Overcoming the Double Empathy Problem Within Pairs of Autistic and Non-autistic Adults Through the Contemplation of Serious Literature

Recent research based on the needs of the autistic community has explored the frequent social misunderstandings that arise between autistic and non-autistic people, known as the double empathy problem. Double empathy understandings require both groups to respect neurodiversity by focussing on individuality across groups. This study aimed to explore how literature, through its ability to uncover nuanced emotional response differences between readers, could facilitate double empathy understandings within pairs of autistic and non-autistic adults. A longitudinal, qualitative design was used, with 4 gender-matched pairs. Participants read Of Mice and Men for 1 week, whilst completing a structured, reflective diary. This was followed by 4 one-hour paired reading sessions, where pairs discussed the book and their reflections in depth. Participants were then invited to a final one-on-one interview to discuss their thoughts and experiences of the paired reading sessions. Thematic and literary analysis of the session and interview data revealed four themes (1) The Book as Social Oil; (2) From a World of Difference to a World of Affinity; (3) Emotional Intelligence: From Thinking About to Feeling with; and (4) From Overwhelming to Overcoming. All participants reported having achieved an individualised view of one another to explore their nuanced differences. The non-autistic group reported a more sensitive understanding of what it means to be autistic, while the autistic group overcame concerns about non-autistic people stereotyping autism, and instead reported feeling valued and accommodated by their non-autistic partners.

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"I'm trying to reach out, I'm trying to find my people": Loneliness and loneliness distress in autistic adults

10.31234/osf.io/7ckeq ◽

2021 ◽

Author(s):

Lisa Quadt ◽

Gemma Louise Williams ◽

James S Mulcahy ◽

Marta Silva ◽

Dennis E O Larsson ◽

...

Keyword(s):

Strong Correlations ◽

Sensory Sensitivity ◽

Autistic Group ◽

Autistic People ◽

The Social ◽

Autistic Adults ◽

Anxiety Depression ◽

Insight Into ◽

Autistic Population ◽

Group Regression

Despite the persistent stereotype that autistic individuals are not motivated to seek meaningful social relationships, rates of loneliness among the autistic population are higher than in the non-autistic population. In this two-part, mixed methods study, we sought to 1) quantify the level of distress associated with loneliness in autistic and non-autistic adults and 2) gain qualitative insight into autistic experiences of loneliness. In Study A, 209 participants (encompassing a group of autistic individuals and a group of non-autistic comparison participants) completed questionnaire ratings of their level of loneliness, associated distress, trait anxiety, depression, and sensory sensitivity. Results indicated that the autistic group scored higher levels across all measures. Both groups manifest strong correlations between loneliness and loneliness distress. In the autistic group, but not the non-autistic group, regression analyses showed that loneliness and sensory sensitivity predicted levels of anxiety, wherein the effect of loneliness on anxiety was partially mediated by the level of sensory sensitivity. In Study B, nine autistic adults took part in ten-minute, unstructured dyadic conversations around the topic of loneliness. Inductive and deductive analyses enriched qualitative understanding of the experiences of loneliness of autistic individuals. Our results broadly oppose the social motivation deficit hypothesis and we instead frame our findings within the larger context of ‘ethical loneliness’, concluding that a concerted effort is needed to overcome the fundamental disconnect with the neurotypical world experienced by many autistic people.

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Camouflaging in non-autistic adults is associated with poorer mental health

10.31234/osf.io/myp4g ◽

2019 ◽

Author(s):

Mark Somerville ◽

Sarah E. MacPherson ◽

Sue Fletcher-Watson

Keyword(s):

Mental Health ◽

Executive Function ◽

Autistic Traits ◽

Self Report ◽

Linear Regression Models ◽

Mental Health Symptoms ◽

Health Symptoms ◽

Autistic People ◽

Autistic Adults ◽

The Relationship

Camouflaging is a frequently reported behaviour in autistic people, which entails the use of strategies to compensate for and mask autistic traits in social situations. Camouflaging is associated with poor mental health in autistic people. This study examined the manifestation of camouflaging in a non-autistic sample, examining the relationship between autistic traits, camouflaging, and mental health. In addition, the role of executive functions as a mechanism underpinning camouflaging was explored. Sixty-three non-autistic adults completed standardised self-report questionnaires which measured: autistic traits, mental health symptoms, and camouflaging behaviours. In addition, a subset (n=51) completed three tests of executive function measuring inhibition, working memory, and set-shifting. Multiple linear regression models were used to analyse data. Results indicated that autistic traits are not associated with mental health symptoms when controlling for camouflaging, and camouflaging predicted increased mental health symptoms. Camouflaging did not correlate with any measure of executive function. These findings have implications for understanding the relationship between autistic traits and mental health in non-autistic people and add to the growing development of theory and knowledge about the mechanism and effects of camouflaging.

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Is social camouflaging associated with anxiety and depression in autistic adults?

Molecular Autism ◽

10.1186/s13229-021-00421-1 ◽

2021 ◽

Vol 12 (1) ◽

Author(s):

Laura Hull ◽

Lily Levy ◽

Meng-Chuan Lai ◽

K. V. Petrides ◽

Simon Baron-Cohen ◽

...

Keyword(s):

Mental Health ◽

Intellectual Disability ◽

Social Anxiety ◽

Online Survey ◽

Mental Health Problems ◽

Autistic Traits ◽

Health Problems ◽

Autistic People ◽

Autistic Adults ◽

Anxiety Depression

Abstract Background There is inconsistent evidence for a clear pattern of association between ‘camouflaging’ (strategies used to mask and/or compensate for autism characteristics during social interactions) and mental health. Methods This study explored the relationship between self-reported camouflaging and generalised anxiety, depression, and social anxiety in a large sample of autistic adults and, for the first time, explored the moderating effect of gender, in an online survey. Results Overall, camouflaging was associated with greater symptoms of generalised anxiety, depression, and social anxiety, although only to a small extent beyond the contribution of autistic traits and age. Camouflaging more strongly predicted generalised and social anxiety than depression. No interaction between camouflaging and gender was found. Limitations These results cannot be generalised to autistic people with intellectual disability, or autistic children and young people. The sample did not include sufficient numbers of non-binary people to run separate analyses; therefore, it is possible that camouflaging impacts mental health differently in this population. Conclusions The findings suggest that camouflaging is a risk factor for mental health problems in autistic adults without intellectual disability, regardless of gender. We also identified levels of camouflaging at which risk of mental health problems is highest, suggesting clinicians should be particularly aware of mental health problems in those who score at or above these levels.

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The impact of the COVID-19 pandemic on autistic adults – a survey

Advances in Autism ◽

10.1108/aia-10-2020-0057 ◽

2021 ◽

Vol ahead-of-print (ahead-of-print) ◽

Author(s):

Conor James Davidson ◽

Keri Lodge ◽

Alwyn Kam

Keyword(s):

Coping Strategies ◽

Design Methodology ◽

Online Survey ◽

Negative Impact ◽

Significant Deterioration ◽

Cross Sectional ◽

Content Type ◽

Autistic People ◽

Autistic Adults ◽

The Impact

Purpose To date there has been limited research on the impact of the COVID-19 pandemic on autistic people. This study aims to present the results of a survey of autistic people (n = 51) conducted by a UK specialist autism team. Design/methodology/approach A cross-sectional online survey. Findings A total of 72% respondents reported either some or significant deterioration in mental health during the pandemic. The issues that caused most negative impact were uncertainty over what will happen next and disruption of normal routine. Respondents reported a variety of coping strategies to help them through the pandemic. Originality/value To date there has been little research looking specifically at the impact of the COVID-19 pandemic on autistic people. This paper adds weight to the evidence that the pandemic has had a particularly severe impact on autistic adults and includes useful information on potential coping strategies for this population.

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Instructions to attend to an observed action increase imitation in autistic adults

Autism ◽

10.1177/1362361319882810 ◽

2019 ◽

Vol 24 (3) ◽

pp. 730-743 ◽

Cited By ~ 1

Author(s):

Emma Gowen ◽

Andrius Vabalas ◽

Alexander J Casson ◽

Ellen Poliakoff

Keyword(s):

Eye Movements ◽

Visual Attention ◽

Eye Movement ◽

Hand Movement ◽

Autistic Group ◽

Instruction Condition ◽

Following Instructions ◽

Autistic Adults ◽

Movement Imitation ◽

Vertical Elevation

This study investigated whether reduced visual attention to an observed action might account for altered imitation in autistic adults. A total of 22 autistic and 22 non-autistic adults observed and then imitated videos of a hand producing sequences of movements that differed in vertical elevation while their hand and eye movements were recorded. Participants first performed a block of imitation trials with general instructions to imitate the action. They then performed a second block with explicit instructions to attend closely to the characteristics of the movement. Imitation was quantified according to how much participants modulated their movement between the different heights of the observed movements. In the general instruction condition, the autistic group modulated their movements significantly less compared to the non-autistic group. However, following instructions to attend to the movement, the autistic group showed equivalent imitation modulation to the non-autistic group. Eye movement recording showed that the autistic group spent significantly less time looking at the hand movement for both instruction conditions. These findings show that visual attention contributes to altered voluntary imitation in autistic individuals and have implications for therapies involving imitation as well as for autistic people’s ability to understand the actions of others.

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Language, Form and Emotion in James Joyce’s Portrait of an Artist as a Young Man: A Literary Analysis

Advances in Language and Literary Studies ◽

10.7575/aiac.alls.v.8n.5p.158 ◽

2017 ◽

Vol 8 (5) ◽

pp. 158

Author(s):

Robert S.P. Jones

Keyword(s):

Associative Learning ◽

Emotional Response ◽

Emotional Responses ◽

Human Experience ◽

Literary Analysis ◽

The Novel ◽

Psychological Perspective ◽

Literary Traditions ◽

Language Form ◽

The Relationship

James Joyce’s Portrait of the Artist as a Young Man has fascinated readers for more than a century and there are layers of psychological meaning to be found throughout the novel. The novel is the perfect vehicle to discuss the relationship between form language and emotion as Joyce deliberately manipulated the emotional response of the reader through innovations in form and language, departing dramatically from previous literary traditions. This paper attempts to take a fresh look at the novel from a psychological perspective and seeks to examine underlying conditioning processes at work in the narrative – particularly the concept of associative learning. Understanding emotional responses to different stimuli is the bedrock of psychological investigation and 100 years after the date of its publication, Portrait of an Artist presents remarkably fresh insights into the human experience of emotion. Despite its age, Portrait of the Artist contains many contemporary psychological insights.

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Barriers to healthcare for autistic adults: Consequences & policy implications. A cross-sectional study

10.1101/2020.04.01.20050336 ◽

2020 ◽

Author(s):

Mary Doherty ◽

Stuart D Neilson ◽

Jane D O'Sullivan ◽

Laura Carravallah ◽

Mona Johnson ◽

...

Keyword(s):

Mental Health ◽

Cross Sectional Study ◽

Sectional Study ◽

Physical And Mental Health ◽

Cross Sectional ◽

Adverse Health ◽

Adverse Health Outcomes ◽

Clinic Appointment ◽

Autistic People ◽

Autistic Adults

AbstractBackgroundAutistic people experience significantly poorer physical and mental health along with reduced life expectancy.AimTo identify self-reported barriers to primary care by autistic adults compared to parents of autistic children and non-autistic adults and link these barriers to self-reported adverse health consequences.Design and SettingFollowing consultation with the autistic community at an autistic conference, Autscape, a quantitative and qualitative survey was developed.MethodThe self-report survey was administered online through social media platforms.ResultsThe 57-item online survey was completed by 507 autistic adults, 196 parents of autistic children and 157 control subjects. 79.7% of autistic adults, 52.8% of parents and 36.5% of controls reported difficulty visiting a GP. The highest-rated barriers by autistic adults were deciding if symptoms warrant a GP visit (72.2%), difficulty making appointments by telephone (61.9%), not feeling understood (55.8%), difficulty communicating with their doctor (53.1%) and the waiting room environment (50.5%).Autistic adults reported a preference for online or text based appointment booking, facility to email in advance the reason for consultation, first or last clinic appointment and a quiet place to wait.Increased adverse health outcomes reported by autistic adults correlated with difficulty attending, including untreated physical and mental health conditions, not attending specialist referral or screening programmes, requiring more extensive treatment or surgery due to late presentations, and untreated potentially life threatening conditions.ConclusionReduction of healthcare inequalities for autistic people requires that healthcare providers understand autistic perspectives and communication needs. Adjustments for autism specific needs are as necessary as ramps for wheelchair users.How this fits inAdverse health outcomes are common among autistic people and so it is important to understand how we can promote access to primary care.This cross sectional study indicates that 79.7% of autistic patients (compared to 36.5% of controls) reported difficulty visiting a GP.Common barriers were: deciding if symptoms warrant a GP visit, difficulty using the telephone to book appointments, not feeling understood and difficulty communicating with their doctor.Common suggestions to promote access included: online or text based appointment booking facility, emailing in advance the reason for consultation, providing first or last clinic appointment and having a quiet place to wait.

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Emotional processing of ironic vs. literal criticism in autistic and non-autistic adults: Evidence from eye-tracking

10.31234/osf.io/h6dj4 ◽

2019 ◽

Author(s):

Mahsa Barzy ◽

Ruth Filik ◽

David Williams ◽

Heather Jane Ferguson

Keyword(s):

Emotional Processing ◽

Real Life ◽

Emotional Responses ◽

Target Sentence ◽

Emotional States ◽

Typically Developing ◽

Two Stage ◽

Autistic People ◽

Autistic Adults ◽

Specific Difficulty

Typically developing (TD) adults are able to keep track of story characters’ emotional states online while reading. Filik et al. (2017) showed that initially, participants expected the victim to be more hurt by ironic comments than literal, but later considered them less hurtful; ironic comments were regarded as more amusing. We examined these processes in autistic adults, since previous research has demonstrated socio-emotional difficulties among autistic people, which may lead to problems processing irony and its related emotional processes despite an intact ability to integrate language in context. We recorded eye movements from autistic and non-autistic adults while they read narratives in which a character (the victim) was either criticised in an ironic or a literal manner by another character (the protagonist). A target sentence then either described the victim as feeling hurt/amused by the comment, or the protagonist as having intended to hurt/amused the victim by making the comment. Results from the non-autistic adults broadly replicated the key findings from Filik et al. (2017), supporting the two-stage account. Importantly, the autistic adults did not show comparable two-stage processing of ironic language; they did not differentiate between the emotional responses for victims or protagonists following ironic vs. literal criticism. These findings suggest that autistic people experience a specific difficulty taking into account other peoples’ communicative intentions (i.e. infer their mental state) to appropriately anticipate emotional responses to an ironic comment. We discuss how these difficulties might link to atypical socio-emotional processing in autism, and the ability to maintain successful real-life social interactions.

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Knowing me, knowing you: Spontaneous use of mentalistic language for self and other in autism

Autism ◽

10.1177/1362361320951017 ◽

2020 ◽

pp. 136236132095101

Author(s):

Alexandra Zinck ◽

Uta Frith ◽

Peter Schönknecht ◽

Sarah White

Keyword(s):

Similar Pattern ◽

Mental States ◽

The Self ◽

The Other ◽

Psychological Traits ◽

Unique Pattern ◽

Self And Other ◽

Autistic People ◽

Physical Traits ◽

Autistic Adults

Recent studies on mentalizing have shown that autistic individuals who pass explicit mentalizing tasks may still have difficulties with implicit mentalizing tasks. This study explores implicit mentalizing by examining spontaneous speech that is likely to contain mentalistic expressions. The spontaneous production of meta-statements provides a clear measure for implicit mentalizing that is unlikely to be learned through experience. We examined the self- and other-descriptions of highly verbally able autistic and non-autistic adults in terms of their spontaneous use of mentalistic language and meta-representational utterances through quantitative and qualitative analysis. We devised a hierarchical coding system that allowed us to study the types of statements produced in comparable conditions for the self and for a familiar other. The descriptions of autistic participants revealed less mentalistic content relating to psychological traits and meta-statements. References to physical traits were similar between groups. Within each group, participants produced a similar pattern of types of mental utterance across ‘self’ and ‘other’ conditions. This suggests that autistic individuals show a unique pattern of mental-state-representation for both self and other. Meta-statements add a degree of complexity to self- and other-descriptions and to the understanding of mental states; their reduction in autism provides evidence for implicit mentalizing difficulties. Lay abstract Autistic people can have difficulties in understanding non-autistic people’s mental states such as beliefs, emotions and intentions. Although autistic adults may learn to overcome difficulties in understanding of explicit (overt) mental states, they may nevertheless struggle with implicit (indirect) understanding of mental states. This study explores how spontaneous language is used in order to specifically point to this implicit (indirect) understanding of mental states. In particular, our study compares the spontaneous statements that were used in descriptions of oneself and a familiar other person. Here, we found that autistic and non-autistic adults were comparable in the number of statements about physical traits they made. In contrast, non-autistic adults made more statements about mentalistic traits (about the mental including psychological traits, relationship traits and statements reflecting about these) both for the self and the other. Non-autistic and autistic adults showed no difference in the number of statements about relationships but in the number of statements about psychological traits and especially in the statements reflecting on these. Each group showed a similar pattern of kinds of statements for the self and for the other person. This suggests that autistic individuals show the same unique pattern of description in mentalistic terms for the self and another person. This study also indicates that investigating spontaneous use of language, especially for statements reflecting about mental states, enables us to look into difficulties with implicit (indirect) understanding of mental states.

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Epilepsy in adulthood: Prevalence, incidence, and associated antiepileptic drug use in autistic adults in a state Medicaid system

Autism ◽

10.1177/1362361320942982 ◽

2020 ◽

pp. 136236132094298

Author(s):

Lauren Bishop ◽

Kiley J McLean ◽

Eric Rubenstein

Keyword(s):

Intellectual Disability ◽

Drug Use ◽

Confidence Interval ◽

Antiepileptic Drug ◽

Population Level ◽

Autistic People ◽

Increased Risk ◽

Autistic Adults ◽

Antiepileptic Medications ◽

Incident Cases

Although epilepsy commonly presents with autism in children, it is currently unknown whether established estimates represent the prevalence and incidence of epilepsy in autistic adults. Our objective was to use population-level Medicaid data to determine prevalence, incidence, and antiepileptic drug use associated with epilepsy in a unique population of autistic adults aged 21+ with (N = 2738) and without (N = 4775) intellectual disability and to compare results to adults with intellectual disability alone (N = 18,429). We found that 34.6% of autistic adults with intellectual disability and 11.1% of autistic adults without intellectual disability had epilepsy, compared to 27.0% of adults with intellectual disability alone. New incidence of epilepsy was 23.6 incident cases per 1000 person years (95% confidence interval: 21.3, 26.2) in autistic adults with intellectual disability, 7.7 incident cases per 1000 person years (95% confidence interval: 6.6, 8.9) in autistic adults without intellectual disability, and 15.9 incident cases per 1000 person years (95% confidence interval: 15.2, 16.7) in adults with intellectual disability alone. Female sex and intellectual disability were associated with increased risk of prevalent and incident epilepsy in autistic adults. Findings underscore the importance of treating prevalent epilepsy and screening and preventing incident epilepsy in autistic adults as they age. Lay abstract Epilepsy is more common in autistic children compared to children without autism, but we do not have good estimates of how many autistic adults have epilepsy. We used data from a full population of 7513 autistic adults who received Medicaid in Wisconsin to figure out the proportion of autistic adults who have epilepsy, as compared to 18,429 adults with intellectual disability. We also wanted to assess how often epilepsy is first diagnosed in adulthood. Finally, we wanted to see whether antiepileptic drugs are being used to treat epilepsy in autistic adults. We found that 34.6% of autistic adults with intellectual disability and 11.1% of autistic adults without intellectual disability had epilepsy, compared to 27.0% of adults with intellectual disability alone. Autistic women and autistic adults with intellectual disability were more likely than autistic men and autistic adults without intellectual disability to have both previous and new diagnoses of epilepsy. Finally, we found that antiepileptic medications are commonly prescribed to autistic people who do not have epilepsy potentially to treat mental health conditions or behavior problems, and that antiepileptic medications are not always prescribed to autistic people with epilepsy even though they are indicated as a first-line epilepsy treatment. The findings of this study highlight the need to effectively treat and prevent epilepsy in autistic adults.

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