This study captured the experiences of 35 autistic adolescents and their parents after completing a 16-session variant of social skills group training KONTAKT® (ACTRN12617001117303). Semi-structured interviews explored participants' and relatives' perceptions of KONTAKT® and associated social outcomes. Adolescents were classified as either high (HR, n = 23) or low (LR, n = 12) responders based on the primary outcome effects during the previous trial. Thematic analysis revealed that both HR and LR participants their parents were satisfied with KONTAKT®, noting consistent patterns of improvement in adolescents' social understanding, communication, relationships, and empowerment, although positive reports were more frequent among HR than LR groups. This study enhances the understanding of the impact of SSGT, which is key in improving their content, principles, and administration.

A systematic review and meta-analysis were utilised to explore the methodological quality, program fidelity, and efficacy of social skills group programs (SSGPs) aiming to support autistic adolescents in navigating their everyday social worlds. The study evaluated the methodological quality and theoretical fidelity of studies, with a random effect meta-analysis conducted to summarise the overall efficacy of SSGP and its effect on social communication and interaction, behavioural/emotional challenges, adaptive functioning, and autism characteristics. Although findings from the 18 identified studies indicated an adjusted medium overall effect with these programs successfully supporting autistic adolescents’ socialisation needs (g = 0. 60, p < 0.001), most studies demonstrated medium to low program fidelity despite their good methodological quality. Given the significant heterogeneity of SSGPs and variations in the design and measurement frameworks of efficacy studies, understanding the generalisability of the findings of this research is unclear.

While there is a large body of evidence drawn from randomised controlled trials supporting the efficacy of SSGT in autistic adolescents, the control arms of these studies are almost exclusively treated either as usual or waitlist. Addressing this limitation, 90 verbal autistic adolescents (70% male) aged 12-17 years (M = 13.77, SD = 1.6) with IQ > 70 participated in this pragmatic two-armed randomised controlled trial design study evaluating the efficacy of sixteen 90-min sessions of SSGT KONTAKT (R) (n = 46) in comparison to a manualised interactive group cooking programme (n = 44) of equal dosage controlling for the potentially confounding effects of exposure to a social group context. The primary outcome was the adolescents' progress towards achieving their personally meaningful social goals at follow-up. Secondary outcomes were changes in autistic traits, quality of life, facial emotion recognition skills, social anxiety, and loneliness. Assessments were conducted at baseline, post intervention and 12-week follow-up. The interaction between time point and group allocation was investigated through a random-effects regression model (linear mixed model) to examine changes in the dependent outcomes. While intention-to-treat analysis (N = 90) demonstrated that both SSGT (ES = 1.36, p < .001) and active control (ES = 1.10, p < .001) groups made progress towards their personally meaningful social goals at follow-up, KONTAKT (R) participants demonstrated greater progress in social goal attainment than their peers in the active control group (ES = 0.35, p = .04). Findings suggest that KONTAKT (R) is efficacious in supporting autistic adolescents to achieve their personally meaningful social goals compared to other prosocial group activities.

This study investigated the feasibility and cultural validity of KONTAKT©, a manualised social skills group training, in improving the social functioning of adolescents with autism spectrum disorder (ASD). KONTAKT© was delivered to 17 adolescents (m_age = 14.09, SD_age = 1.43; 70% male) with ASD over sixteen 90 min sessions. A pre-test post-test design evaluated changes in personally meaningful social goals, symptom severity, quality of life, interpersonal efficacy, social anxiety, loneliness, and facial emotion recognition at pre, post and 3 months follow-up. Focus groups were conducted post intervention. Findings indicate that KONTAKT© may support Australian adolescents with ASD in achieving their personally meaningful social goals. This study resulted in finalisation of KONTAKT© in preparation for evaluation of its efficacy in a randomised controlled trial (Australian New Zealand Clinical Registry (ANZCTR): ACTRN12617001117303, ClinicalTrials.gov: NCT03294668).

BACKGROUND:

Individuals diagnosed with autism spectrum disorder (ASD) experience impairing challenges in social communication and interaction across multiple contexts. While social skills group training (SSGT) has shown moderate effects on various sociability outcomes in ASD, there is a need for (1) replication of effects in additional clinical and cultural contexts, (2) designs that employ active control groups, (3) calculation of health economic benefits, (4) identification of the optimal training duration, and (5) measurement of individual goals and quality of life outcomes.

METHOD/DESIGN:

With the aim of investigating the efficacy and cost-effectiveness of a SSGT, KONTAKT©, a two-armed randomized control trial with adolescents aged 12-17 years (N = 90) with ASD and an intelligence quotient (IQ) of over 70 will be undertaken. Following stratification for centre and gender, participants will be randomly assigned to either KONTAKT© or to an active control group, a group-based cooking programme. Participants will attend both programmes in groups of 6-8 adolescents, over 16 one-and-a-half-hour sessions. The primary outcome examined is adolescent self-rated achievement of personally meaningful social goals as assessed via the Goal Attainment Scaling during an interview with a blinded clinician. Secondary outcomes include adolescent self-reported interpersonal efficacy, quality of life, social anxiety, loneliness, face emotion recognition performance and associated gaze behaviour, and parent proxy reports of autistic traits, quality of life, social functioning, and emotion recognition and expression. Cost-effectiveness will be investigated in relation to direct and indirect societal and healthcare costs.

DISCUSSION:

The primary outcomes of this study will be evidenced in the anticipated achievement of adolescents' personally meaningful social goals following participation in KONTAKT© as compared to the active control group. This design will enable rigorous evaluation of the efficacy of KONTAKT©, exercising control over the possibly confounding effect of exposure to a social context of peers with a diagnosis of ASD.

TRIAL REGISTRATION:

Australian New Zealand Clinical Trials Registry (ANZCTR). ACTRN12617001117303. Registered on 31 July 2017. anzctr.org.au ClinicalTrials.gov, NCT03294668. Registered on 22 September 2017. https://clinicaltrials.gov.

Recently, there has been heightened interest in suggestions of enhanced visual acuity in autism spectrum disorders (ASD) which was sparked by evidence that was later accepted to be methodologically flawed. However, a recent study that claimed children with ASD have enhanced visual acuity (Brosnan et al. in J Autism Dev Disord 42:2491–2497, 2012) repeated a critical methodological flaw by using an inappropriate viewing distance for a computerised acuity test, placing the findings in doubt. We examined visual acuity in 31 children with ASD and 33 controls using the 2 m 2000 Series Revised Early Treatment Diabetic Retinopathy Study chart placed at twice the conventional distance to better evaluate possible enhanced acuity. Children with ASD did not demonstrate superior acuity. The current findings strengthen the argument that reports of enhanced acuity in ASD are due to methodological flaws and challenges the reported association between visual acuity and systemising type behaviours.

Background: Little is known about whether individuals with autism spectrum disorder (ASD) or attention deficit hyperactive disorder (ADHD) experience any specific facilitators or barriers to driving education.

Objective: To explore the facilitators or barriers to driving education experienced by individuals with ASD or ADHD who obtained a learner’s permit, from the perspective of the learner drivers and their driving instructors.

Methods: Data were collected from 33 participants with ASD or ADHD, and nine of their driving instructors.

Results: Participants with ASD required twice as many driving lessons and more on-road tests than those with ADHD. Participants with ADHD repeated the written tests more than those with ASD. Driving license theory was more challenging for individuals with ADHD, whilst individuals with ASD found translating theory into practice and adjusting to “unfamiliar” driving situations to be the greatest challenges.

Conclusion: Obtaining a driving license was associated with stressful training experience.

PURPOSE: There is a significant knowledge gap regarding the lives of adults on the autism spectrum. Some literature suggests significant health and mental health inequalities for autistic adults, yet there is a lack of comprehensive longitudinal studies exploring risk factors. Further, most research does not include the perspective of autistic adults in its conduct or design. Here, we describe the baseline characteristics and inclusive research approach of a nationwide longitudinal study. ​

PARTICIPANTS: The Autism Cooperative Research Centre for Living with Autism's Australian Longitudinal Study of Adults with Autism (ALSAA) is a questionnaire-based longitudinal study of autistic adults (25+ years old) with follow-up at 2-year intervals. Autistic advisors were involved in each stage of research apart from data analysis. Three questionnaires were developed: self-report, informant report (ie, proxy report) and carers (ie, carer experiences and characteristics). ​

FINDINGS TO DATE: An inclusive research protocol was developed and agreed with autistic advisors. Baseline data were collected from 295 autistic adults (M=41.8 years, SD=12.0) including 42 informant responses, 146 comparison participants and 102 carers. The majority of autistic participants (90%) had been diagnosed in adulthood (M=35.3 years, SD=15.1). When compared with controls, autistic adults scored higher on self-report measures of current depression and anxiety. Participant comments informed ongoing data gathering. Participants commented on questionnaire length, difficulty with literal interpretation of forced response items and expressed gratitude for research in this area.

​FUTURE PLANS: A large comprehensive dataset relating to autistic adults and their carers has been gathered, creating a good platform for longitudinal follow-up repeat surveys and collaborative research. Several outputs are in development, with focus on health service barriers and usage, caregivers, impact of diagnosis in adulthood, further scale validations, longitudinal analyses of loneliness, suicidal ideation, mental illness risk factors and other areas. Baseline data confirm poorer mental health of autistic adults. The ALSAA demonstrates a working approach to inclusive research.

While behavioural difficulties in facial emotion recognition (FER) have been observed in individuals with Autism Spectrum Disorder (ASD), behavioural studies alone are not suited to elucidate the specific nature of FER challenges in ASD. Eye tracking (ET) and electroencephalography (EEG) provide insights in to the attentional and neurological correlates of performance, and may therefore provide insight in to the mechanisms underpinning FER in ASD. Given that these processes develop over the course of the developmental trajectory, there is a need to synthesise findings in regard to the developmental stages to determine how the maturation of these systems may impact FER in ASD. We conducted a systematic review of fifty-four studies investigating ET or EEG meeting inclusion criteria. Findings indicate divergence of visual processing pathways in individuals with ASD. Altered function of the social brain in ASD impacts the processing of facial emotion across the developmental trajectory, resulting in observable differences in ET and EEG outcomes. 

Employment rates for autistic individuals are poor, even compared to those from other disability groups. Internationally, there remains limited understanding of the factors influencing employment across the stages of preparing for, gaining, and maintaining employment. This is the third in a series of studies conducted as part of an International Society for Autism Research (INSAR) policy brief intended to improve employment outcomes for autistic individuals. A multi-informant international survey with five key stakeholder groups, including autistic individuals, their families, employers, service providers, and researchers, was undertaken in Australia, Sweden, and the United States to understand the facilitators and barriers to employment for autistic adults. A total of 687 individuals participated, including autistic individuals (n = 246), family members (n = 233), employers (n = 35), clinicians/service providers (n = 123), and researchers (n = 50). Perceptions of the facilitators and barriers to employment differed significantly across both key stakeholder groups and countries, however, ensuring a good job match and focusing on strengths were identified by all groups as important for success. Key barriers to employment included stigma, a lack of understanding of autism spectrum disorder (ASD) and communication difficulties. Results suggest that a holistic approach to employment for autistic individuals is required, aimed at facilitating communication between key stakeholders, addressing attitudes and understanding of ASD in the workplace, using strength-based approaches and providing early work experience. LAY SUMMARY: Autistic individuals experience significant difficulty getting and keeping a job. This article presents a survey study involving autistic individuals, their families, employers, service providers and researchers in Australia, Sweden, and the United States to understand their perspectives on the factors that support or act as barriers to employment. While perspectives varied across key stakeholders, strategies such as using a holistic approach, targeting workplace attitudes and understanding, focusing on strengths, and providing early work experience are important for success. 

Despite efforts to improve employment outcomes for autistic individuals, internationally their employment rates remain low. There is a need to better understand the factors influencing successful employment for autistic adults in the labor market from the perspectives of multiple keystakeholders. This study represents the second in a series of papers conducted as part of an International Society for Autism Research policy brief aimed at improving employment outcomes for autistic individuals. A community consultation methodology using focus groups, forums, and interviews was applied with autistic individuals (n = 19), family members (n = 18), service providers (n = 21), employers (n = 11), researchers (n = 5), and advocacy group representatives (n = 5) in Australia, Sweden, and the United States, aiming to identify the factors perceived to determine gaining and maintaining employment for autistic individuals. Directed content analysis, guided by the International Classification of Functioning, Disability and Health (ICF), was conducted to investigate the key factors influencing employment outcomes for autistic individuals. Meaningful verbal concepts, or units of text with common themes, were also derived from the qualitative data and then linked and compared to the ICF Autism Spectrum Disorder (ASD) Core-sets. Across countries, activity and participation and environmental factor categories of the ICF were the most associated with employment outcomes. Results suggest that removal of environmental barriers and enhancing environmental facilitators may assist to remediate ASD-related difficulties in the workplace.

LAY SUMMARY: This study sought to understand the perspectives of autistic individuals and key stakeholders on factors influencing if autistic adults get and keep jobs. Across Australia, Sweden, and the UnitedStates, focus groups and interviews were conducted to understand international perspectives on what helps and hinders getting and keeping a job for autistic individuals. The environment, including supports, relationships, attitudes, and services, were perceived to be the most important for workplace success. Intervention targeting barriers and facilitators in the workplace environment may support autistic adults to be successful in the labor market.

Background: Atypical visual perception in individuals with Autism Spectrum Disorders (ASD) may contribute to superiority in disembedding tasks. Gaze behavior has provided some insights in to mechanisms underlying this purported superiority in children, however evidence is limited and requires additional investigation.

Method: The performance and gaze behavior of 27 adolescents with ASD and 27 matched typically developing (TD) peers were examined during the Figure Ground Subtest of the Test of Visual Perception Skills-third edition (TVPS-3).

Results: Compared to their TD counterparts, adolescents with ASD were no different in accuracy, however, had a longer response time. Differences in gaze behavior were also observed, characterized by adolescents with ASD spending less time viewing the incorrect and target figures, and spending a greater proportion of time viewing irrelevant areas of the stimuli compared to TD adolescents.

Conclusions: Results suggest that while altered visual perception was observed, this did not contribute to superiority in disembedding tasks in adolescents with ASD. Future research is required to elucidate conditions under which altered visual perception may contribute to behavioral superiority. 

Shared zones are a contemporary traffic zone that promotes equality between multiple road users and efficiently utilizes available space, while simultaneously maintaining safety and function. As this is a relatively new traffic zone, it is important to understand how pedestrians navigate a shared zone and any potential challenges this may pose to individuals with impairments. The aim of this study was to utilize eye-tracking technology to determine fixations and fixation duration on traffic relevant objects, non-traffic relevant objects, and eye contact, in 40 individuals with and without Autism Spectrum Disorder (ASD) in a shared zone and a zebra crossing. It was assumed that individuals with ASD would make less eye contact in the shared zone compared to the group of typically developing adults. A total of 3287 fixations across the shared zone and zebra crossing were analysed for areas of interest that were traffic relevant, non-traffic relevant, and eye contact, and for fixation duration. Individuals with ASD did not display any difference in terms of eye contact in the shared zone and the zebra crossing when compared to the controls. All pedestrians were more likely to look at traffic relevant objects at the zebra crossing compared to the shared zone. Individuals with ASD had an overall shorter fixation duration compared to the control group, indicating people with ASD either process information quickly, or they do not process it for long enough, although these findings require further investigation. While shared zones have many benefits for traffic movement and environmental quality, it appeared that pedestrians displayed safer road crossing behaviours at a zebra crossing than in a shared zone, indicating that more education and environmental adaptations are required to make shared zones safe for all pedestrians. 

Background: The clinical process for being evaluated for an autism diagnosis is often time consuming and stressful for individuals and their caregivers. While experience of and satisfaction with the diagnostic process has been reviewed in the literature, few studies have directly investigated the viewpoints of individuals diagnosed with autism and caregivers of autistic individuals about what is important in the autism diagnostic process.

Method: A Q methodological design was employed to capture the subjective viewpoints about the diagnostic process of individuals on the autism spectrum and caregivers of autistic individuals. Thirty-eight participants responded to a set of 66 statements representing different aspects of the autism diagnostic process.

Results: The analysis identified three significant viewpoints: Get it Right, Make it Easy, and See it All. Participants reflected upon the importance of a comprehensive diagnostic assessment process, ease of diagnostic processes, and a holistic approach to autism diagnosis for autistic individuals and caregivers of autistic individuals.

Conclusions: The findings provide a consumer perspective that encourages reform of the current process for diagnosing autism in Australia, and an insight into what consumers are wanting from diagnostic services. This information is useful for policy-makers and service providers to create a more supportive and client-centred diagnostic process at all levels of service delivery.

Employment outcomes for individuals with autism spectrum disorder (ASD) are poor and there is limited understanding on how best to support individuals with ASD in the workplace. Stakeholders involved in the employment of adults with ASD, including employers and employment service providers have unique insights into the factors influencing employment for this population. Organisational and individual factors facilitating successful employment for adults with ASD across Australia and Sweden were explored, including the supports and strategies underpinning employment success from an employers' perspective. Three themes including Knowledge and Understanding of ASD, Work Environment and Job Match emerged, suggesting that a holistic approach was key to supporting success, with employer knowledge and understanding of ASD underpinning their ability to facilitate employment.

Background

Shared zones are characterised by an absence of traditional markers that segregate the road and footpath. Negotiation of a shared zone relies on an individual’s ability to perceive, assess and respond to environmental cues. This ability may be impacted by impairments in cognitive processing, which may lead to individuals experiencing increased anxiety when negotiating a shared zone.

Method

Q method was used in order to identify and explore the viewpoints of pedestrians, with and without cognitive impairments as they pertain to shared zones.

Results

Two viewpoints were revealed. Viewpoint one was defined by “confident users” while viewpoint two was defined by users who “know what [they] are doing but drivers might not”.

Discussion

Overall, participants in the study would not avoid shared zones. Pedestrians with intellectual disability were, however, not well represented by either viewpoint, suggesting that shared zones may pose a potential barrier to participation for this group.

People with intellectual disability (ID) may find shared zones troublesome to negotiate because of the lack of the traditional clearly defined rules and boundaries. With the built environment identified as a barrier to active travel and community access, it is vital to explore how pedestrians with ID navigate shared zones to ensure that this group is not placed in harm's way or discouraged from active travel because of the implications of shared zones. This study investigated the visual strategies of 19 adults with ID and 21 controls who wore head mounted eye trackers in a Shared Zone and at a zebra crossing (as a contrast traffic environment). In total 4750 valid fixations were analysed. Participants with ID fixated on traffic relevant objects at a rate of 68 percent of the control participants. Furthermore, the males with ID were 9(4.4–18.7) times more likely to fixate on non-traffic relevant objects compared with traffic relevant objects, much higher odds than that of females with ID 1.8(0.4–1.7). Zebra crossings appeared to act as a cue, drawing pedestrians' visual attention to the traffic environment, with both groups more likely to look at traffic relevant objects on/at the zebra crossing (66%: 34%). Future implementation of shared zones needs to be carefully considered in relation to the safety of road users with ID and their capacity to identify and assess salient environmental information.

Increasingly, women simultaneously balance the roles of mother, parental carer and worker. However, individual role balance strategies among these working ‘sandwich’ generation women have not been thoroughly explored. Eighteen women combining these three roles were interviewed about their individual role balance strategies. Findings were identified through the framework analysis technique, underpinned by the Model of Juggling Occupations. Achieving and maintaining role balance was explained as a complex process accomplished through a range of strategies. Findings revealed the women used six within-role balance strategies: living with integrity, being the best you can, doing what you love, loving what you do, remembering why and searching for signs of success. The women also described six between-role balance strategies: maintaining health and wellbeing, repressing perfectionism, managing time and energy, releasing responsibility, nurturing social connection and reciprocating. These findings provide a basis for health care providers to understand and potentially support working ‘sandwich’ generation women.

Women combining paid employment with dual caring responsibilities for children and aging parents, otherwise known as the sandwich generation, experience both benefits and costs related to role participation and quality of life. However, previous literature is inconclusive regarding the impact of this role combination on role balance. In the context of these mixed findings on role balance for working sandwich generation women, this study aimed to explore how within role characteristics and between role interactions are related to role balance for these women. This aim was achieved through the use of a questionnaire administered to 18 Australian working sandwich generation women. Data were analyzed using descriptive statistics and correlation coefficients, with findings suggesting the women studied tended to experience neither role balance or role imbalance. Within-role characteristics, particularly within the mother and family member roles, were related to role balance. In addition, between-role conflict and role interactions involving either the home maintainer or family member roles had the greatest impact on role balance.

Children with Autism Spectrum Conditions (ASC) are included and thus expected to participate in mainstream schools. However, ASC are characterized by poor communication and difficulties in understanding social information; factors likely to have negative influences on participation. Hence, this thesis studied body functions hypothesized to affect social interaction and both perceived and observed participation of students with ASC in mainstream schools.

Case-control studies were conducted to explore visual strategies used for face identification and required for recognition of facially expressed emotions in adults with ASC. Consistency of these visual strategies was tested in static and interactive dynamic conditions. A systematic review of the literature explored parents’ perceptions of factors contributing to inclusive school settings for their children with ASC. Questionnaires were used to investigate perceived participation in students with ASC and their classmates. Correlations between activities the students wanted to do and reported to participate in were identified. Teachers’ accuracy in rating their students with ASCs’ perception of participation was investigated. Furthermore, correlations between the accuracy of teachers’ ratings and the teachers’ self-reported professional experience, support and personal interest were examined. Correlations between teachers’ ratings and their reported classroom actions were also analysed. The frequency and level of engagement in social interactions of students with ASC and their classmates were also observed. Correlations between observed frequencies and self-rated levels of social interactions were explored.

The International Classification of Functioning, Disability and Health-Version for Children and Youth (ICF-CY) has been used as a structural framework, since ICF-CY enables complex information to be ordered and possible interactions between aspects in different components and factors to be identified. In regard to Body Functioning, difficulties identifying faces and recognizing basic facially expressed emotions in adults with ASC were established. The visual strategies displayed a high stability across stimuli conditions. Teachers’ knowledge about their students with ASC, in addition to their ability to implement ASCspecific teaching strategies, was emphasized as enhancing Environmental Factors for participation. Students with ASC reported less participation and fewer social interactions than their classmates, which could be interpreted as activity limitations and participation restrictions. However, in regard to some activities, they may have participated to the extent they wanted to. Compared with classmates, observations of students with ASC showed that they participated less frequently in social interactions, but were not less involved when they actually did. No correlations were found between perceived participation and observed social interactions in students with ASC.

Teachers rated their students with ASCs’ perceived participation with good precision. Their understanding of the students with ASCs’ perception correlated with activities to improve the attitudes of classmates and adaptation of tasks. No such correlations were found in regard to reported activities aimed at enhancing social relations.

The ability to process faces is usually well established in adults. Poor face processing can impact social functioning and the difficulties in face processing found in adults with ASC are probably the result of

developmental deviations during childhood. Therefore, monitoring and assessing face processing abilities in students with ASC is important, in order to tailor interventions that aim to enhance participation in the social environment of mainstream schools.

Since participation is a complex construct, interventions need to be complex, as well. In order to facilitate positive peer relations, teachers need to provide Activities adapted to the interests and social abilities of the students with ASC, and in which students with and without ASC can experience positive interactions. This requires that teachers assess all aspects that can affect Participation, including Environmental Factors, and the student’s functioning in regard to Activities and Body Functions. To enhance social interactions, interventions must be planned based on these assessments. If needed, interventions may require teaching students with ASC visual strategies, in order to enhance face processing and thereby the ability to recognize faces and facially expressed emotions. Observations together with self-reported information regarding the students’ preferences and their involvement constitute a basis for the planning and evaluating of such interventions. To include self-determination aspects could allow for possible interventions to be tailored in line with the students’ perceived needs and their own wishes, rather than primarily meeting a standard set by a control group. However, good insight into the students’ perception of Participation may not be enough. In order to adapt teaching instructions, communication and activities teachers also need ASC specific knowledge.

Children with autism spectrum conditions (ASC) increasingly participate in inclusive education. The present study reviewed studies of children with ASC for parents’ perceptions of aspects they believed contributed to inclusive mainstream school settings. Understanding the parental perspective on the facilitators for inclusion of their child with ASC in mainstream schools is likely to improve inclusive practice. Twenty-eight empirical articles revealed that parents perceived teachers as playing a vital role in the inclusion of their children with ASC. The school was considered important in creating an environment that enabled inclusion, particularly through positive peer relations, prevention of bullying and help from support staff. At the societal level, funding and legislative policies were considered important. By understanding these aspects, policy-makers, teachers, school administrators and therapists may better be able to address parents’ inclusion concerns and thereby develop strategies to improve inclusion in mainstream schools.

Several studies, using eye tracking methodology, suggest that different visual strategies in persons with autism spectrum conditions, compared with controls, are applied when viewing facial stimuli. Most eye tracking studies are, however, made in laboratory settings with either static (photos) or non-interactive dynamic stimuli, such as video clips. Whether or not these results are transferable to a “real world” dialogue situation remains unclear. In order to examine the consistency of visual strategies across conditions, a comparison of two static conditions and an interactive dynamic “real world” condition, in 15 adults with Asperger syndrome and 15 matched controls, was made using an eye tracker. The static stimuli consisted of colour photos of faces, while a dialogue between the participants and the test leader created the interactive dynamic condition. A within-group comparison showed that people with AS, and their matched controls, displayed a high degree of stability in visual strategies when viewing faces, regardless of the facial stimuli being static or real, as in the interactive dynamic condition. The consistency in visual strategies within the participants suggests that results from studies with static facial stimuli provide important information on individual visual strategies that may be generalized to “real world” situations.

Can the disadvantages persons with Asperger syndrome frequently experience with reading facially expressed emotions be attributed to a different visual perception, affecting their scanning patterns? Visual search strategies, particularly regarding the importance of information from the eye area, and the ability to recognise facially expressed emotions were compared between 24 adults with Asperger syndrome and their matched controls. While wearing a head mounted eye tracker, the participants viewed 12 pairs of photos of faces. The first photo in each pair was cut up into puzzle pieces. Six of the 12 puzzle pieced photos had the eyes bisected. The second photo showed a happy, an angry and a surprised face of the same person as in the puzzle pieced photo. Differences in visual search strategies between the groups were established. Adults with Asperger syndrome had greater difficulties recognizing these basic emotions than controls. The distortion of the eye area affected the ability to identify emotions even more negatively for participants with Asperger syndrome.

Objective: While local bias in visual processing in children with autism spectrum disorders (ASD) has been reported to result in difficulties in recognizing faces and facially expressed emotions, but superior ability in disembedding figures, associations between these abilities within a group of children with and without ASD have not been explored.

Methods: Possible associations in performance on the Visual Perception Skills Figure–Ground test, a face recognition test and an emotion recognition test were investigated within 25 8–12-years-old children with high-functioning autism/Asperger syndrome, and in comparison to 33 typically developing children.

Results: Analyses indicated a weak positive correlation between accuracy in Figure–Ground recognition and emotion recognition. No other correlation estimates were significant.

Conclusion: These findings challenge both the enhanced perceptual function hypothesis and the weak central coherence hypothesis, and accentuate the importance of further scrutinizing the existance and nature of local visual bias in ASD.

Objectives: To examine perceived participation in students with ASC and their classmates in mainstream schools and to investigate correlations between activities the students wanted to do and actually participated in.

Methods: Twenty-two students with ASC and their 382 classmates responded to a 46-item questionnaire regarding perceived participation in mainstream schools.

Results: On 57% of the items, students with ASC perceived lower participation than their classmates. These results emphasize the importance of knowledge about students’ perceived participation. However, positive correlations between what the students wanted to do and actually did indicate that students with ASC may be participating to the extent that they wanted.

Conclusion: Students with ASC perceived lower overall participation in mainstream school than their classmates. The correlations between “I want to” and “I do” statements in students with ASC indicated that aspects of autonomy are important to incorporate when studying, and interpreting, self-rated participation in mainstream schools.

Partly claimed to explain social difficulties observed in people with Asperger syndrome, face identification and visual search strategies become important. Previous research findings are, however, disparate. In order to explore face identification abilities and visual search strategies, with special focus on the importance of the eye area, 24 adults with Asperger syndrome and matched controls viewed puzzle pieced photos of faces, in order to identify them as one of three intact photos of persons. Every second puzzle pieced photo had the eyes distorted. Fixation patterns were measured by an eye tracker. Adults with Asperger syndrome had greater difficulties in identifying faces than controls. However, the entire face identification superiority in controls was found in the condition when the eyes were distorted supporting that adults with Aspergers syndrome do use the eye region to a great extent in face identification. The visual search strategies in controls were more effective and relied on the use of the ‘face information triangle’, i.e. the two eyes and the mouth, while adults with Asperger syndrome had more fixations on other parts of the face, both when obtaining information and during the identification part, suggesting a less effective use of the ‘face information triangle’.

To create an inclusive classroom and act accordingly, teachers’ understanding of the experiences of participation of students with autism spectrum conditions (ASCs) is crucial. This understanding may depend on the teachers’ professional experiences, support and personal interests. The aim of the present questionnaire study was to investigate how well the teachers’ ratings of their students with ASCs’ perception of participation matched with the students’ own ratings. Furthermore, possible correlations between the accuracy of teachers’ ratings and the teachers’ self-reported professional experience, support (including support-staff), and personal interest were investigated. Teachers’ ratings were also used to examine how their understandings correlated with classroom actions. The agreements between teachers’ and students’ ratings were moderate to high, and the ability to attune to the students’ perception of participation was not affected by the presence of a support-staff. The teachers’ personal interest in teaching students with ASC correlated with their accuracy, suggesting that this is a factor to consider when planning for successful placements in mainstream schools. Teachers’ understandings of the students with ASCs’ perception of being bullied or unpopular correlated with implementation of activities to improve the attitudes of classmates, but not with actions to enhance social relations for the students with ASC.

Background: Autism spectrum conditions (ASC) are defined by criteria comprising impairments in social interaction and communication. Altered visual perception is one possible and often discussed cause of difficulties in social interaction and social communication. Recently, Ashwin et al. suggested that enhanced ability in local visual processing in ASC was due to superior visual acuity, but that study has been the subject of methodological criticism, placing the findings in doubt.

Methods: The present study investigated visual acuity thresholds in 24 adults with Asperger’s syndrome and compared their results with 25 control subjects with the 2 Meter 2000 Series Revised ETDRS Chart.

Results: The distribution of visual acuities within the two groups was highly similar, and none of the participants had superior visual acuity.

Conclusions: Superior visual acuity in individuals with Asperger’s syndrome could not be established, suggesting that differences in visual perception in ASC are not explained by this factor. A continued search for explanations of superior ability in local visual processing in persons with ASC is therefore warranted.

This article reports on the lived experiences of 11 adolescents who have a brother or a sister with a diagnosis of autism spectrum condition. Through semistructured, in-depth, in-person interviews, these adolescents shared their experiences and perceptions. These exploratory findings can be used to inform the practice of social workers and other health professionals, and future research. Implications for practice focus on the importance of exploring experiences and perceptions of siblings of children diagnosed with autism spectrum condition to enhance support services for these siblings.

Adolescents on the autism spectrum often have difficulties with the transition from high school to post-school activities. Despite this, little is known about the transition planning processes for this group. This study explored predisposing, reinforcing and enabling factors related to the transition planning processes for adolescents on the autism spectrum in Australia. The PRECEDE model guided a needs assessment, in which descriptive data about transition planning processes were collected via an online questionnaire from adolescents on the autism spectrum, their parents and professionals (N = 162). Predisposing factors included: an individualised and strengths-focused approach, and adolescent motivation, anxiety and insight. Reinforcing factors included: support and guidance, skill development and real-life experiences. Enabling factors were: having a clear plan with a coordinated approach, scheduled meetings and clear formal documentation. Whilst some factors aligned with recommendations for transition planning for adolescents with disabilities in general, there were some autism-specific factors. For example: anxiety, motivation and insight were important predisposing factors, and providing choice and flexibility was an enabling factor.

Background: The majority of existing transition planning programs are focused on people with a disability in general and may not meet the specific need of adolescents on the autism spectrum. In addition, these interventions focus on specific skills (e.g. job readiness or self-determination) rather than the overall transition planning process and there are methodological limitations to many of the studies determining their effectiveness. The Better OutcOmes & Successful Transitions for Autism (BOOST-A (TM)) is an online program that supports adolescents on the autism spectrum to prepare for leaving school. This study aimed to determine the effectiveness of the BOOST-A T in enhancing self-determination. 

Methods: A quasi-randomized controlled trial was conducted with adolescents on the autism spectrum enrolled in years 8 to 11 in Australian schools (N = 94). Participants had to have basic computer skills and the ability to write at a year 5 reading level. Participants were allocated to a control (n = 45) or intervention (n = 49) group and participants were blinded to the trial hypothesis. The intervention group used the BOOST-A T for 12 months, while the control group participated in regular practice. Outcomes included self-determination, career planning and exploration, quality of life, environmental support and domain specific self-determination. Data were collected from parents and adolescents. 

Results: There were no significant differences in overall self-determination between groups. Results indicated significant differences in favor of the intervention group in three areas: opportunity for self-determination at home as reported by parents; career exploration as reported by parents and adolescents; and transition-specific self-determination as reported by parents. 

Conclusions: Results provide preliminary evidence that the BOOST-A T can enhance some career-readiness outcomes. Lack of significant outcomes related to self-determination at school and career planning may be due to the lack of face-to-face training and parents being the primary contacts in the study. Further research is needed to determine effectiveness of the BOOST-A T related to post-secondary education and employment.

BACKGROUND: The transition from high school to post-secondary education and work is difficult for adolescents on the autism spectrum. Transition planning can be an effective way of supporting adolescents on the autism spectrum to prepare for leaving school and to succeed in obtaining employment; however, there is a need for an autism-specific transition planning program with proven effectiveness. This paper describes a trial protocol for evaluating the Better OutcOmes & Successful Transitions for Autism (BOOST-A™); an online interactive program that empowers adolescents on the autism spectrum to plan their transition from school to further study, training, or employment.

METHODS: The trial will involve adolescents on the autism spectrum in high school and their parents, who will be alternately assigned to a control group (regular practice) or an intervention group (using the BOOST-A™). The BOOST-A™ was developed using the PRECEDE-PROCEED model, and is based on the self-determination model, and the strengths- and technology-based approaches. It involves participants completing a series of online modules. The primary outcome will be self-determination, because high self-determination has been linked to successful transition to employment among adolescents on the autism spectrum. Secondary outcomes will include domain-specific self-determination, career planning and exploration, quality of life, and environmental support. Data will be obtained from questionnaires completed by the adolescent on the autism spectrum and their parent/s. Data collection will take place at baseline (Time point 1) and 12 months later (Time point 2).

DISCUSSION AND CONCLUSIONS: This trial will provide evidence of the effectiveness of the BOOST-A™ to assist adolescents on the autism spectrum to successfully transition from school. 

A process evaluation was conducted to determine the effectiveness, usability, and barriers and facilitators related to the Better OutcOmes & Successful Transitions for Autism (BOOST-A (TM)), an online transition planning program. Adolescents on the autism spectrum (n = 33) and their parents (n = 39) provided feedback via an online questionnaire. Of these, 13 participants were interviewed to gain in-depth information about their experiences. Data were analyzed using descriptive statistics and thematic analysis. Four themes were identified: (i) taking action to overcome inertia, (ii) new insights that led to clear plans for the future, (iii) adolescent empowerment through strengths focus, and (iv) having a champion to guide the way. The process evaluation revealed why BOOST-A (TM) was beneficial to some participants more than others. 

Background: Many adolescents with autism face difficulties with the transition from high school into post-school activities. The Better OutcOmes & Successful Transitions for Autism (BOOST-A™) is an online transition planning program which supports adolescents on the autism spectrum to prepare for leaving school. This study describes the development of the BOOST-A™ and aimed to determine the feasibility and viability of the program.

Methods: Two pilot studies were conducted. In Pilot A, the BOOST-A™ was trialled by six adolescents on the autism spectrum, their parents, and the professionals who worked with them, to determine its feasibility. In Pilot B, 88 allied health professionals (occupational therapists, speech pathologists, and psychologists) reviewed the BOOST-A™ to determine its viability.

Results: Participants rated the BOOST-A™ as a feasible tool for transition planning. The majority of allied health professionals agreed that it was a viable program. Based on participant feedback, the BOOST-A™ was modified to improve usability and feasibility.

Conclusion: The BOOST-A™ is a viable and feasible program that has the potential to assist adolescents with autism in preparing for transitioning out of high school. Future research will determine the effectiveness of the BOOST-A™ with adolescents across Australia. 

Strength-based technology clubs are thought to help autistic adolescents transition to adulthood by developing positive traits, enhancing technical skills, and creating supportive networks. A newly developed strength-based technology club was delivered to 25 autistic adolescents, with the feasibility tested via qualitative and quantitative methods. Autistic adolescents, their parents, and club facilitators participated in separate focus groups, with audio data transcribed and thematically analyzed. Quantitative data was collected via adolescent and parent-reported pretest-posttest measures following the 15-week program. Autistic adolescents were highly satisfied with the club (acceptability), the technology club satisfied an unmet need (demand), with the program demonstrating the potential to be integrated into the current therapy system in Australia (integration). Feasibility areas that could be improved in delivering future clubs are discussed.

Background: Strength-based technology clubs for adolescents with autism spectrum disorder (ASD) have become increasingly popular; however, they remain poorly described in the literature. Before the impact and benefit of strength-based technology clubs can be measured, consistency in their design and delivery must be established. This study aimed to identify the essential components of strength-based technology clubs by exploring context, mechanisms, and outcomes of existing strength-based technology clubs.

Method: Twenty-three adolescents with ASD (mean age 12.96 years, SD = 1.86, range = 10–18 years), 25 parents (mean age 46.08 years, SD = 8.27, range = 33–69 years), and 20 facilitators (mean age 27.93 years, SD = 6.55, range = 20–46 years) were purposively sampled from three established strength-based technology clubs. Data were obtained via ethnographic methods, including participant observations, interviews, and focus groups. Data analysis was underpinned by a realist evaluation, which provided the context-mechanism-outcome framework.

Results: Data analysis revealed that strength-based technology clubs had four context themes (personal factors of adolescents, personal factors of facilitators, personal factors of parents, institution), three mechanism themes (activity design, strengths and abilities, environment), and three outcome themes (skill building, connection with others, emotion).

Conclusion: The results highlighted the importance of understanding the personal context of adolescents, providing an individualized approach, leveraging individual interests, and modifying the environment to suit the individual. The findings contributed to defining a strength-based approach within ASD, and have demonstrated that positive outcomes can be achieved by focusing on strengths rather than deficits. Future ASD services can use the results as a framework for applying a strength-based approach. The efficacy of newly designed strength-based programs can then be tested.

Strength-based programs that incorporate technology have gained increasing popularity as an approach to improve outcomes for individuals with autism spectrum disorder (ASD). Despite this, the core elements of strength-based technology programs remain poorly described. This study aimed to identify the core elements of strength-based technology programs for youth with ASD through a systematic review of the literature. Electronic databases were searched for qualitative studies delivering strength-based technology-driven interventions to youth on the spectrum. Ten of the 874 studies identified met the criteria. Qualitative analysis revealed three core elements of strength-based technology programs for this population: mutual respect, demonstrating skills, and interests. The findings underpin the design of future strength-based technology programs for youth with ASD.

Autistic individuals experience poor vocational outcomes internationally. Transition planning and interventions during adolescence may assist in improving outcomes in adulthood. Strength-based technology clubs show promise in improving outcomes for autistic adolescents by developing skills specific to the Information and Communication Technology industry, and fostering positive traits, such as self-determination. Although strength-based technology clubs have been examined with autistic adolescents, to date, no framework has been proposed to underpin their design and delivery. In this conceptual analysis, we propose a practical framework for delivering strength-based technology clubs for autistic adolescents. The framework builds on work from a previous systematic review of qualitative research and a realist evaluation study of technology clubs for autistic adolescents, combined with theoretical understandings from three health models. The new framework comprised the components of interests, value, autonomy, and requirements, forming the acronym IVAR. Interests refer to strategies drawing on adolescents' areas of interest. Value represents a culture of valuing autistic adolescents as individuals for their unique strengths and skills. Autonomy refers to providing opportunities for adolescents to make decisions, and Requirements refers to aspects of the social and physical environment. Practical recommendations of the framework are discussed, including design and delivery of future strength-based technology clubs, facilitator training, and design activities. The proposed IVAR framework may be useful in guiding the development of strength-based technology clubs. Future research is needed to validate the feasibility and efficacy of the IVAR framework in underpinning the delivery of strength-based technology clubs to autistic adolescents.

Community brief

Why is this topic important?

The shift from adolescence to adulthood can be challenging for young people on the autism spectrum, and opportunities for employment may be limited. Modern approaches to improving employment outcomes for autistic youth highlight the importance of adopting a strength-based framework, such as matching the strengths and interests of autistic young people to future career pathways. The strengths of many autistic individuals are considered beneficial for employment in the Information and Communication Technology (ICT) sector. Strength-based technology clubs provide opportunities for autistic young people to develop their technological and social skills, meet role models working in the ICT industry, and help them to find work experience.

What was the purpose of this article?

The purpose of this article was to develop a new framework for delivering strength-based technology clubs to autistic adolescents. The development of this framework was guided by the authors' earlier work in this area.

What do the authors conclude?

The authors proposed a new framework for delivering strength-based technology clubs to autistic adolescents. The framework contains four components, creating the acronym IVAR: Interests, Value, Autonomy, and Requirements. The component, Interests, refers to strategies that draw on adolescents' areas of interest, such as changing activities to include adolescents' focused interests. Value represented a culture of valuing autistic adolescents as individuals for their unique strengths and skills. Autonomy refers to providing opportunities for adolescents to make decisions during the program, and Requirements refers to the design of the social and physical environment.

What do the authors recommend for future research on this topic?

The authors recommend that future research should focus on exploring how practical and appropriate the IVAR framework is in supporting the delivery of strength-based technology clubs for autistic adolescents. The four IVAR components are potentially applicable to other areas of community focus to guide strength-based approaches more generally within autism research.

How will this analysis help autistic adults now and in the future?

This analysis and discussion will provide researchers, autistic individuals, and the community with practical examples of how service providers can apply IVAR to design and deliver strength-based technology programs for autistic adolescents.

Objective: To examine visual search patterns and strategies used by children with and without Asperger syndrome/high functioning autism (AS/HFA) while watching a magic trick. Limited responsivity to gaze cues is hypothesised to contribute to social deficits in children with AS/HFA.

Methods: Twenty-one children with AS/HFA and 31 matched peers viewed a video of a gaze-cued magic trick twice. Between the viewings, they were informed about how the trick was performed. Participants’ eye movements were recorded using a head-mounted eye-tracker.

Results: Children with AS/HFA looked less frequently and had shorter fixation on the magician’s direct and averted gazes during both viewings and more frequently at not gaze-cued objects and on areas outside the magician’s face. After being informed of how the trick was conducted, both groups made fewer fixations on gaze-cued objects and direct gaze.

Conclusions: Information may enhance effective visual strategies in children with and without AS/HFA.

Purpose: Autistic adults reportedly experience poorer quality of life (QoL) than their non-autistic peers. However, many tools used to measure their QoL were not developed for autistic adults, but for the general population. It is possible that factors contributing to the QoL of autistic individuals could vary from that of the general population, meaning commonly used tools may inadequately capture the nuances of autistic QoL. It is, therefore, imperative that autistic QoL is comprehensively conceptualized from the perspective of autistic adults.Methods: We used a qualitative semi-structured interview methodology guided by an overarching coproduction approach to capture factors contributing to autistic QoL. A research team, including an autistic researcher and a steering group of five autistic adults, worked together throughout the entire research process. An additional autistic researcher provided consultation about how to authentically coproduce this research. Coproducing this research included the steering group and autistic researcher in developing the methodology, the interview guide, and the thematic analysis and naming of the themes. We interviewed 29 autistic adults aged 18-55 who lived in Australia.Results: Coproduced thematic analysis identified five themes: activities and routines; relationship supports and socialization; mind and body; personal experiences; and environment. Participants described how subthemes within each theme positively and/or negatively impacted their QoL. Examples of subthemes that may represent factors uniquely impacting QoL for autistic adults include understanding their self-identity, sensory experiences, and the impact of societal attitudes.Conclusion: While some elements identified by autistic adults also appear in non-autistic conceptualizations of QoL, the impact and importance of these factors may vary from non-autistic experiences. We also identified some factors that may uniquely impact QoL for autistic adults. Community Brief Why is this an important issue? Quality of life (QoL) is an important but underresearched outcome for autistic adults. Supports are often provided with the aim of improving QoL, but our understanding of QoL is based on understandings from non-autistic populations. The factors contributing to QoL in autistic adults might be different from non-autistic adults, and assessments used by health professionals to measure QoL may not accurately measure autistic QoL. Understanding the factors that support QoL for autistic adults is important for ensuring accurate assessment and for providing more effective support to enhance QoL for autistic individuals. What was the purpose of this study? This study wanted to understand what factors influence autistic adults' QoL. It is the first step toward understanding autistic QoL, which could inform the measurement of autistic QoL. What did the researchers do? The research involved in this study used a participatory approach, working with a steering group that included five autistic adults. An autistic researcher is also part of the research team, and a second autistic researcher provided advice about how to authentically coproduce the study. The steering group and research team developed an interview guide about QoL. We used it in interviews with 29 autistic adults aged 18-55 years. The research team and steering group analyzed the interviews to represent the perspectives of the participants. The research team and steering group developed the themes together. What were the results of the study? We identified five themes summarizing the factors that influence autistic QoL: activities and routines; relationships supports and socialization; mind and body; personal experiences; and environment. Participants described how subthemes within each theme positively and negatively impacted their QoL. Some subthemes include understanding their self-identity, sensory experiences, socialization, relationships, health, and the impact of societal attitudes. How do these findings add to what is already known? This research provides an in-depth understanding of the factors that influence autistic adults' QoL. Until now, there has been a limited understanding of these factors. What are the potential weaknesses of the study? The participants in this study were generally highly educated, and most were diagnosed in adulthood. Only one participant reported having an intellectual disability, and all participants communicated verbally. This could mean that the results do not represent all factors important to the QoL of those with an intellectual disability or who use other forms of communication. How will these findings help autistic people now and in the future? These findings highlight the factors that health professionals should consider when working with autistic adults to enhance their QoL. These results can also inform the development of better assessments to measure autistic QoL.

"Why are neurotypicals so pig-ignorant about autism?" an autistic person wrote on the Curtin Autism Research Group's on-line portal as a response to a call for research questions. Coproduced with an autistic researcher, knowledge about and attitudes towards autism were analysed from 1,054 completed surveys, representing the Australian neurotypical adult population. The majority, 81.5% of participants had a high level of knowledge and 81.3% of participants had a strong positive attitude towards autism. Neither age, nor education level had an impact on attitudes. However, attitudes were influenced by knowledge about 'Societal Views and Ideas'; 'What it Could be Like to Have Autism'; and the demographic variables 'Knowing and having spent time around someone with autism'; and gender (women having more positive attitudes than men). Thus, targeted interventions, geared more towards men than women, to increase knowledge about autism could further improve attitudes and increase acceptance of the autistic community.

Autistic individuals often possess strengths and abilities. Despite these strengths, employment outcomes for this population remain low. Strengths-based programs, focusing on developing skills in a supportive environment, may enable autistic adolescents to more effectively prepare for the workforce. This study explores the principal components and associated outcomes of a strengths-based program designed to support autistic children and adolescents to develop interests and skills in Science, Technology, Engineering, Arts, and Mathematics. The baseline results of 52 parents of autistic youth participating in a 3-year longitudinal survey study were explored, with results showing that according to parents the program positively impacted participants' sense of belonging, confidence and self-esteem, health and well-being, social relationships and interactions, and activities and participation.