with non-autistic adults, autistic adults reported less negative impact on their social life and more negative impact on health and support services. In the autism group, stress was mainly related to changing and unclear measures. A wide range of coping strategies were described as helpful in reducing stress during the pandemic.

Exploring the perception of stress in childhood and early adolescence.

Stressful life experiences may jeopardize the healthy development of children. To improve interventions, more knowledge is needed on the perception of stress by children. In adults, stress is regarded as a state of low valence and high arousal. It is unclear whether children perceive stress similarly. In the current study, 35 children of the general population completed three tasks aiming to provide insight into their knowledge of the concept stress. In the first task, participants were asked about their verbal knowledge of the concept stress. In the second task, they rated the valence and arousal of eight emotion-evoking vignettes. In the final task, participants completed an experience sampling survey for at least 1 day, consisting of a stress thermometer and pictorial scales of valence and arousal. Participants' perception of stress was found to be mainly valence focused. Age and sex were found to play a role in the degree of arousal focus. Older participants differentiated more in arousal levels than younger participants, as did girls in comparison with boys. Because the perception of stress depends on developmental and other individual factors, using stress as a single measurement dimension in a survey is not recommended.

Mental health of autistic adults during the COVID-19 pandemic: The impact of perceived stress, intolerance of uncertainty, and coping style.

LAY ABSTRACT: More and more research shows us that autistic individuals are at risk of experiencing mental health problems in response to the COVID-19 pandemic. However, little is known about why this is the case. At two timepoints during the pandemic, we asked 149 autistic and 147 non-autistic adults about feelings of anxiety, depression, and stress, and about characteristics that may explain why some (autistic) people have a larger chance of developing anxiety and depression during this pandemic. In our study, autistic adults experienced more anxiety and depression than non-autistic adults. Across autistic and non-autistic individuals, the people who experienced more stress at timepoint 1 experienced more anxiety and depression 4 months later. This was especially the case for those individuals who use maladaptive coping styles, such as denial or venting, and for those who have difficulties dealing with uncertain situations. Our findings show the burden of the COVID-19 pandemic on the mental health of autistic adults. Interventions to support autistic adults during and after the pandemic are needed, and they may want to focus on the negative impact of stress and teach autistic (and non-autistic) adults more adaptive ways to cope with stressful circumstances.

Conceptualization of quality of life in autistic individuals.

The present study examines to what extent two core characteristics of the quality of life (QoL) construct were incorporated in the field of autism: (1) its subjective nature; and (2) its multidimensionality. Therefore, we reviewed 174 articles examining QoL in individuals with autism. The review showed parents reporting a lower QoL compared with autistic individuals themselves, especially on internal domains. This may suggest different expectations about what a good QoL may entail. Such an underestimation of QoL by others is commonly observed in individuals with disabilities (the so-called 'disability paradox'). For the multidimensionality of the QoL construct, our findings suggest that the narrower (and more unidimensional) construct of health-related QoL is often measured instead of QoL. Additionally, a substantial proportion of items did not measure QoL, but they evaluated characteristics that may or may not have an impact on QoL. Researchers and clinicians should be aware that QoL domains are selected and operationalized differently by different instruments. QoL may benefit from an exclusive focus on subjective aspects, which can be measured alongside more normative, objective characteristics of individuals or their environment.

Cortical Synchrony as a Mechanism of Collinear Facilitation and Suppression in Early Visual Cortex.

Stimulus-induced oscillations and synchrony among neuronal populations in visual cortex are well-established phenomena. Their functional role in cognition are, however, not well-understood. Recent studies have suggested that neural synchrony may underlie perceptual grouping as stimulus-frequency relationships and stimulus-dependent lateral connectivity profiles can determine the success or failure of synchronization among neuronal groups encoding different stimulus elements. We suggest that the same mechanism accounts for collinear facilitation and suppression effects where the detectability of a target Gabor stimulus is improved or diminished by the presence of collinear flanking Gabor stimuli. We propose a model of oscillators which represent three neuronal populations in visual cortex with distinct receptive fields reflecting the target and two flankers, respectively, and whose connectivity is determined by the collinearity of the presented Gabor stimuli. Our model simulations confirm that neuronal synchrony can indeed explain known collinear facilitation and suppression effects for attended and unattended stimuli.

How well are DSM-5 diagnostic criteria for ASD represented in standardized diagnostic instruments?

Five years after the publication of DSM-5 in 2013, three widely used diagnostic instruments have published algorithms designed to represent its (sub-)criteria for Autism Spectrum Disorder (ASD) in children and adolescents. This study aimed to: (1) establish the content validity of these three DSM-5-adapted algorithms, and (2) identify problems with the operationalization of DSM-5 diagnostic criteria in measurable and observable behaviors. Algorithm items of the Autism Diagnostic Observation Schedule-Second Edition (ADOS-2), Developmental, Dimensional and Diagnostic Interview (3di) and Diagnostic Interview for Social and Communication Disorders-11th edition (DISCO-11) were mapped onto DSM-5 sub-criteria. The development and decision-making rules integrated in their algorithms were then compared with DSM-5. Results demonstrated significant variability in the number and nature of sub-criteria covered by the ADOS-2, 3di and DISCO-11. In addition to differences in the development of algorithms and cut-off scores, instruments also differed in the extent to which they follow DSM-5 decision-making rules for diagnostic classification. We conclude that such differences in interpretation of DSM-5 criteria provide a challenge for symptom operationalization which will be most effectively overcome by consensus, testing and reformulation.

Do Parental Interviews for ASD Converge with Clinical Diagnoses? An Empirical Comparison of the 3di and the DISCO in Children with ASD, a Clinically-Referred Group, and Typically Developing Children.

Two semi-structured parental interviews are available with algorithms developed to measure DSM-5 criteria of ASD, namely the Developmental, Dimensional and Diagnostic Interview (3di) and the Diagnostic Interview for Social and Communication Disorders (DISCO-11). The main aim of this study was to examine the agreement between classification according to both interviews, and their convergence with the clinical diagnosis. Therefore, the 3di and DISCO-11 were administered from three groups of parents of a 4-18 year old. Results showed 75% agreement between both instruments, but in the ASD group only 16% of the children scored above threshold on both instruments. Exploratory analyses suggested that the 3di failed to detect rigid and repetitive behaviors, whereas the DISCO-11 was insufficiently sensitive in detecting socio-communicative problems.

Parenting Strategies Used by Parents of Children with ASD: Differential Links with Child Problem Behaviour.

Here, we explored the structure of the 'Parenting Strategies Questionnaire', a new scale designed to measure parenting strategies for problem behaviour in ASD. We then examined links between child behaviour and parenting in a sample of 222 predominantly-UK parents of ASD children exhibiting behaviour found difficult or challenging. Analysis revealed three parenting subscales: Accommodation, Reinforcement Approaches and Reducing Uncertainty. Both Accommodation and Reducing Uncertainty were linked to child problem behaviour. Child factors explained up to 29% of the variance in Accommodation, with Socially Inflexible Non-compliance the strongest predictor, and up to 24% of the variance in Reducing Uncertainty, with Intolerance of Uncertainty the strongest predictor. Child factors were not related to Reinforcement Approaches. Longitudinal studies investigating these relationships are needed.

Global Motion Perception in Autism Spectrum Disorder: A Meta-Analysis.

Visual perception in individuals with autism spectrum disorder (ASD) is often debated in terms of enhanced local and impaired global perception. Deficits in global motion perception seem to support this characterization, although the evidence is inconsistent. We conducted a large meta-analysis on global motion, combining 48 articles on biological and coherent motion. Results provide evidence for a small global motion processing deficit in individuals with ASD compared to controls in both biological and coherent motion. This deficit appears to be present independent of the paradigm, task, dependent variable, age or IQ of the groups. Results indicate that individuals with ASD are less sensitive to these types of global motion, although the difference in neural mechanisms underlying this behavioral difference remains unclear.

Conceptualizing neurodevelopmental disorders as networks: Promises and challenges.

The target article by Borsboom et al. proposes network models as an alternative to reductionist approaches in the analysis of mental disorders, using mood disorders such as depression and anxiety as examples. We ask how this framework can be applied to neurodevelopmental disorders such as autism spectrum disorder (ASD) and attention deficit hyperactivity disorder (ADHD). Specifically, we raise a number of promises and challenges when conceptualizing neurodevelopmental disorders as networks.

Connection-based and object-based grouping in multiple-object tracking: A developmental study.

Developmental research on Gestalt laws has previously revealed that, even as young as infancy, we are bound to group visual elements into unitary structures in accordance with a variety of organizational principles. Here, we focus on the developmental trajectory of both connection-based and object-based grouping, and investigate their impact on object formation in participants, aged 9-21 years old (N = 113), using a multiple-object tracking paradigm. Results reveal a main effect of both age and grouping type, indicating that 9- to 21-year-olds are sensitive to both connection-based and object-based grouping interference, and tracking ability increases with age. In addition to its importance for typical development, these results provide an informative baseline to understand clinical aberrations in this regard. Statement of contribution What is already known on this subject? The origin of the Gestalt principles is still an ongoing debate: Are they innate, learned over time, or both? Developmental research has revealed how each Gestalt principle has its own trajectory and unique relationship to visual experience. Both connectedness and object-based grouping play an important role in object formation during childhood. What does this study add? The study identifies how sensitivity to connectedness and object-based grouping evolves in individuals, aged 9-21 years old. Using multiple-object tracking, results reveal that the ability to track multiple objects increases with age. These results provide an informative baseline to understand clinical aberrations in different types of grouping.

Gaze-Contingent Display Changes as New Window on Analytical and Holistic Face Perception in Children With Autism Spectrum Disorder.

The strength of holistic face perception in children with autism spectrum disorder (ASD) was evaluated by applying the gaze-contingent mask and window technique to a face matching and discrimination task in 6- to 14-year-old children with (n = 36) and without ASD (n = 47), and by examining fixation patterns. Behavioral results suggested a slower and less efficient face processing in the ASD sample compared with the matched control group. Comparing the moving mask and window conditions revealed a reduced holistic face processing bias in the younger age group but not in the older sample. Preferential viewing patterns revealed both similarities and differences between both participant groups.

Multiple Object Tracking Reveals Object-Based Grouping Interference in Children with ASD.

The multiple object tracking (MOT) paradigm has proven its value in targeting a number of aspects of visual cognition. This study used MOT to investigate the effect of object-based grouping, both in children with and without autism spectrum disorder (ASD). A modified MOT task was administered to both groups, who had to track and distinguish four targets that moved randomly amongst four distracters, irrespective of the grouping condition. No group difference was revealed between children with and without ASD: both showed adequate MOT abilities and a similar amount of grouping interference. Implications of the current result are considered for previous MOT studies, the developmental trajectory of perceptual grouping, and the idea of heightened sensitivity to task characteristics in ASD.

How do Parents Manage Irritability, Challenging Behaviour, Non-Compliance and Anxiety in Children with Autism Spectrum Disorders? A Meta-Synthesis.

Although there is increasing research interest in the parenting of children with ASD, at present, little is known about everyday strategies used to manage problem behaviour. We conducted a meta-synthesis to explore what strategies parents use to manage irritability, non-compliance, challenging behaviour and anxiety in their children with ASD. Approaches included: (1) accommodating the child; (2) modifying the environment; (3) providing structure, routine and occupation; (4) supervision and monitoring; (5) managing non-compliance with everyday tasks; (6) responding to problem behaviour; (7) managing distress; (8) maintaining safety and (9) analysing and planning. Results suggest complex parenting demands in children with ASD and problem behaviour. Findings will inform the development of a new measure to quantify parenting strategies relevant to ASD.

"Hold Me Tight So I Can Go It Alone": Developmental Themes for Young Adults With Autism Spectrum Disorder.

Although research shows that young adults with autism spectrum disorder (ASD) struggle with higher rates of depression, anxiety, and other co-occurring psychiatric disorders, their psychological development through emerging adulthood remains understudied. To explore relevant developmental themes for young adults with ASD while subscribing to a social-constructionist epistemology, we interviewed young adults with ASD and their mental health care professionals individually, and organized focus groups with their parents in a multiperspective design. Developmental themes were identified using interpretative phenomenological analysis. Despite a substantial body of research considering lack of social motivation, a central ASD characteristic, narratives were remarkably socially oriented. This article discusses the overarching themes of (a) searching for balance and negotiating ASD and (b) searching for suitable surroundings in different areas of life, as well as their implications for clinical practice.

Visual Search in ASD: Instructed Versus Spontaneous Local and Global Processing.

Visual search has been used extensively to investigate differences in mid-level visual processing between individuals with ASD and TD individuals. The current study employed two visual search paradigms with Gaborized stimuli to assess the impact of task distractors (Experiment 1) and task instruction (Experiment 2) on local-global visual processing in ASD versus TD children. Experiment 1 revealed both groups to be equally sensitive to the absence or presence of a distractor, regardless of the type of target or type of distractor. Experiment 2 revealed a differential effect of task instruction for ASD compared to TD, regardless of the type of target. Taken together, these results stress the importance of task factors in the study of local-global visual processing in ASD.

In the Eye of the Beholder: Rapid Visual Perception of Real-Life Scenes by Young Adults with and Without ASD.

Typically developing (TD) adults are able to extract global information from natural images and to categorize them within a single glance. This study aimed at extending these findings to individuals with autism spectrum disorder (ASD) using a free description open-encoding paradigm. Participants were asked to freely describe what they saw when looking at briefly presented real-life photographs. Our results show subtle but consistent group-level differences. More specifically, individuals with ASD spontaneously reported the presence of people in the display less frequently than TD participants, and they grasped the gist of the scene less well. These findings argue for a less efficient rapid feedforward processing of global semantic aspects and a less spontaneous interpretation of socially salient information in ASD.

Ultra-Rapid Categorization of Meaningful Real-Life Scenes in Adults With and Without ASD.

In comparison to typically developing (TD) individuals, people with autism spectrum disorder (ASD) appear to be worse in the fast extraction of the global meaning of a situation or picture. Ultra-rapid categorization [paradigm developed by Thorpe et al. (Nature 381:520-522, 1996)] involves such global information processing. We therefore tested a group of adults with and without ASD, without intellectual disability, on a set of ultra-rapid categorization tasks. Individuals with ASD performed equally well as TD individuals except when the task required the categorization of social interactions. These results argue against a general deficit in ultra-rapid gist perception in people with ASD, while suggesting a more specific problem with the fast processing of information about social relations.

Reduced recognition of dynamic facial emotional expressions and emotion-specific response bias in children with an autism spectrum disorder.

Emotion labelling was evaluated in two matched samples of 6-14-year old children with and without an autism spectrum disorder (ASD; N = 45 and N = 50, resp.), using six dynamic facial expressions. The Emotion Recognition Task proved to be valuable demonstrating subtle emotion recognition difficulties in ASD, as we showed a general poorer emotion recognition performance, in addition to some emotion-specific impairments in the ASD group. Participants' preference for selecting a certain emotion label, irrespective of the stimulus presented, played an important role in our results: response bias-corrected data still showed an overall decreased emotion recognition performance in ASD, but no emotion-specific impairments anymore. Moreover, ASD traits and empathy were correlated with emotion recognition performance.