In November 2023, the Department of Health and Social Care published guidance, entitled ‘Baroness Hollins’ Final Report: My Heart Breaks – Solitary Confinement in Hospital Has no Therapeutic Benefit for People with a Learning Disability and Autistic People’. The report's commendable analysis of the problems and identification of the areas where practice should be improved is unfortunately not matched by many of its recommendations, which appear to be contrary to evidence-based approaches. The concerns are wide-ranging, from the use of the term ‘solitary confinement’ for current long-term segregation (LTS) and seclusion, to presumption that all LTS and seclusion is bad, to holding clinicians (mainly psychiatrists) responsible for events beyond their locus of control. Importantly, there is a no guidance on how to practically deliver the recommendations in an evidence-based manner. This Feature critically appraises the report, to provide a comprehensive summary outlining potential positive impacts, identifying specific concerns and reflecting on best practice going forward.

This perspective article addresses the critical issue of equitable access to sustainable healthcare services for children with autism spectrum disorder (ASD). Despite the increasing prevalence of ASD globally, significant disparities persist in accessing appropriate healthcare services. The lack of comprehensive data on autism prevalence and incidence in many regions further exacerbates this challenge, hindering the development of targeted interventions and equitable resource allocation. This paper sheds light on barriers to equitable access, including geographical disparities, cultural stigma, communication barriers and inadequate training of healthcare providers. Strategies for achieving sustainable solutions are proposed, including the expansion of telehealth services, financial assistance programmes, competency training, community-based support programmes and investment in high-quality research. By addressing these challenges and implementing evidence-based interventions, we can work towards ensuring that all children with autism have access to the healthcare services they need for optimal development and well-being.

This paper explores the use of mindset material in terrorism cases. Mindset material is a broad category of evidence, including social media activity and internet search histories, relied on to infer or imply that the accused is affiliated or aligned with terrorists. Although mindset material plays a central role throughout the justice process in terrorism cases, no work to date has explored and discussed its use in depth. In this paper I draw on doctrinal and empirical findings, including interviews, to examine how and why it has come to play such a central role in terror cases. While mindset material is a well-intentioned tool used to selectively enforce broadly drafted and vaguely defined terrorism offences, it is also a blunt tool, and sees great emphasis placed on the accused's inferred status as terrorist (or not). In this paper I explore and problematise the use of mindset material and the inferences drawn from it, specifically in relation to to fantasists, the merely curious, and young autistic defendants. I posit that mindset material is symptomatic of a need to revisit the substantive law and to rethink the proper role of the criminal law in preventing terrorism.

Autism spectrum disorder prevalence more than quadrupled in the United States between 2000 and 2020. Ice storm-related prenatal maternal stress (PNMS) predicts autistic-like trait severity in children exposed early in gestation. The objective was to determine the extent to which PNMS influences the severity and trajectory of autistic-like traits in prenatally flood-exposed children at ages 4–7 years and to test moderation by sex and gestational timing. Soon after the June 2008 floods in Iowa, USA, 268 women pregnant during the disaster were assessed for objective hardship, subjective distress, and cognitive appraisal of the experience. When their children were 4, 5½, and 7 years old, mothers completed the Social Communication Questionnaire (SCQ) to assess their children’s autistic-like traits; 137 mothers completed the SCQ for at least one age. The final longitudinal multilevel model showed that the greater the maternal subjective distress, the more severe the child’s autistic-like traits, controlling for objective hardship. The effect of PNMS on rate of change was not significant, and there were no significant main effects or interactions involving sex or timing. Prenatal maternal subjective distress, but not objective hardship or cognitive appraisal, predicted more severe autistic-like traits at age 4, and this effect remained stable through age 7.

In this study, we assessed the interactions of mothers and fathers with their children diagnosed with autism spectrum disorder (ASD) in terms of emotional availability (EA) and compared them with the interactions of healthy controls. Children, aged 13–60 months and applied to the Infant Mental Health Unit between January 2019 and March 2021 and their parents without any clinical diagnosis, were included. The EA levels of mothers and fathers of the autistic group, which included 30 boys and 13 girls, and those of the control group, which included 10 boys and 10 girls, were compared. According to the results obtained, it was determined that the EA levels of mothers and fathers of healthy controls were not different; however, the mothers were more sensitive and better in structuring the content of play compared with the fathers in the ASD group. It was noted that the fathers of children with ASD were more hostile than the mothers. EA should be taken as a criterion to determine the intensity and content of treatment, particularly in ASD. Additionally, increased awareness of fathers in EA may provide better results in the intervention process.

‘Relaxed’ events are now common across the public Arts and Heritage sectors. Although designed with the needs of autistic children and their families in mind, they suit people with a range of access needs. Our project at The Open University asked: what would a ‘relaxed tutorial’ look like, and who might benefit from it? Across two years (2021–2023), tutors in the Department of Classical Studies at The Open University trialled a set of autism-friendly accessibility adjustments to live online tutorials for distance learners on a Roman History module. We found that relaxed tutorials were welcomed by students with anxiety disorders, caring responsibilities, chronic conditions and low confidence, as well as by autistic students. Since the project was concluded in 2023, relaxed tutorials have been rolled out across further Classical Studies modules at The Open University. Their principles and structure offer a new way of looking at accessibility adjustments which could be adapted to other teaching contexts and levels.

Social camouflaging (SC) is a set of behaviors used by autistic people to assimilate with their social environment. Using SC behaviours may put autistic people at risk for poor mental health outcomes. Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, the goal of this systematic review was to investigate the development of SC and inform theory in this area by outlining the predictors, phenotype, and consequences of SC. This review fills a gap in existing literature by integrating quantitative and qualitative methodologies, including all gender identities/age groups of autistic individuals, incorporating a large scope of associated factors with SC, and expanding on theory/implications. Papers were sourced using Medline, PsycInfo, and ERIC. Results indicate that self-protection and desire for social connection motivate SC. Camouflaging behaviors include compensation, masking, and assimilation. Female individuals were found to be more likely to SC. Additionally, this review yielded novel insights including contextual factors of SC, interpersonal relational and identity-related consequences of SC, and possible bidirectional associations between SC and mental health, cognition, and age of diagnosis. Autistic youth and adults have similar SC motivations, outward expression of SC behavior, and experience similar consequences post-camouflaging. Further empirical exploration is needed to investigate the directionality between predictors and consequences of SC, and possible mitigating factors such as social stigma and gender identity.

Difficulties in empathy are frequent among children with autism spectrum disorder (ASD), and often considered a core feature of autism. Reduced empathy during the second year of life has been shown to predict subsequent ASD diagnosis. However, links between empathy in the first year and ASD have not yet been investigated. Moreover, prior work focused on empathy for others’ distress but not for others’ joy. To address these gaps, this prospective longitudinal study followed 60 infants (33% girls), 39 at high genetic risk of ASD (siblings of children with ASD) and a matching control group. Infants’ empathic responses to others’ distress and happiness were assessed at ages 6, 9, and 12 months, using simulations by the mother/experimenter and videos of crying and laughing infants. Diagnosis was determined between 18 and 36 months. Infants later diagnosed with ASD showed a reduced empathic response toward a person simulating distress, but not toward a video of a crying peer, and not in response to others’ joy (either in simulation or video). Overall, reduced empathic concern during the first year of life appears to be an early prodromal marker of subsequent ASD. Implications for theory, research, and practice are discussed.

English-speaking autistic children use the hesitation marker um less often than non-autistic children but use uh at a similar rate. It is unclear why this is the case. We employed a sample of Dutch-speaking children from the Preschool Brain Imaging and Behavior Project to examine hesitation markers in autistic and non-autistic preschoolers with the aim to 1) make a crosslinguistic comparison of hesitation marker usage and 2) examine hypotheses regarding the underlying linguistic mechanisms of hesitation markers: the symptom hypothesis and the signal hypothesis. We found initial group differences in all hesitation markers but these results were rendered insignificant after controlling for age, sex and nonverbal cognition. We found significant correlations between hesitation marker usage and expressive and receptive language, but not autism traits. Lastly, we show interesting cross-linguistic differences in hesitation marker usage between Dutch-speaking participants and previously described English-speaking participants, such as a preference for um over uh.

Autistic children and their parents are at risk for mental health problems, but the processes driving these connections are unknown. Leveraging three data cycles (spaced M = 11.76 months, SD = 2.77) on 162 families with autistic children (aged 6–13 years), the associations between parent–child relationship quality (warmth and criticism), child mental health problems, and parent depression symptoms were examined. A complete longitudinal mediation model was conducted using structural equation modeling. Father depression mediated the link between child mental health problems and father critical comments (β = −0.017, p = 0.018; CI [−.023 – −.015]). Father report of child mental health problems mediated the association between father depression and father critical comments (β = 0.016, p = 0.040; CI [0.003–0.023]) as well as the association between father positive remarks and father depression (β = −0.009, p = 0.032; CI [−0.010 – −0.009]). Additionally, father positive remarks mediated the connection between father depression and child mental health problems (β = 0.022, p = 0.006; CI [0.019–0.034]). No mediation effects were present for mothers. Findings highlight that the mental health of parents and autistic children are intertwined. Interventions that improve the parent–child relationship may reduce the reciprocal toll of parent and child mental health problems.