Autism spectrum disorder is a complex condition associated with significant impairments in social communication and behavioral functioning. Diagnosis is dependent on clinician expertise, gathering of developmental history, and observation of specific behaviors. The suggested protocols include tools rendered invalid during the pandemic, which created significant barriers for diagnostic assessments. Furthermore, there are additional barriers in low-income countries in access to screening tools and standardized diagnostic tests for autism spectrum disorders that were only exacerbated during COVID-19. The Brief Observation of Symptoms of Autism instrument was developed to improve access to diagnostic assessment via telehealth during this time. The current study sought to validate the use of the Brief Observation of Symptoms of Autism within two Latin American countries. A sample of 313 children and adults from Argentina and Chile were examined. Results showed valid sensitivity and specificity scores with good fit across modules using two factors (i.e. Social Affect and Restricted, Repetitive Behaviors). Preliminary results of the current study demonstrated that the Brief Observation of Symptoms of Autism is a valid instrument for Latin American population and shows promise to be used beyond the pandemic to ease the diagnostic process. This is a collaborative work with BRINCAR Parent Association, who defined the need in our country to run the validation of Brief Observation of Symptoms of Autism and gave us support as the stakeholders at Lancet Commission.

Autistic youth generally use healthcare services more often than non-autistic youth. However, we know very little about the factors that can affect health service use and the types of services that are used, and this has not been explored in Aotearoa New Zealand. We analysed data from New Zealand to compare health service use among autistic and non-autistic youth (0 to 24-year-olds). Data were available for 19,479 autistic youth and 1,561,278 non-autistic youth. We compared hospitalizations, specialist visits, emergency department visits and use of different types of medications. In this study, autistic youth were found to have been hospitalized for medical and mental health reasons, more often than non-autistic youth. Autistic youth were also more likely to have attended specialist appointments and to have been given medication. These differences were particularly large for medications commonly used for mental health conditions (e.g. anxiety, depression, attention deficit hyperactivity disorder) or associated symptoms. Autistic youth who also had an intellectual disability were more likely to use healthcare services for physical health conditions, but were less likely to use mental health services, when compared with autistic youth who did not have an intellectual disability. These findings, along with other research, suggest that the healthcare needs of autistic youth are not always being met. Further work is needed to enhance our understanding of co-occurring conditions among autistic youth, including those that result in high rates of health service use, in order to inform the development of healthcare services and training for healthcare professionals to better cater to the needs of autistic youth.

Autistic children and adolescents may encounter difficulties at school, especially in mathematics, experiencing a pattern of negative feelings, distress, and concerns, which has been called mathematics anxiety. We asked 110 boys (50 autistic, 60 non-autistic) aged between 8 and 16 years old to report their feelings toward mathematics. Specifically, we asked them to fill in a questionnaire on their levels of mathematics anxiety at school and to report their emotional (valence, arousal) and cognitive (perception of competence, worries) responses before and after completing a mathematical task with time pressure. Mathematics anxiety might be an important factor to consider when assessing academic functioning of autistic children and adolescents, to understand whether it can interfere with their school success and well-being. In our sample, no significant group differences emerged for mathematics anxiety experienced at school. However, autistic children and adolescents performed worse in the timed math test than non-autistic peers. Regarding emotional and cognitive factors, lower valence, higher arousal, and higher worries were reported by the autistic participants compared with non-autistic peers. No group differences emerged for perception of competence. Teachers and clinicians should be aware that time pressure could be a negative factor in terms of proficiency and worries in autistic children and adolescents. Furthermore, it is essential to discourage the development of resignation toward academic learning and to improve positive feelings, self-esteem, and self-awareness for a more supportive learning environment.

In the United Kingdom, autistic adults struggle more to find jobs than non-autistic adults, which is a big concern to the government. To help more autistic people get jobs, hiring processes need to be better. By understanding what employers find challenging about hiring autistic people, we can come up with solutions to improve autistic people's employment chances. A survey of 1212 employers and employees who hire people was conducted to find out what affects employers' decisions to hire autistic people. Most people said they were open to hiring autistic applicants. This was particularly true for younger employers and men. People who had hired autistic people before were more likely to intend to do so again. However, key barriers to hiring were (1) not knowing enough about autism and (2) problems with how hiring is usually done in organisations. Employers also reported worrying about whether autistic employees would fit in at work, their productivity and the need for better training and changes to hiring methods. Our results indicate that it is important to educate employers about autism and make hiring practices more inclusive.

We do not know much about what support services people think are okay for young autistic children. This study was a survey of 253 people. We asked autistic adults, parents, and professionals from Australia and New Zealand whether they thought it was okay to provide support services to autistic children. About half the people who shared their thoughts said it was okay to provide support services to autistic children and the other half said it depended on what the support service was like. They had three main ideas about whether support services were okay or not. The first one is that we should remember that these autistic children are children first, so we need to keep their childhood experiences in mind and let them have a say in decisions. The second is that we should not try to 'fix' the child, but instead, use supports that respect and understand the unique ways the child thinks. The final idea is that early, personalised help is good for autistic children and can make a positive difference in their lives. This study suggests that we should focus on what each child needs, think about how children can join in, and provide help in ways that respect autistic children.

Racial and ethnic disparities in service utilization in autism are widely documented. Autism-related parental stigma may play a role if parents from racial/ethnic minoritized backgrounds experience dual stigma from autism and from membership in a marginalized group. This study examines racial/ethnic differences in autism-related stigma and compares the impact of stigma on service utilization in a large, diverse sample of US-based parents of autistic children (final sample = 764; White 41.6%, Black 16.6%, Latino/a/x/Hispanic 20.9%, Asian 7.5%, Multiracial 9.6%, Native American 1.8%, Pacific Islander 0.5%, Middle Eastern 0.2%, and Other 0.2%). Parents completed online surveys assessing affiliate and community stigma, service utilization, and perceived unmet treatment needs. Small but significant racial/ethnic group differences emerged in some aspects of stigma and service utilization. Specifically, Asian and Latino/a/x parents were less likely to fully engage in recommended services; Asian parents endorsed less service availability; Latino/a/x and multiracial parents reported more unmet needs; and Asian and White parents reported significantly more affiliate stigma. There was little indication that stigma contributed to racial/ethnic differences in service utilization, except for Asian families. Results indicate that socioeconomic factors interact with race/ethnicity to impact service use and stigma.

Attitudes towards autism vary across countries. Some of this variation could reflect differences in cultural values across countries, or differences in how much people know about autism. Until now, most research on this topic has asked people directly about their attitudes towards interacting with autistic people. As a result, we understand little about why some people unconsciously hold negative attitudes towards autism, and whether these unconscious attitudes vary across countries. We studied explicit attitudes (willingness to interact), implicit attitudes (unconscious beliefs), knowledge about autism, and cultural values in university students from Hong Kong, the United Kingdom and the United States. We found that people were less willing to interact with autistic people if they knew less about autism, aligned with a competitive and hierarchical society ('vertical individualism'), did not see themselves as part of a collective whose members are equal (less 'horizontal collectivism'), and if they unconcsciously associated autism with negative attributes. Students in Hong Kong were less willing to interact with autistic people and had less understanding of autism compared to those in the United Kingdom and the United States. Unconscious biases did not differ across countries. Our findings highlight the need to combat misconceptions about autism to improve attitudes towards autistic people, especially in Hong Kong. Unfortunately, our results suggest that acquiring more accurate knowledge may not be sufficient to alter unconscious biases. Further research is needed to determine the factors underlying unconscious biases.

In research, language ability has historically been measured using structured tasks in laboratory settings. In recent years, there has been a growing emphasis on the need to instead capture language ability in an individual's natural setting (i.e. through social interaction or in their home). Considering natural language may be particularly important for the autistic population, as an autistic child's language ability can be very different depending on the setting. One common tool for capturing natural language is the LENA recording system, which takes audio recordings over long periods of time and provides estimates of children's and caregivers' speech. The purpose of this systematic review is to summarize the use of LENA in autism research, to highlight the strengths and limitations of the system as identified by researchers, and to provide recommendations for future research and clinical use. We identified 42 autism studies that used LENA in a variety of ways and settings. Most studies used LENA within the guidelines put forth by its creators, and it was most commonly used to understand speech or speech development for autistic children. LENA is a useful tool for clinicians and caregivers to gain some insights into child speech, but those considering using it should be aware of concerns about its accuracy and limitations about the information it provides. In this review, we supplement the official LENA guidelines with specific suggestions for use with the autistic population.

In England, one in four children have tooth decay by the age of 5 years. Tooth decay affects many autistic children. Communication differences, sensory sensitivities and preferred routines can make dental care difficult. Daily toothbrushing, healthy eating and drinking, and attending the dentist may be challenging for autistic children. We do not know much about how autistic children feel about looking after their teeth. Learning from them directly is important to understand their needs and make sure their voices are heard. We interviewed 10 autistic children aged between 7 and 13 years to discover how they care for their teeth, what helped and what did not. We talked about toothbrushing, healthy eating and drinking and visiting the dentist. To support our conversations, we used Talking Mats - a tool that can help with communication. Autistic children described a wide range of sensory issues related to looking after their teeth. This finding shows how important it is to tailor care to each child's needs. Children wanted to be included in conversations about their teeth at home and at the dentist. This was felt to make a big difference in building trust and making them feel comfortable and supported. Overall, we found Talking Mats can be used in dental research to engage with autistic children. By understanding children's views, we can better help professionals and parents to support their dental needs. Our research showed that every child's experience is unique, so dental support must be tailored and inclusive to meet children's needs.

Many autistic individuals report difficulties in social situations, where they are required to think about what goes on in others' minds. These states of the mind can include how others perceive the world around them, their beliefs, or their desires. While research has shown that autistic children could be delayed in developing their full capacity in this regard, less is known about how adults process others' experiences and beliefs. Here we used a novel task and asked adults to participate online. Participants self-reported whether they had been diagnosed with autism or not and we split them into two groups depending on their response. We also asked participants to fill in a self-report questionnaire about social preferences and habits and we also asked them to conduct a test of their nonverbal reasoning ability. Importantly, the autistic and the non-autistic groups did not differ in their nonverbal reasoning abilities, and on our task, we observed that the autistic group committed fewer mistakes than the non-autistic group. Autistic participants were particularly fast and made fewer mistakes on those responses that overlapped with their own view and belief of reality. In conclusion, our findings do not support a simple view of autism in terms of deficits in either social or more general thinking abilities. Instead, autistic adults might favour slightly different ways of thinking about other's experiences and beliefs that is more firmly linked to their own experience and knowledge.

Autistic adolescent girls face complex and diverse challenges in the school setting, specifically mental health issues, unmet social and education needs, and social exclusion. The purpose of this review was to provide a general idea of research relating to the experiences of autistic females in secondary school settings by reporting on their experiences and the lived experiences of autistic women reflecting on their past. Based on the identified articles, the barriers girls face in the compulsory education setting centred on four themes of societal barriers grounded in gender; the institutional or physical barriers of schools; social and communicative expectations; and stigmatization. The study highlighted that there is a need to sensitize and educate widely on the topic of autism for teachers, to support staff, school psychologists and peers of autistic youth. The results call attention to the need for future research to focus on the different lived experiences and knowledge of autistic girls.

Everybody has a right to communicate in any way they can, which includes augmentative and alternative communication. The uptake of augmentative and alternative communication in everyday life may be influenced by awareness, perceptions and acceptance of augmentative and alternative communication by caregivers, family members and the wider society. This study aimed to uncover what parents thought about augmentative and alternative communication in a Global South context. Eleven mothers and five fathers (16 participants) of children with complex communication needs were included. Data were collected using an interview guide from a focus-group discussion and semi-structured interviews. The data were analysed using Framework Analysis and from a gender and critical disability theory viewpoint. The key theme found was fear of augmentative and alternative communication stopping the child from learning to speak. The parents wondered if siblings might also use the alternative communication method and stop talking. They worried whether the communication device will negatively highlight their child in society. As parents' views on augmentative and alternative communication influence whether they use it with their child, informing and preparing parents before introducing augmentative and alternative communication to a child and on-going parent training should be considered.

Anxiety is a mental health concern affecting many autistic children, and has been linked to greater differences in social communication and interaction style. Executive functioning (i.e. the ability to direct and regulate attention and behaviour) plays an important role in autistic children's social-emotional development. We tested whether anxiety (reported by parents) predicts social communication and interaction differences (reported by teachers) over time or vice versa among autistic preadolescents. We also investigated whether the link between anxiety and social communication and interaction differed depending on children's EF abilities (reported by teachers). We found parent-reported anxiety predicted teacher-reported social communication and interaction differences a year later - but only for children who had heightened behavioural dysregulation (an aspect of executive functioning that includes impulse and emotion control). Our work suggests autistic preadolescents with behavioural dysregulation and limited anxiety may be at greater risk for social difficulties, and may need more support in this area. Executive functioning may be a useful mechanism to target in treatment for this group of children.

Special education services are important for helping autistic students succeed, but many racially and ethnically minoritized and girl students face difficulties in getting support because they are not identified appropriately in schools. This study looks at the identification of autism in racially and ethnically minoritized and girl students across schools in the United States during the 2019-2020 school year. We found that girls are less likely to be identified compared to boys, which means they might not get the help they need. The gap between racially and ethnically minoritized students and White students in autism identification has improved slightly, but Latinx students still face challenges. We also found that where students live (their locale) affects their chances of being identified, especially for girls and Latinx students. These findings show that there are disparities in school autism identification, and understanding them can help policymakers, educators, and communities make changes to ensure all autistic students get the support they need.

Over the last decade, especially since the pandemic, more research has been happening online. Conducting research online can create opportunities to include autistic people across the world and make our studies more diverse. However, conducting research online had led to scammers, or people pretending to be autistic, participating in autism research studies. Strategies to stop scammers may accidentally leave out autistic people who have difficulty with processing time and open-ended questions. We tried out documented strategies to stop scammers from participating in autism research. We also tested new strategies to understand how helpful they are. Using these strategies, we suspected over 100 people who wanted to participate were scammers and did not invite them to participate. As researchers, we must ensure we stop scammers from participating in our studies. It's important to highlight autistic voices and guarantee we get accurate results. However, the strategies to identify scammers may also leave out autistic people who have communication differences. This is unfair and could also make our results less reliable. The existing and new strategies to stop scammers take a lot of time and resources but they're worth it to make sure our data are reliable, and include only autistic voices.

Fatigue is associated with numerous harmful physical and mental health outcomes. Despite research indicating a relationship between fatigue and sleep, there has been a limited focus on how the variability of a person's sleep may be associated with fatigue. In addition, previous studies have not explicitly explored relationships among child sleep, parent sleep, and parent fatigue. Increasing knowledge about this area of research could be particularly relevant for families with autistic children with an increased likelihood of sleep disturbances. The current study used two weeks of objective sleep (actigraphy) data and subjective ratings of parent fatigue from 81 parents and their autistic children to examine associations among child and parent within-person sleep variability regarding average parent fatigue levels. Evidence was assessed for the role of parent sleep variability in hypothesized connections between child sleep variability and parent fatigue. We found that only greater variability in parents' total sleep time was associated with higher levels of parents' average daily fatigue rating over the two weeks. Child sleep variability was not significantly associated with parent sleep variability or average daily fatigue. In addition, average levels of child sleep were unrelated to parent total sleep time variability and fatigue. Although cautious interpretation is required, findings support the idea that variability in total sleep time may be a unique aspect of parental sleep's association with fatigue, independent of child sleep. In addition, sleep variability could be important to consider when examining sleep in addition to average levels of parameters like total sleep time.

Good relationships between families and schools make a difference to children's learning - and the same goes for autistic children. But parents of autistic children often find it very stressful interacting with teachers and school staff. In this study, we focused on autistic parents of autistic children. We wanted to know about their experiences of interacting with schools and the impact these had on them and their children. We spoke to 31 autistic mothers of autistic children about their experiences. They told us that they felt they were constantly fighting with schools to get the support needed for their autistic children and compared it to like being in a 'war zone'. They were 'sick of being [viewed as] the problem' and felt that their views and autistic expertise were not taken seriously by teachers and schools. This was damaging to their autistic children's mental health as well as their own. Autistic mothers did share some positive experiences too. They spoke about the value of mutual respect and its impact on successful school partnerships. Autistic mothers also spoke about standing up for themselves and their children and how this advocacy and self-advocacy helped them to build better relationships with schools. This research showed how difficult it can be for autistic families to interact with teachers and schools and the impact this can have on the whole family. It also showed us that strong, trusting relationships between school and families are possible - when autistic parents feel safe, and when their knowledge and lived experience are taken seriously by educators.

To support Latinx families of autistic youth navigate school-based transition services and adult disability services, we provided a family advocacy program entitled, ASISTIR (Apoyando a nueStros hIjo/as con autiSmo obTener servIcios de tRansición; Supporting our Children with Autism to Obtain Transition Services). The ASISTIR program consisted of six, two-hour sessions and included the following topics: school-based transition planning, person-centered planning, Supplemental Security Income, Vocational Rehabilitation, and Home and Community-Based Medicaid Waiver. Twenty-nine Latinx family members completed the cohort-based ASISTIR program. After participating family members demonstrated increased knowledge of school-based transition planning and adult disability services. Participants also demonstrated increased empowerment and advocacy.

We know that autistic people have more health problems and are more likely to go to the emergency department and get hospitalized than other people, but we know less about the problems they have once they get to the hospital. In this study, we looked at all autistic adults in Ontario and compared them to adults who were not autistic and to adults who had other kinds of developmental disabilities to see who came back to the emergency department in the month after an emergency department visit, who got re-hospitalized in the month after being sent home from hospital, and who stayed in the hospital longer than they needed to because there was no place appropriate for them to go to. We found that both autistic males and females were more likely to have these things happen to them than the same age- and sex-matched adults who did not have developmental disabilities. We also found that adults with other kinds of developmental disabilities had similar problems to autistic people. This makes us think that we need to work harder to improve health care for autistic adults and adults with other developmental disabilities when they come to hospital. We also need to make community services work better, and work more closely with hospital services, so that people only come to hospital when they need to and that they can go home when they are ready.

Specialists conduct autism evaluations using tools that are expensive and difficult to get trained on. Families often wait a long time and travel far to get a diagnosis for their child. To help with this problem, primary care practitioners can be trained to provide evaluations in local communities. However, usable and accurate tools developed for non-specialists are needed. The Screening Tool for Autism in Toddlers and Young Children (STAT) was created for this purpose, but limited research has been done on accuracy of the tool in community primary care. This study tested the STAT when used by primary care practitioners as part of a diagnostic evaluation in 130, 14- to 48-month-old children. We tested (1) STAT agreement with the Autism Diagnostic Observation Schedule, Second Edition (ADOS-2), and diagnosis based on an expert research evaluation, and (2) the relationship between STAT classification, primary care practitioner diagnosis, and expert diagnosis. STAT classification matched the ADOS-2 in 77% of cases and expert diagnosis in 78% of cases. Autistic children incorrectly classified by the STAT were older, had higher developmental and adaptive skills, and fewer autism symptoms. In 86% of cases, the STAT classification agreed with primary care practitioner diagnosis. STAT classification, primary care practitioner diagnosis, and expert diagnosis agreed in 73% of cases. Overall, the STAT shows good accuracy when used by primary care practitioners as part of a community primary care autism evaluation.

Recent research shows that in conversations, both participants influence the outcome. More specifically, conversations do not go as smoothly when autistic and non-autistic people talk together compared to when people of the same neurotype (either all autistic or all non-autistic) talk to each other. In studies finding a "same-neurotype communicative advantage", interaction partners knew about each other's neurotype. Because of this methodological choice, it is unclear whether mixed-neurotype interactions go less smoothly because participants knew they were interacting with a different neurotype or because each neurotype really has a distinct communication style. In our study, 134 adults were grouped into same-sex pairs: 23 autistic, 23 non-autistic, and 21 mixed-neurotype pairs. The pairs did not know if the other person was autistic or not. They completed an online task where the "Director" instructs the "Matcher" to reorder abstract pictures. Pairs did this task in two ways: by typing in a live chat and by speaking into a microphone without video. The study looked at how long the task took and how much the Director talked/wrote. Results showed that non-autistic pairs were faster to complete the task than autistic pairs and mixed pairs, meaning pairs with at least one autistic person were slower in general to complete the task. Interestingly, in mixed pairs, only autistic Directors produced more words than non-autistic Directors, in both typing and speaking. These findings suggest that even without knowing about their partner's neurotype and seeing/hearing their partner, autistic adults communicate differently when they interact with a non-autistic person.

Autistic people describe having to mask or 'camouflage' their autistic selves to fit into certain social settings. Many researchers have used the CAT-Q to measure the extent to which autistic people engage in camouflaging. However, some researchers have questioned whether the CAT-Q measures camouflaging or whether it measures other related experiences and behaviours associated with social anxiety, fear of being negatively judged or social autistic traits. In our study, we analysed the CAT-Q to check whether it is indeed similar to or different from these related experiences. To do this, we asked 308 autistic adults to complete the CAT-Q and questionnaires about social anxiety, fear of being negatively judged and autistic social features. Then, we put all the CAT-Q items together with the items from each of the other measures in three separate analyses (called factor analyses) to see how the items would group together. These analyses showed us whether camouflaging behaviours are distinguishable and different from, or cluster together with, these other experiences. We found that most of CAT-Q items grouped together separately from the other measures' items, suggesting that camouflaging differs from these other related experiences. Only some items from one of the CAT-Q subscales clustered together with some social anxiety and autistic items, suggesting these may need to be teased out better in the future. Generally, our findings show that we can use the CAT-Q to measure camouflaging behaviours among autistic people.

Societal expectations for social-emotional behavior differ across sexes; however, diagnostic definitions of autism do not account for this when delineating "typical" versus "atypical." This study examines sex differences in autism in one behavior associated with strong gender biases: smiling. Computer vision was used to quantify smiling in 60 autistic (20 female) and 67 neurotypical (25 female) youth during conversations. Effects of sex and diagnosis were examined on degree of smiling, smile prototypicality, changes in smiling, and impact of smiling on interaction quality. Sex differences in smiling persisted across diagnosis groups: females smiled more than males, and their smiles were more prototypical. Autistic youth smiled less, and less prototypically, than neurotypical youth, with no sex by diagnosis interactions. In autism, the association between smile activity and interaction quality approached statistical significance, seemingly driven by autistic males but not females. Findings are consistent with population trends for females to smile more during social exchanges and "display rules" requiring more positive expressivity from females. Autism has historically been defined based on differences between autistic and neurotypical . Failure to acknowledge sex-based differences in social-emotional behavior may leave some females appearing to have fewer autistic traits, increasing their risk of being under-identified and misunderstood.

During a conversation, on average, autistic individuals are often more likely than non-autistic people to provide an off-topic comment and/or to pause for longer before providing a response. One possible explanation for this is that autistic individuals prefer, or are more tolerant of, unconventional communication styles. To explore this possibility, we investigated whether autistic and non-autistic 9-13-year-olds find off-topic or delayed responding a deterrent to friendship or interaction. Participants listened to scripted conversations and then rated social desirability statements, such as 'I would enjoy chatting to the [target speaker]'. We also examined the prevalence of these behaviours in children's own conversational responses. We found that autistic children were just as likely as non-autistic children to dis-prefer unconventional conversational responding. Both groups indicated that they were less likely to want to be friends with the speaker, or to chat with them, when they provided off-topic or delayed responses. However, despite their judgements of others, the same autistic children were more likely to provide off-topic responses themselves than their non-autistic peers, as well as giving fewer on-topic responses which facilitate back-and-forth conversation. Overall, this is problematic for autistic children, as our findings suggest that the tendency to exhibit unconventional conversational behaviours will have negative social consequences, even when interacting with other autistic peers.

Being a father of an autistic son is a profound and complex experience. Fathers adapt to their autistic sons' unique needs and are always in search of services to ease uncertainties about their sons' present and future. We interviewed 10 Hungarian fathers who have adult-aged autistic children. We asked them about their experiences raising their autistic sons during childhood and adulthood. Our study focused on fathers of adult-aged sons because most research has studied mothers' experiences of autistic children under 18 years old. It is also essential to know how to be like a father with adult-aged autistic children. Fathers shared their ongoing struggle with uncertainty, always seeking the best possible solutions for their sons. They also talked about how they understand and adapt to autism and accept their sons with their special, autism-related characteristics. The findings of this research provide a deeper understanding of fathers' parenting experience, giving suggestions for professionals on supporting them and making their experiences valuable to the community of parents raising autistic children.

Most autism research and services focus on individuals with formal autism diagnoses. However, autism activists and self-advocates have raised awareness about the challenges that can prevent individuals from seeking or getting an autism diagnosis. We interviewed 65 queer and transgender adults who either self-identified as autistic without a formal diagnosis or who had a formal autism diagnosis. We found that participants made meaning of their autistic diagnosis and/or identity and found affirmation in this, faced significant barriers and deterrents to getting diagnosed, and experienced invalidation as both a barrier to and product of diagnosis. Due to the challenges that individuals face in getting a diagnosis, we recommend that researchers and advocates consider including self-identified autistic individuals in research and services.

Autistic people often face both physical and mental health challenges throughout their lives, which can lead to a higher risk of premature death due to health inequalities. However, we know very little about the healthcare experiences of autistic older adults. In this study, we talked with 19 autistic adults aged 65 years or above living in the United Kingdom. We found these main themes: (1) A lifetime of being misunderstood; (2) Autistic people falling between the gaps; (3) Processing autism diagnosis in later life; (4) Concerns about service pressures and scarce resources; (5) Lack of continuity of care, empathy and understanding; (6) Anxiety, alexithymia and sensory overload; and (7) Reduced social support and concerns for the future. Themes show that autistic older adults face unique healthcare access challenges because services don't consider their lifelong experiences of social exclusion. Participants also worried about age-related decline coupled with reduced social support, which makes it harder for them to get support. To address these challenges, healthcare services should provide more targeted support, make policies and funding consistent, and improve healthcare provision by providing staff training. Importantly, they must also speak with autistic older adults so they can advocate for their current and future care.

Early identification of Autism Spectrum Disorder is very important, especially in low and middle-income countries, where access to resources is often limited. The Child Behavior Checklist 1.5-5 is a tool that has been used to help identify children with autism spectrum disorder through specific behavior patterns. However, its effectiveness in low- and middle-income country settings has not been thoroughly studied. This research focused on evaluating the Child Behavior Checklist 1.5-5 as a screening tool for autism spectrum disorder among Brazilian children. The study involved 1292 children aged 3-5 years from the general population and 70 children with autism spectrum disorder aged 1-5 years. Using advanced statistical methods, the study tested how well the Child Behavior Checklist identified children with autism spectrum disorder and how reliable it was in this context. The findings showed that the Child Behavior Checklist 1.5-5 performed well in identifying autism spectrum disorder, with high reliability and consistency in the results. Although one item in each of the autism spectrum problems and withdrawn syndrome subscales did not perform as strongly, the overall tool was effective. In summary, the Child Behavior Checklist 1.5-5 proves to be a reliable and valid tool for early autism spectrum disorder screening in Brazilian children. This can help ensure that more children in low- and middle-income country settings are identified early and receive the necessary support and interventions to help them thrive. Future research should continue to test this tool in different contexts to confirm its usefulness across various populations.