Our understanding of psychological experiences of anxiety in autism could be improved if it were shaped by autistic individuals. However, anxiety research in autism often begins with cognitive conceptualisations drawn from neurotypical or non-autistic individuals. This qualitative study aimed to explore psychological experiences of anxiety using semi-structured one-to-one interviews with a diverse sample of 20 U.K.-based, autistic adults, aged 18–55 years. Transcripts were analysed using two complementary methods: conceptual content analysis, where existing theories were tested against the data with predefined codes; and reflexive thematic analysis, where meaning was constructed from the data while considering research subjectivity. Our sample highly endorsed existing cognitive constructs: intolerance of uncertainty (100% of participants), repetitive negative thinking (100%), attentional biases (70%) and intrusive mental imagery (70%). Some autism-specific characteristics were indicated. The endorsement of imagery is particularly striking given claims that autism is often associated with weak imagery. Autistic adults described the way in which being autistic interacted with anxiety, through psychological and lived experiences. Existing support for anxiety problems was deemed insufficient and may be improved by further refining our understanding of anxiety in autism through future quantitative and qualitative research. Lay Abstract Anxiety is a top priority for research for the autistic community. We could increase our understanding of what might contribute to anxiety problems in autism by speaking to autistic people and learning about the different experiences they have had. We interviewed 20 U.K.-based autistic adults (aged 18–55 years) and asked them about their anxiety problems, including how they felt about well-known ideas of what might be involved in anxiety in autism. We looked at the answers to the interviews in two ways. The first way considers what autistic people think about the well-known ideas. The second way looks at similarities in the answers that autistic people gave. All participants’ anxiety problems involved repeated negative thoughts and struggling with uncertain situations. Most also said that they tend to focus on noises or other sensory experiences within their environment and imagine situations in their mind when they are anxious. Being autistic came with challenges that could make them more anxious, including struggling with changes to routine and being bullied. Autistic people described how anxiety made their life difficult and ways in which current support for anxiety is not helpful enough. We discuss ways that we could better understand anxiety in autism and improve the support given to autistic people.
Introduction Adolescence is characterized by active and ongoing identity development. Autism is one aspect of identity and positive feelings about one’s autistic identity predict better self-esteem and psychological wellbeing among autistic people. This study aimed to explore autistic adolescents’ thoughts, feelings, and attitudes about their autism diagnosis. Methods Sixty autistic adolescents (Average Age = 16.65 years) in the Washington, D.C. metropolitan area participated in brief semi-structured interviews asking the adolescents to describe their current diagnoses, feelings toward those diagnoses, and whether they disclose their diagnoses to friends or feel comfortable talking about them in social settings. Reflexive thematic analysis was used to code interview responses and generate themes. Results From the interviews, five main themes were generated related to participant feelings toward their autism diagnosis: 1) value of neurodivergent community, 2) autism terminology, 3) stigma or stereotypes about autism, 4) journey to understanding, and 5) autistic identity. Conclusion This study highlights the diverse, complex, and nuanced thoughts autistic adolescents have about their autism diagnosis. Factors such as internalized stigma, neurodivergent community, and knowledge about autism impact identification with an autism diagnosis. Our findings emphasize the importance of neurodivergent community and neurodiversity-affirming views to increase positive autistic identity and self-acceptance.
K. Sharp, L. Baczewski, J. R. Bertollo et al.· Frontiers in Psychiatry· 0 citations
It is concluded that, according to autistic adults, early interventions should take an autism-affirmative approach, be developmentally appropriate and foster self-determination, and researchers and practitioners can use these findings to develop and provide support that aligns with autistic people’s priorities.
Elizaveta Nosova, A. Sturrock, Neil Humphrey et al.· Autism· 1 citation
This study aims to examine how elevated autistic traits relate to different anxiety response systems in a non-clinical adult sample. Specifically, it explored whether particular dimensions of the autistic trait profile were differentially associated with cognitive, physiological and motor manifestations of anxiety within a dimensional and neurodiversity-informed framework.
A total of 117 adults (45 men, 38.5%; 72 women, 61.5%), aged 18–84 years (M = 34.14, SD = 13.45), completed the abridged version of the Inventory of Situations and Responses of Anxiety (ISRA-B) and the Autism Spectrum Quotient (AQ-50). Correlational analyses and multiple linear regression models were conducted to examine associations and predictors of overall anxiety, its cognitive, physiological and motor components and anxiety across specific situational domains, with age and gender included as covariates.
Sensitivity to change emerged as the most consistent predictor, significantly predicting overall anxiety as well as its cognitive, physiological and motor dimensions and anxiety in test, interpersonal, phobic and daily situations. Communication-related autistic traits significantly predicted motor anxiety and anxiety in phobic contexts. By contrast, attention to detail showed no significant associations and the imagination domain did not emerge as a robust predictor once age and gender were controlled. These results underscore the role of predictability and adaptation to novelty in the expression of anxiety among adults with elevated autistic traits.
This study has several limitations. Its cross-sectional design and exclusive reliance on self-report measures preclude causal inference and may have introduced response biases. In addition, the sample size was relatively modest and diagnostic information was collected through self-report only, without independent clinical verification. Although age and gender were controlled in the regression models, other potentially relevant factors were not systematically assessed. These limitations highlight the need for longitudinal, multimethod studies with larger samples to clarify the mechanisms involved in the relationship between elevated autistic traits and anxiety.
These findings suggest the need to adapt the assessment and treatment of anxiety in adults with elevated autistic traits, even in the absence of a formal diagnosis. In clinical practice, this implies considering the regulatory role that predictability, structure or certain forms of rigidity may serve, as well as tailoring interventions to each person’s attentional, sensory and communicative profile. The results support more individualised formulations that are less reliant on protocols developed exclusively for neurotypical populations.
This study highlights that many adults with elevated autistic traits may experience significant anxiety without having been clinically identified, which can hinder both access to appropriate support and the understanding of their distress. More timely and accurate recognition of these profiles may improve clinical and social responses, reduce misinterpretations of their behaviour and promote environments that are more understanding of and responsive to, neurocognitive diversity.
The study offers a novel approach by analysing anxiety as differentiated response systems (cognitive, physiological and motor) and across situational domains, rather than as a unitary construct, in a dimensional sample that includes adults with elevated autistic traits without a formal diagnosis. The findings support a dimensional understanding of anxiety in autism-related profiles and highlight the need for assessment and clinical intervention to be tailored to these individuals’ mode of functioning, avoiding the unadjusted application of approaches validated primarily in the general population.
Lucía Torices Callejo, M. Á. Pérez Nieto· Advances in Autism· 0 citations
Autism has historically been conceptualized in ways that exclude the possibility of flourishing or a “good life.” However, shifts in our understanding of autism, alongside a more recent discourse driven primarily by the voices of autistic people, have highlighted that many autistic people can flourish according to their subjectively determined standards. The application of neuronormative ideas of what it means to live a good life is increasingly challenged. This study, led by neurodivergent researchers, examines autistic flourishing from the perspective of autistic adults.
This co-produced phenomenological study sought to explore autistic perspectives on flourishing. We interviewed a total of 29 autistic adults one to four times each, either through focus groups, individual oral interviews, or written responses. We analyzed the interview data using qualitative reflexive thematic analysis.
Participants described their definitions of flourishing, both short and long terms. They included personal growth, connection, and self-determination, as well as opportunities for experiencing pleasure. Based on the insights of autistic adults, we understand autistic flourishing as a dynamic phenomenon that unites long-term growth and autonomy with short-term experiences of mental, physical, or holistic enjoyment.
Autistic flourishing means engaging with the world in one’s own autistic way, not adapting to neuronormative standards. It should not be conflated with neurotypical flourishing, as this weakens its meaning. It should be explored how support can nurture autistic ways of being, rather than push for conformity with neuronormative expectations.
Åsa Hedlund, T. Lindström, Sven Bölte et al.· Autism in Adulthood· 1 citation
Autistic individuals often experience differences in social-cognitive processing, including mentalization, the capacity to understand one's own and others' mental states, which may influence social and emotional functioning. This systematic review synthesizes the current evidence base on interventions targeting mentalization and Theory of Mind (ToM), conceptualized here as related but distinct constructs, with ToM reflecting more specific cognitive perspective-taking skills within the broader mentalization framework. A comprehensive search across multiple databases, without restrictions on language or year of publication, identified 19 eligible studies involving autistic individuals and their caregivers. Study quality was appraised using the Mixed Methods Appraisal Tool (MMAT), providing an indication of methodological rigor across diverse designs, though not a formal assessment of risk of bias. Across studies, interventions were generally associated with improvements in reflective functioning and performance on structured ToM tasks (e.g., false-belief understanding). However, these gains were predominantly observed in proximal, task-based measures, with limited and inconsistent evidence for generalization to real-world social functioning. This pattern raises important questions regarding the ecological validity of commonly used ToM assessments and whether observed improvements reflect meaningful changes in everyday social interaction or task-specific learning. Substantial heterogeneity in study design, intervention characteristics, outcome measures, and participant profiles further limits comparability and precludes firm conclusions regarding effectiveness. Overall, while mentalization- and ToM-based interventions show promise, the current evidence base remains methodologically and conceptually constrained. Future research should prioritize ecologically valid outcome measures, clearer specification of intervention mechanisms, and more rigorous study designs, including long-term follow-up, to better determine whether these interventions support meaningful, real-world social and relational outcomes for autistic individuals and their families.
Natalia Kirsman, Lee Barel Refaeli, Yael Enav et al.· Clinical Child and Family Ps...· 1 citation
This paper introduces an autistic-led and developed narrative-based assessment protocol addressing the paradigmatic and systematic underdiagnosis of autism in adult females. Traditional diagnostic instruments, validated primarily on male cohorts, fail to capture the Female Autism Phenotype characterized by sophisticated masking, internalized traits, and distinct cognitive styles. Through analysis of 988 written narratives from autistic women worldwide, eight thematic domains emerged: observational detachment, social navigation challenges, masking/identity fragmentation, sensory-perceptual differences, relational patterns, distinctive cognitive styles, characteristic developmental trajectories, and ethical rigidity. In opposition to an often-accepted paradigm of autism, where the subject is a male child, often with accompanying intellectual disability, 70.7% of this study's participants held college degrees, challenging deficit-based stereotypes. The narrative methodology circumvents masking behaviors triggered by face-to-face assessments, with 76% of participants expressing experiences in writing they couldn’t verbalize. Drawing on Critical Autism Studies and Husserlian phenomenology, bridging the gap between Social/Behavioral Sciences and the Arts and Humanities, the Wilderwood Reflective Assessment and Diagnostic Indicator of Autistic and Neurodivergent Cognitive Expression (WRADIANCE) shifts diagnostic power from clinician observation to client self-report, honoring autistic women's capacity for self-knowledge. This neurodivergent-affirming approach represents a fundamental paradigm shift in autism assessment, offering a pathway to identification that validates rather than pathologizes female autistic experience.
R. Evanko, M. Evanko· Neurodiversity· 0 citations
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