Showing posts with label research. Show all posts
Showing posts with label research. Show all posts

The Problem With Autistic Communication Is Non-Autistic People: A Conversation With Dr. Catherine Crompton

Dr. Catherine Crompton is doing ground-breaking research on autistic social dynamics and communication, so we were thrilled to interview Dr. Crompton about her work on Information Transfer between Autistic and Neurotypical People during INSAR 2019. We were fascinated (and gratified) to learn about her findings that when there are communication disconnects between the two groups, it tends to be a mutual hiccup rather than an autistic-specific problem.

Shannon Rosa of Thinking Person's Guide to Autism (TPGA): I’m speaking with Dr. Catherine Crompton from the University of Edinburgh. Catherine is working on a project that examines whether performance on cultural transmission tasks varies, depending on the diagnostic status of the social partner, which basically, if you want to summarize that in layman’s terms?

Dr. Crompton: It means that we’re looking at how autistic people interact with other people, whether that is different, depending on whether the person they’re interacting with is also autistic or whether they’re neurotypical.

TPGA: Thanks so much. So can you please tell us a little bit about yourself, about your background and your affiliations?


Shannon Rosa and Dr. Catherine Crompton at INSAR 2019
[image: Two white women posing together, one with red chin-
length hair and glasses, the other with long brown hair and bangs.]

Dr. Crompton: Sure, currently I’m a postdoctoral researcher at the Patrick Wild Centre at the University of Edinburgh and before that I did my undergraduate degree in psychology. Before that, I worked at an outreach service for autistic adults that did a lot of community-based stuff with people who were doing lots of different things, and who wanted support for various different bits and bobs in their life. I did that for a few years and then I went and did my Ph.D in aging. My Ph.D wasn’t in autism, but now I’ve come back to doing autism stuff in the project that I’m doing now.

TPGA: Why did you choose to study the efficiency of how autistic and non-autistic people exchange information?

Dr. Crompton: There are two reasons why this project came about. Firstly, we’ve had a huge amount of first-person accounts and anecdotal evidence that autistic people can find spending time with other autistic people more comfortable and easier and less stressful, and just easier than interacting with non-autistic people. We’ve heard a lot from people who have said, “once I found more autistic people I thought I had found my community” and this kind of stuff. And we didn’t have any empirical evidence to back that at all.

We’ve got a theoretical framework within the double empathy problem which kind of says a similar thing, in that the problems of interacting and interactions between autistic and neurotypical people isn’t necessarily all down to a deficit on the part of the autistic person. It’s more to do with a mismatch in communication style, and mismatch in background.

There is now a growing body of evidence that’s looking at double empathy problem matters, but when we started this project we were really keen to try to address these two areas in an empirical and data-driven way, to see whether this is something that we could explore scientifically in a controlled fashion. We were really interested to see if our theories would stand up to empirical tests.

TPGA: Got it. Can you please tell us about your research sample. What were your selection criteria and why?

Dr. Crompton: For everyone that was involved, we asked that they were over 18 years of age. We didn’t put an older age limit on it because we didn’t want to be overly restrictive. There was no reason for us to be, so we just asked that everyone was over 18; and within our autistic group we said that people could either be clinically diagnosed or self-identified as being autistic. We didn’t want to exclude anyone from taking part who felt that they were part of the autistic community, and had that lived experience. We did use measures with everyone who came in. So even if people were self-diagnosed we asked them to do a couple of screening measures, made sure that they were within the area that we would expect them to be.

We matched our groups on age and gender and IQ and years of education, and things like that. So all the factors we might expect to have potentially an effect on sharing information, or on learning a new task, we just made sure our groups were matched on those things. We also made sure that all our participants were native English speakers, or spoke English to a native-level.

The only other thing that we used as an exclusion criteria is social anxiety disorder. I think it would have been fairly self-selecting anyway, in that we were very up front with people and we said, “if you’re coming in, we’re going to ask you to talk to people that you don’t know. There’s going to be other people there.” So I doubt that we necessarily would have really got a lot of people with social anxiety coming forward, but we just said, just for the purpose, because this is a first and very exploratory we just wanted to try to make things as easy as possible to analyze. So we just said, “sorry, but we can’t take anyone with social anxiety disorder.”

TPGA: What were the primary findings and implications of your study?

Dr. Crompton: The study’s got a few different arms and legs, but the main body of the study is using a diffusion chain, which is like a scientific version of the game "Telephone." So the researcher will tell someone a story or show them how to do a new thing or teach them a new skill, and then that person has to teach the next person, that person has to teach the next person, and so on. We did this in groups of eight; and we had groups where everyone was autistic and groups where everyone was non-autistic and groups that alternated between neurotypical and autistic people.

We did three tasks across multiple groups and we found that when autistic people are sharing information they do so with a similar accuracy to neurotypical people. But when you have groups of people who alternate information sharing between being an autistic person and a neurotypical person, we see that the amount of information that’s shared, the amount of data that’s transferred within these groups, really drops off significantly.

It’s when you’ve got this mismatch of neurotypes that you’re really seeing a problem in the communication—we’re not seeing that within our autistic-only groups. So that’s what we’re presenting here at INSAR. We did add extra little arms and legs on it, so we also looked at how people rated their own experience of the interaction. We wanted to know what it felt like for them. And so we found that the autistic people felt much more comfortable when interacting with other autistic people. There was much higher rapport when they were talking to other autistic people.

I should say, these are people that have never met before. Everyone was strangers. But they felt much more comfortable and much happier when they were talking to autistic people at a comparable level than with non-autistic people talking to non-autistic people. And, again, when it’s mixed groups of autistic and non-autistic people, the rapport is much lower than we get when it’s just an autistic group or just a neurotypical group.

We’re also having those videos coded for markers of interactional rapport as well. So we’re having the subjective, “what was the experience like for you?” question and we’re also having a master’s student, Becca Stewart, who is coding the videos for objective markers of rapport.

We’ve also done a qualitative arm where we did interviews with autistic people about their experiences of spending time with other autistic people, what that was like for them, and how it compares to when they spend time with non-autistic people. So we’ve got a really nice, complementary set of findings.

TPGA: Were there any findings that surprised you?

Dr. Crompton: I was surprised with the diffusion chain findings where we found that the mixed group didn’t do so well. It was surprising that we found the effect to be as strong as we did. You would hypothesize, based on the literature and the clinical diagnostic criteria of autism, that you would have your neurotypical group doing fine and well and they’re all great, and maybe when you’ve got an autistic person and a neurotypical person that the neurotypical person has wonderful social skills so they’ll maybe be able to scaffold that relationship and scaffold the information transfer so they’d maybe come second, they’d do okay. And that if you had a group of all autistic people that everything’s just going to fall apart. That’s what you would hypothesize—if you’d just read the literature and the clinical diagnostic criteria. The fact that we found in such a strong statistically significant way what we did was really lovely and really great. It was surprising that we found it in such a strong effect, but very lovely to find.

TPGA: Yes, please blow apart those autism stereotypes! So what could have gone wrong?

Dr. Crompton: Oh my god, everything!

[both laugh.]

Dr. Crompton: What could have gone wrong… loads of things could have gone wrong. It was a difficult study to run logistically. Not really in terms of hard-brain science, just logistics and admin. We had to match all of our groups on age and gender, and we had to get people to come in, in groups of eight. A lot of people traveled a really long way. And we had to say to people, “you’re going to come in to this horrible, not very nice building, in Edinburgh that you’ve never been to before, and talk to people that you’ve never met before, and do a task that I can’t tell you what it is right now, but you’ll see it when you get here and you’re going to be here for a few hours.”

It’s a lot to ask of anyone. It’s a huge amount to ask, and quite a stressful experience—so we worked really hard to try to make it very accessible, and to share as much information as we possibly could with people before they came in.

The process was made much easier because we have two autistic consultants on the project. Dr. Claire Evans-Williams, who is an autistic psychologist, and Cos Michael. Claire and Cos were really great in working with me to put together this huge wodge of information that we sent to people that had everything that you could ever want to know, and I think that helped. We actually didn’t have anyone who said they were going to come in and didn’t come in, which is a miracle. It was really great, we had really, really brilliant participants. That made it a lot easier. Logistically, it was difficult in terms of getting… I mean, it’s hard enough to get eight of your pals to get down to the pub at the same time together, so getting eight people to come in and do a thing is pretty tough. So that was hard.

And also, I think another thing that could have gone wrong from a more scientific angle is we could have really picked bad tasks. So the diffusion chain stuff has been used pretty extensively in cultural evolution psychology—which isn’t my background at all. It’s not been used in autism. As far as I know, it’s not been used in autism in adults at all. And we wanted to make sure we picked a task to use in the diffusion chain tasks that was not going to be systematically more difficult for autistic people. So we didn’t want to have a task that the neurotypical people would be fine at and the autistic people wouldn’t because they were autistic. We didn’t want to have anything that was too fine motor-oriented, or had horrible sensory stuff, or had a big language load, or had all these kind of different things that we know that autistic people might particularly struggle with, especially in a stressful situation like this. So we worked for a really long time to find tasks that would be okay and would be possible and acceptable and fun and that was difficult, scientifically as well.

Because you want to get something where you’re going to get a good amount of variance in your data, so you need a task that you can score within a range where you can then get good statistics. It’s difficult to come up with a task that does all of these things that you normally get in scientific tasks but that can still be kind of very measurable in a concrete way. We could have just picked the wrong task and it could have all gone horribly wrong.

TPGA: How has your study been received?

Dr. Crompton: I think it’s been received pretty positively. Obviously, this study comes off the back of a lot of autistic people telling us about their experiences, and saying that they feel more comfortable with other autistic people—so they’re probably reading this and saying, “yes, I know,” which is fine [laughs]. First person accounts are so important. It’s what the study was based on. But to make impact at policy level you need to have data for it as well. It’s just the way of the world. So we needed some data for it even if it did state the obvious to a lot of people.

TPGA: We talk about about that a lot when we discuss research at TPGA. Much of the time, it doesn’t matter if you know; you have to show.

Dr. Crompton: Yeah, exactly. And I think the thing is a few people have said, “that’s very obvious,” and it might be obvious to them—but it’s not obvious to everyone else. It’s really not. And it's not in the narrative that we’re getting about autism in this public dissemination of autism knowledge and autism awareness, so it’s kind of important that we’ve got the data to back that up.

We’ve had a huge amount of really, really positive feedback, and a lot of people saying it really resonates with them. They’ve said that it’s been really nice for them to see that this is a “real” effect, it’s not something that they’re imagining: there’s numbers to back it up.

I think the most important thing the data shows is that autistic people can communicate just fine in the right situation. We’ve had a really nice response of people saying, “thank you for showing that I’m not doing it wrong, I’m just doing it differently,” which is great, so it’s been really nice.

TPGA: How would you like the findings of your study to affect approaches of professionals to supporting autistic people in the real world?

Dr. Crompton: [laughter] …. so...

TPGA: Well, you alluded to this in your previous answer by saying that you can’t change policy if you don’t have data.

Dr. Crompton: Yeah, so I think there’s a few interesting ways that this could be taken forward. I think, most importantly, it’s a pretty radical finding so I think we need replications, and we need similar studies showing similar things. In saying that, there’s work at this conference that’s being shown by Brett Heasman and Kerrianne Morrison and it’s all converging on this same narrative, so there’s this growing body of evidence suggesting the same thing.

I think, particularly from our study, it shows the importance of things like autistic-led spaces and the value that can have, and that the need to create these spaces where autistic people can be comfortable amid themselves and talk to other autistic people is really important—whether that’s as part of schools and education, whether that’s in post-diagnostic support, opportunities for adults, things like that.

I think it’s really important to make sure that opportunity is available for people. The last thing I want people to think we’re suggesting is that we should ghetto-ize autistic people. “You go and talk to the people who are like you.” That’s absolutely not what I’m saying and not what we would want at all. But I think creating these spaces that aren’t led by someone who’s telling you what to do, who doesn’t know what your experience is, is really, really important.

I think that we’ve got a good chance to be leading on and doing some good work from this, and we’re about to start another project based on these findings that’s looking at co-designing a peer support system for autistic adults. I’m working with the Autistic Mutual Aid Society of Edinburgh to create that, and I think it’s a really nice, practical applied way of taking this work and seeing how we can translate these findings into the real world. How can we look at what the applications of these things can be, and whether they can benefit people.

Obviously, it’s difficult to translate basic science findings into clinical practice or educational practice or whatever else. It’s all a step-by-step process, but I think it’s a really exciting step. I’m really excited to see what happens with it.

TPGA: Thank you, Catherine, I really appreciate talking with you.

Dr. Crompton: Thank you.

----

Transcription by Max Sparrow.
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INSAR 2019: Yet Useful Research and Autistic Representation Persisted

Shannon Rosa
Senior Editor

The TPGA team attends INSAR, the annual meeting of the International Society for Autism Research, annually and has done so for eight years. We participate as journalists covering important autism research for our community, and also from our combined personal investments as parents of high-support autistic teens, autistic self-advocates, and autism professionals. 

I found INSAR 2019 to be the most progressive annual INSAR meeting since I first started attending in 2011, going by TPGA's priorities of spotlighting research addressing the health and well being of existing autistic people, centering improved autistic quality of life as an optimal outcome, and increasing and acknowledging participation of autistic people themselves. I also appreciate seeing an increasing emphasis on autistic people and their families' day-to-day under-recognized concerns, including co-occurring conditions like GI issues and sleep disturbances, practical considerations of transitions to adulthood, suicidality and other mental health matters, physical activity, and tailoring supports and outreach for low income and/or racially diverse communities.

Most researchers we talked with and listened to seemed to understand that, in undertaking autism research, they are de facto advocates for the underserved and actively marginalized autistic and autism communities. I appreciate their work, as well as their solidarity with INSAR's autistic attendees, and was not alone:

Yet the things I was pleased about at the conference happened despite, not because of, the INSAR powers-that-be. While increasing numbers of conference researchers and presenters recognize that autistic people and their families need all the autism research we need, this year the INSAR board announced it was trying to "restore balance," and de-center non-biomedical autism research.

Why? Politics. We were told the reason was lobbying by SFARI, the Simons Foundation Autism Research Initiative. SFARI prefers the meeting as originally conceived back in 2001: neuroscience-based, and in keeping with SFARI's traditional medical model, deficit-defined approach to autism. While Simons efforts don't dominate INSAR funding, the foundation is a major source of autism research funding. And, like many well-funded-and-connected entities, flexing their influence generally gets results.

Even when those results doesn’t make sense: Excluding or minimizing non-biomedical research at INSAR would unnecessarily limit good and useful autism research, because there aren't any other international autism research conferences of note. Plus, the Society for Neuroscience conference is still happening every year, and continues to have autism content. There's no rational reason to stop making space for as much diversity in research and researchers as annual INSAR conferences can shoehorn in, and, frankly, this "change is bad" approach seems like an ironically rigid and maladaptive move for an organization bent on eliminating or "treating" such traits in the autistic population.

Simons also funds Spectrum Magazine*, which covers autism research, and, in leading up to the INSAR conference, published two pieces titularly about "autism wars" and "tension," but which were really about why a lot of medical model approach people don't want to listen to or respect rights-based autistic advocacy. It seems disingenuous, or at least ill-informed, to highlight and promote arguments that autistic self-advocates—generally known for their dedication to social justice without regard for personal cost (a stance research bears out)—aren't trying to serve the greater good of their entire community. Now, as Spectrum is a Simons effort, I am aware that it is not realistic to expect the magazine to cover autism research in a non-deficit model way. And I certainly don’t mean to imply that the phalanx of Spectrum journalists who cover the annual INSAR meetings are bad people, but rather that they operate according to their mission, just as we do, and that when they get things right by autistic people, that tends to be the exception rather than the rule.

While part of the problem in medical model autism researchers' and journalists' deficits-only lens is a tendency to see autistic people as subjects rather than human beings with opinions and rights, as Sara Luterman noted,
…another issue may be non-autistic people's own communication deficits. We talked with Dr. Catherine Crompton, whose research on Information Transfer between Autistic and Neurotypical People brings quantification to Dr. Damian Milton’s Double Empathy Problem. Her study concluded that, while autistic people communicate well with each other, and non-autistics synch well with non-autistics, there are significant gaps in trying to communicate information between autistic people and non-autistic people. (We interviewed Dr. Crompton during the conference, so stay tuned for our report.)

It may be that this same communication gap was behind attempts to pit researchers and autistic people against each other during the conference:
Which is odd considering that many attending researchers are themselves autistic, and already often discriminated against, including having their expertise and experience met with skepticism—as James Cusack noted:
INSAR needs to stop pushing back against an increased autistic groundswell, if for no other reason that, as INSAR board member and autistic advocate John Elder Robison noted, five percent of registered INSAR 2019 attendees were autistic self-advocates and/or researchers, and/or journalists. Five percent percent of 2200 people is, well, kind of a lot, and if autistic attendance keeps increasing without officially sanctioned, genuine inclusion, INSAR is going to find itself in a pickle.

Autistic researcher Dr. Jac den Houting with their 
poster on participatory research in Australia. 
[image: A white person with dark pulled-back hair and lip
piercings, next to a study results poster.]
Self-advocate Louise Tardif, presenting a group poster on 
Services for Family-Dependent Adults. Photo © Jon Adams.
[image: A white person with long straight brown hair
with bangs, standing in front of a study results poster.]
And Mr. Robison's five percent estimate doesn’t include the autistic researchers who aren’t officially "out," from either explicit or implicit discouragement from their teams and institutions about disclosing their neurostatus:
So, all, please check out these Autism Acceptance guidelines from The Autistic Self Advocacy Network, and share them liberally with your peers, teams, and organizations.

[*sound of needle being dragged across a record*]

As for the conference programming itself, that was an exercise in sheer FOMO terror. (If you want to experience delayed overwhelm, you can still look through the conference program and abstract book [PDF]). We tried to hit as many sessions as we could, but still missed Sarah Hampton on Autistic Mothers’ Wellbeing during Pregnancy and the Postnatal Period; Dr. Lisa Croen on SSRIs and pregnancy (no link to autism, people!); Dr. Josephine Blagrave, Dr. Emily Bremer, and Dr. Andrew Colombo-Dougovito on caveats, barriers, and best practices for physical activity for autistic people—and even sometimes missed crucial nuggets in panels we did attend, e.g.:

Here's what we did attend: Dr. Sarah Cassidy and group's excellent pre-conference session on autism and mental health (we live tweeted much of it, but it was also recorded in its entirety, so hopefully we will be able to share more about it soon). We were impressed by everything we saw, including Dr. Christina Nicolaidis's presentation of Dora Raymaker's work on autistic burnout, and Dr. Rachel Moseley, whose work on self-injury in autistic people without intellectual disability is sobering—so definitely watch out for our forthcoming interview with Dr. Moseley.

Dr. Rachel Moseley during her presentation on autism and self-injury
[image: White woman with glasses and long dark hair, speaking at a session,
and pointing at a projected slide about reasons autistic people self-injure.]
The INSAR press conference, aside from announcements about wanting the meeting to be a redo of its biomedical sciences origin story, contained exciting and useful research fom Dr. Olivia Veatch on sleep disturbances (not sleeping is bad for all humans, and so, yeah, it's bad for autistic people too), and Dr. Ruth Ann Luna on gut and microbiome issues (we are finally seeing research about co-occurring conditions as separate health issues with autistic-specific expressions, rather than as "treatable" symptoms of autism. This is a relief). We interviewed Dr. Luna, and that article is coming soon too.

One of the highlights of the conference for us was AutINSAR, a conversation between autism researchers and/or autistic community members, both in person and on Twitter, which we co-hosted for the third year in a row. AutINSAR was rollicking good fun with excellent points made by all, and so heavily attended IRL that people had to sit on the floor around the perimeter of the room. It takes a while to compile Twitter chats into usable formats, but rest assured a full summary is coming.

The IRL #AutINSAR crew
Back row: Emily and Manuel Casanova, Jon Adams, Bret Heasman, Sue Fletcher-Watson, Anne Fritz,
Cat Hughes, Aaron Bouma, Bethan Davies, Corina Becker, Stephanie Vreeland, and Steven Kapp
Center row: Sara Luterman, Christina Nicolaidis, Lorcan Kenny, Christine Jenkins,
and Louise Tardif. Front: TPGA editors Shannon Rosa & Carol Greenburg
[image: Crowd of neurodivergent people posing in the corner of the INSAR press room.]

John Elder Robison, reigning over the Stakeholder's luncheon
[image: A tall white man with short silver hair and glasses, 
speaking at a podium, wearing a red paper crown.]
The annual Stakeholder's luncheon was also useful. John Elder Robison was emcee, reminding us about shared community goals and the productive things that can happen when people work together. There were tables and tables of autistic people in proud solidarity, along with parents and other family members (we had at least two siblings at our table). I was glad some high-support individuals were there too, and was not the only person who appreciated some of the autistic attendees' verbal stims, as in my case they reminded me of my son, whom I hadn't seen for a few days. Of the speakers, the most bracing was Dr. Vikram Patel (who also gave a keynote), who reminded us that on a global scale most autistic people have no supports whatsoever.

One table of neurodiverse good company at the INSAR Stakeholder's luncheon.
[image: Nine people of diverse races, autism affiliations, and neurologies:
Back row: Carol Greenburg, Kyle DeCoste, Dr. Deb Karhson, Fernanda Castellon,
Sara Luterman, and Stephanie Vreeland.
Front row: Corina Becker, Elliott Keenan, and Dr. Steven Kapp.]
Dr. Patel's message was a reminder of why we do what we do at TPGA: We aim to generate as much useful and freely available autism information as we can, and get it to people who need it, regardless of what other supports they may have. And even though our resources are still mostly in English, we are open to translating and adapting them for other communities. Ask us!

During the main conference, we attended and live-tweeted several sessions: Co-Morbidities (co-occurring conditions like anxiety, depression, and executive functioning difficulties), Health and Well-Being in Transition-Age Youth and Adults, and Cultural and Structural Factors Underlying Diagnostic and Service Disparities Among Racial/Ethnic Minority Children in the U.S.

We also attended and published highlights on Learning How to Prevent Suicide in Partnership with Autistic People and Their Allies, which featured a pointed and moving talk from autistic artist Jon Adams. The Special Interest Group (SIG) on Gender, Sexuality, and Romantic Relationships addressed real-world concerns, and I particularly welcomed the section on supporting people with intellectual disabilities. We also appreciated the SIG on Autism and Related Disorders in the Context of Humanitarian Emergencies, which included the reminder that we cannot merely translate autism materials; we have to make them culturally-specific and -informed.

All the very practical but non-biomedical sessions we attended were popular, and some, like the Co-Morbidities sessions, had attendees lined up against the walls and sitting on the floor despite the room having hundreds of seats. This means attendees are voting with their feet (and butts). I'd like to think the INSAR board can't ignore how much INSAR attendees want to see quality of life-attuned research.

I also hope the INSAR board takes note that, as Dr. Sue Fletcher-Watson reported, dismissing autistic accommodations at the meeting itself is uncool. Last year the conference tried to promote flappause, AKA flapping one's hands instead of applause, so as not to assault those with auditory sensitivities (i.e., a large section of the autistic population). This year year the board backed off due to non-autistic pressures, and said flappause was a personal choice. I think this was an [expletive] move at an autism conference. Autistic attendees weren't pleased, and flappause continued to happen among increasingly sheepish applause:

We need to increase autistic accommodation at INSAR, not reduce it. Having a sensory/quiet room is a good start, but the poster sessions were still sensory hell, and many autistic attendees publicly reported having a tough time navigating the conference in general. And we know the INSAR board is aware of these issues, as board member John Elder Robison is publicly soliciting, listening to, and taking autistic concerns seriously.
So those are my takeaways from INSAR 2019: Oodles of solid content and autistic representation, despite conference organizers not entirely in touch with the most ethical motivation for autism research: to figure out best practices for helping and supporting the autistic people and their families who are already here, already struggling, and who deserve the best quality of life possible. Hopefully the INSAR board will start listening, with results reflected in next year's 2020 conference in Seattle.

We're interested to hear your take on INSAR 2019.

----

*Disclosure: Editors Shannon Rosa and Carol Greenburg have written for Spectrum Magazine.
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INSAR 2019: Gender, Sexuality, and Romantic Relationships

Today's INSAR 2019 Special Interest Group (SIG) on Gender, Sexuality, and Romantic Relationships was led by Laura Graham Holmes and Jeroen Dewinter, and co-led by Anna van der Miesen. Essentially, relationships and sexuality are central to everyone's health and well-being. But there isn't enough useful research and materials available fo autistic people of all ages and abilities, their families, and healthcare professionals, and many have expressed the need for research and guidance. So that's what the SIG leaders and the participants in this well-attended session talked about. Any errors or omissions in the highlights below are on us.

SIG participants Sara L, Dori Z, Jac dH, and Christina N, in discussion
[image: Four people of varying gender identities and neurotypes,
talking at a conference table.]
Last year’s Gender, Sexuality, and Romantic Relationships INSAR SIG was about determining the most important issues for the autistic community, in terms of gender and sexuality and relationships. The ultimate goal for this SIG is to create a resource hub.

The SIG leaders started out with the World Health Organization (WHO) guidelines:
"Sexual health is a state of physical, mental and social well-being in relation to sexuality. It requires a positive and respectful approach to sexuality and sexual relationships, as well as the possibility of having pleasurable and safe sexual experiences, free of coercion, discrimination and violence."
Sexuality is a holistic concept. It’s not just about risk reduction. It’s also about living good lives.
Sexuality is for everyone, not just those who have relationships with partners.

Gender is separate from sexuality. A useful resource is The Gender Elephant, "an educational tool that can be used by anyone to help learn and teach the concepts of gender identity, gender expression, sex, physical attraction, and romantic attraction."

The Gender Elephant teaches gender and romantic concepts with simplified visuals
[image: Illustration of a pink elephant in a gray suit, next to a visual chart explaining gender
 identity, gender expression, sex assigned at birth, physical attraction, & emotional attraction.]
Most available research about autism and sex is about sexual behavior, knowledge, and attraction, and also identifying as LGBTQ+. Which is good, bt we want more research on matters that can contribute to autistic people’s quality of life.

We need to incorporate concepts like self-determination.

Previous autism & sexuality SIGs revealed three major areas of interest:

  1. Getting a better understanding of autism, sexuality, & relationships.
  2. Supporting sexual wellbeing and relationship satisfaction.
  3. Autistic perspectives in research, healthcare, and society.
We need to take this research on autistic sexuality realities, and bring it back to the community to help counter myths about autism and sexuality, and get people the resources that will actually improve their life quality.

Working closely with autistic people on autism and sexuality matters makes research better and leads to more useful supports.

Commentary: The best information about sexuality and autism is coming from the autistic and advocacy communities right now, not the research community. We need more practical and applied resources.

Seems like lots of people in the autism and sexuality SIG are looking for collaborators. Some folks are working on tools to help autistic young adults have open conversations about autism and sexuality and their personal experiences.

We need to help clinicians break down the uncomfortable conversations about autism and sexuality, especially since these topics should but rarely come up in autism evals like the ADOS. How do we get relevant gender and sexuality questions into autism studies other people are already doing?

We then moved to the discussion group on including and reaching non-speaking people and people with intellectual disabilities (ID).

Sara Luterman talked about the utter lack of sexual resources for people with ID resources, especially for LGBTQ+ needs. People with ID are complicated sexual being too, and autistic people are more likely to be LGBTQ+.

Carol Greenburg, who is both autistic and the parent of a partially-speaking autistic teen, mentioned Autistic people with ID need to learn about health boundaries: Pulling a girl’s ponytail because a kid is attracted to her is NOT OK, with kids w/ID or no.

Sara Luterman reminded group that teens look at pr0n! So how do we support that healthily?

Parent reports on sexuality are NOT going to be accurate. Again, this is true for autistic people w/ID and people with neither of those traits.

To teach sex ed properly, we have to talk the variety of ways in which people express their sexuality. Parents tend to be OK with it, sort of, until LGBTQ+ and tech (vibrators etc.) aspects arise. Then it's considered off-color.

What teaching health sexuality boundaries for people with ID can look like: IT’s OK to take pictures of your own bits, but it is NOT OK to send those pictures to other people without their consent.

What do visual supports for people with ID, in terms of sexuality materials, look like? Is there a SymbolStix symbol for a penis? And visual materials like po_rn are not realistic at all.

We also need good guides about things like masturbation, and consider that parents can introduce the materials, but then have the teens/clients watch the materials on their own. (We recommend Diverse City DVDS) A problem, though: many group homes are run by religious groups, and/or only have one computer in a public place. This means that not only do autistic people not have access to sexuality materials, but if they do, there’s no place to use them in private.

Another autism and sexuality complication for autistic people, from Sara Luterman: When you need more support, then functionally, you have less privacy.

Also: Even in mainstream sex ed, there’s a lot about how to say NO, and not a lot about how to say YES.

Sexuality is not unhealthy! So let’s talk about pleasure and well-being instead.

We also need more training materials about sexual identity matters, as those tend to be lacking in autism contexts.

John Elder Robison: Is the autism neurotype a key matching factor for successful relationships for #autistic people?
We need a self-advocacy curriculum for kids, because sometimes it’s not safe for adults to be involved, and kids need to know when and if to approach adults about sexual safety matters.
Kidpower California was suggested as a resource, but we have not verified it.

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INSAR 2019: Learning How to Prevent Suicide in Partnership with Autistic People and Their Allies

Yesterday we attended the INSAR 2019 panel Where Do We Go from Here? Learning How to Prevent Suicide in Partnership with Autistic People and Their Allies, led by Sarah Cassidy from Nottingham University who has been doing this for four years now. Here is what the speakers had to say. (Any errors or omissions are on us.)

More than 10K stakeholders worldwide have identified the top 10 priorities, with equal representation of #autistic people:
  1. What increased barriers do autistic people experience when seeking help which may put them at greater risk of dying by suicide?
  2. What are the risk and protective factors for suicide in autism across the lifespan?
  3. To what extent are autistic people not believed about the extent of their distress?
  4. How can we further understand suicide where mental health is not a factor across the lifespan?
  5. What are the best ways of identifying and assessing suicidal thoughts and suicidal behaviours, in autistic people, in research and clinical practice?
  6. How should interventions be adapted for autistic people and individual presentations?
  7. What is the experience of suicidality in autsitic people? Is this experience different than the general population?
  8. How do autistic people seek help when they are in a crisis?
  9. How well do existing models of understanding suicide apply to autistic people?
  10. What is the impact of poor sleep on suicide risk in autistic people and how can this be measured?

John Adams, an autistic person and artist on why lived experience is key:

“I don’t live with autism. I live with my wife and two cats. I do live with PTSD."

"We’re losing autistic people daily, and they’re often not remembered."

What barriers do autistic people face? Jon Adams says:
  • Attitudes towards me
  • Attitudes about me
  • The current mental health system
  • Being dismissed
  • No specific autistic pathway
What are the risk and protective factors for suicide in autism across the lifespan?

To what extent are autistic people blamed about the severity of their distress? This leads to trauma.

Adams has heard people say they can’t get treatment for PTSD until the trauma stops? WTF.

"Our narrative is often dismissed and misunderstood."

I want to stay as long as I can, but is leaving a pragmatic decision I need to take if I become infirm?

Autistic people should be leading these discussions, yet our experiences are often written over. The next generation deserves better.

“Mindfulness” is useless. And medication to numb him is not OK either. He wants action, but on #autistic people’s terms.

What is the experience of suicidality in autistic people?

Also: Mental health professionals often cause PTSD in autistic people, according to Jon Adam. Restricted and repetitive behavior SAVED him.

How do autistic people seek help when they are in a crisis?

They’re often called "treatment resistant." Adams says, maybe instead of blaming autistic people, consider how you’re treating them. Why wold they want to “stay” if you blame them so?

Why are the effects of sleep issues on suicidality in autistic people? Sleep problems are bad for everyone, and autistic people are human, so sleep problems in autistic people are bad.

Recommends others treat autistic people with consideration, acceptance, kindness, and genuine listening to unique experiences.  

How can we best identify and assess suicidal thoughts and suicidal behaviors in autistic people?

The validity of tools depends on context:

How can we determine if a tool developed for the general population is OK for autistic people? One factor missing is alexithymia, or not necessarily having access to the real-time experience of one’s own emotions.

We have to involve the autistic community in any tools or interventions for helping people with suicidality.
The Mental Health in Autism project is a participatory research project to deeply new assessment tools for autistic adults.

Theorize that #autistic people would have difficulty communicating their suicidal intent, so they tested the theory.

For threat of suicide attempts, autistic people are more likely than general population that they are having suicidal thoughts, but that this is associated with lifetime   and attempted suicide.

Autistic adults have difficulty attempting certain questions, e.g., questions about what they will do in the future. “I can’t say never, even though I’m not at risk now."

We need to adapt measures to better determine suicidality in the autistic community. We need to do a LOT more work.

Next steps: Measure has been adapted to unrecognizability! Which is good.

Next: Paul Lipkin from Kennedy Krieger, on screening for suicide risk in a pediatric autism population.

WHO say close to 800K people die from suicide every year.

For each death, there are 20 attempts.

Suicide is the 10th leading cause of death for all ages.

The pediatric community has not been on top of this.
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How Autism Conferences Can Better Include and Respect Autistic People

Shannon Des Roches Rosa
Senior Editor, TPGA

[Content note: This article discusses suicidality and ableism]

The 2019 International Meeting for Autism Research in Montreal begins today, so let's discuss how autism conferences can best help the autistic people without whom autism conferences would not exist—based on how past autism conferences have gone, what can improve, and why participatory research (involving autistic people themselves) needs to be prioritized.

Last year's INSAR 2018 conference gave me some hope for the future of autism research. I'd never before seen anything like the slide below at any INSAR conference, not since I first started attending INSAR in 2011 (when it was still "IMFAR"). This Autistica slide, with the the motto of "Long, happy, healthy lives for all autistic people" encapsulates everything I want from INSAR presenters, and autism research:

Photo: Sara Luterman
[image: Projected slide showing a group of human faces in profile,
facing right, in white, blue, and dark orange. Orange text on the left reads,
 "Long, happy, healthy lives for all autistic people." Text at the bottom of the slide
reads, "Autistica" and "Dr. Abigail Thompson"]
It was about damn time that INSAR made autistic people feel welcome and centered. Even so, being the cockeyed optimist that I am, before INSAR 2018 I had already noted how INSAR (then-IMFAR) has become more inclusive of autistic people's priorities, since I first started atteneding in 2011:
"I remain hopeful that these meetings will continue to evolve to meet the needs and interests of autistic people. The schedule for this year’s meeting suggests it will. It features collaborations with autistic people and panels on adolescent and adult issues, mental health, sexuality and quality of life and services."
That hope wobbled when faced with the research covered at the INSAR 2018 press conference, which did not reflect those topics so much, and was a mixed bag: from reassuring parents that autistic kids being bilingual and having screen time was OK, to intriguing brain structure analyses, to yet more robot saviors for autism.

Yet I was grateful, over the three days of the conference to see the #INSAR2018 Twitter stream dominated by autistic people and autistic-informed perspectives:
I was also glad to see autistic-informed research such as Lily Levy's work on the fallout from autistic camouflaging or "masking." As Levy told us when we interviewed her at INSAR 2018, "We’re learning from the experiences of autistic people, instead of imposing this top down research driven, like, “now we’re going to look at your genes.”

Additionally impressive was Sarah Cassidy's INSAR 2018 Special Interest Group (SIG) on autism and suicidality, the third such INSAR SIG in three years, which brought ~60 autistic people and autism researchers and professionals to discuss research on, and factors underlying and mitigating, suicidality in autistic people—as well as next steps for researchers. Cassidy's group continues to do excellent work, recently publishing a paper showing that,
"On the basis of our findings, services should be alerted to the high lifetime risk of suicidal ideation and suicide plans or attempts, especially in individuals receiving a late diagnosis of Asperger's syndrome, in view of the substantial risk in this group."
But despite all the ways in which INSAR 2018 addressed the concerns and well-being of autistic people, journalist Cos, who is from the UK, and who was attending INSAR 2018 for the first time as an Autistica autistic ambassador, was not impressed overall. She had this observation on the conference:
"I knew it would be shocking, but the degree to which the language negated us was overwhelming. Amongst many researchers, it was the casual talk of deficit, of risk, the othering of classification: we were children with autism, males or females with autism. We were people with autism and their interest was in the autism, not the people.  I’ve heard farmers speak of their cattle with more respect for individuality."  
Per Cos's take, researchers need to stop treating autistic people like objects. I encourage every researcher who studies autism to read Becca Lory's article What is it like to participate in research as an autistic person?, at Autism in Adulthood, for a primer in what fair and considerate practices (and do not) look like.

You should also read what autistic advocate Morénike Giwa-Onaiwu said to WHYY on the missed opportunities of most contemporary autism research, and why researchers need to engage with autistic people themselves: “It’s looking at autism as the problem instead of how to improve the world around us so that autistic people can thrive.”

With autistic people making it clear that they don't like being ignored on autism issues, why are autistics still having to fight for recognition and validity at autism conferences? It's not for lack of feedback. INSAR board member John Elder Robison made a barnstorming plea to autism researchers to prioritize autistic people in 2014. At INSAR 2018, he continued this theme, noting,
"I asked the researchers if they recognized that they were not studying life with autism, but rather parental interpretation of life with autism. Accurately studying life with autism means studying actual autistic people, not people who watch us."
It was also in 2014 that I presented at a National Autistic Society (NAS) professionals conference in the UK, and was astounded by how remarkably advanced that conference was, in terms of autistic inclusion. It is NAS policy to open up their conferences with autistic keynote speakers, to set an "us" rather than "them" tone, and make it very clear who the conferences are meant to benefit.

That NAS conference's approach to including and respecting autistic people was revelatory to me, because it was as recently as 2012 that I sat in the back of an IMFAR keynote presentation, listening to a presentation with autistic friends about how they had no empathy or ability to make…friends. (We all laughed openly.)

But 2012 was before UK autistic autism researcher Damian Milton put forth his Double Empathy theory made it clear that "theory of mind" needs to go both ways, in interactions between autistic and non-autistic people:
"Whilst it is true that autistic people can struggle to process and understand the intentions of others within social interactions, when one listens to the accounts of autistic people, one could say such problems are in both directions." 
image: Sara Luterman, a white person with glasses and a knitted cap,  and Damian Milton, a white man with a salt-and-pepper beard, on a Rotterdam street littered with bicycles
Sara Luterman and Damian Milton, during INSAR 2018
[image: Sara Luterman, a white person with glasses and a knitted cap,
and Damian Milton, a white man with a salt-and-pepper beard,
on a Rotterdam street littered with bicycles.]
Though Milton and other autistic folk, including autistic researchers, are increasingly and openly attending autism conferences, this objectification of autistic people continues to happen. But, a shift is happening, in which mischaracterizations of autistic people are longer always tolerated. At the 2018 NAS professionals conference, psychiatrist and researcher Iain McClure he gave a talk advancing embarrassingly objectifying theories about autistic people. He was chastised on the spot by Linda Buchan, a neurodivergent clinical psychologist, who, according to Dean Beadle, an autistic lecturer and former journalist who was present,
 “…called out his regressive, negative and offensive tone and made it clear that those views are a thing of the past. She spoke up for all of our community today and she is a hero. She richly deserved the cheers, claps and ovation that she got.”
What can conference planners do to avoid mistakes like McClure's ableist speech? (Or avoid getting called out publicly for making ableist gaffes?) We spoke to the NAS's Carol Povey after the McClure incident, and she said that while the NAS gives its lecturers guidelines on respectful language about autism and autistic people, sometimes people like McClure ignore them—to their peril. We advise autism conference planners to both follow the NAS's example and try to provide guidelines for respectful language, and to also use The Autistic Self Advocacy Network's freely available guidelines for Making conferences autism-friendly, which reminds planners that, "The autistic spectrum includes a wide variety of persons with a wide variety of support needs. Planning ahead for your Autistic guests will help establish equal participation."

For autism research-specific events like INSAR, folks need to look to orgs like The Participatory Autism Research Collective, "A community for people who want to promote autistic involvement in autism research," and who specifically called out the McClure incident. If we promote an attitude of more participatory approaches to research, ones in partnership with autistic people, that approach will ideally translate to the research presented at INSAR, and the way it is presented.

What does participatory research look like? The August 2018 article Making the future together: Shaping autism research through meaningful participation, from Sue Fletcher-Watson, Jon Adams, Kabie Brook, Tony Charman, Laura Crane, James Cusack, Susan Leekam, Damian Milton, Jeremy R. Parr, and Elizabeth Pellicano discusses how:
"Specific manifestations of participatory research might include leadership by autistic researchers, partnership with autistic people or allies as co-creators of knowledge, engagement with the community in general (e.g. via social media) and consultation with relevant individuals or community organisations."
INSAR professionals would also do well to heed formal autistic/researcher collaborations such as Shaping Autism Research, and AASPIRE. The latter org brought to INSAR 2018 hard copies of the inaugural edition of its journal Autism in Adulthood—full of juicy insights about autism and autism research from autistic adults.

image: Four white people: Christina Nicolaidis,  John Elder Robison, Sara Luterman, and Shannon Rosa, holding up copies of the journal Autism in Adulthood.
Hard copies of Autism in Adulthood's inaugural journal!
[image: Four white people: Christina Nicolaidis, John Elder Robison, Sara Luterman,
and Shannon Rosa, holding up copies of the journal Autism in Adulthood.]
Also useful: AASPIRE recently published "practice-based guidelines for the inclusion of autistic adults, both as research team members and as study participants." And Jac den Houting spoke on prioritizing autistic voices in autism research at the Frankl Open Science Platform:
"Participatory research is important for a number of reasons: empowering the community, ensuring quality data, and making sure that the studies carried out have real potential to improve the lives of people with autism." 
Finally, try to walk the walk of researcher Rosalind Picard, who presented her research on meltdown-detecting wearables for autistic people at INSAR 2018 (as reported by Sara Luterman at NOS Magazine):
"Dr. Picard began her keynote by stressing the importance of autistic feedback in her work. She recalled an autistic friend’s observation that 'my biggest problem is not understanding the emotions of others. My biggest problem is you are not understanding my emotions.''
Thankfully, at INSAR 2019 there will be a way for researchers to figure out how to do right by autistic people: Participating in or following the AutINSAR Twitter chat, an in-person and online discussion about autism research priorities, with the conversation taking place directly between autistic and/or autism researchers. AutINSAR 2019 will take place on Thursday May 2, at 12:30, in the INSAR Press Room. (Until then, please peruse the AutINSAR chats of 2018 and 2017.)

Some of the onsite #AutINSAR participants, left to right: Jon Adams,
Sara Luterman, Donna Bish, Andrew Colombo-Dougovito, Lily Levy,
Laura Crane, Mel Bovis, Carol Greenburg, Georgina Perez Liz,
and Shannon Rosa. 
Not pictured: Jelle van Dijk
Photo by Josie Blagrave. 

[Image description: Neurodiverse adults smiling and posing together]
Overall, we know that autistic research priorities need to be more balanced: We need just as much research into quality of life issues as we do in brain structures and genetics. A short list of topics autism researchers could put more weight behind, and thus support the autistic people their work is supposed to be about, include investigating co-occurring conditions like Ehlers-Danlos, the real-world effects of "Early Intervention," and how negative interactions with medical professionals affects autistic people's access to medical care. For a start.

I'll leave you with a quote from Sue Fletcher-Watson's post-INSAR 2018 thoughts, and a stance which I share: "Here’s hoping that at INSAR 2019 and beyond we might hear from a few more scientists whose methods inspire the community as much as they dazzle their fellow scientists."  
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AutINSAR Twitter Chat 2019: What Autistic People Need From Autism Research

What do autistic people need from autism research? What is current autism research doing right? How does research let autistic people and their families down, and why? And how can we convey these concerns to autism researchers? That is what #AutINSAR is all about: a conversation between autism researchers and autistic community members, both in person and on Twitter. We had fantastic conversations at IMFAR 2017 in San Francisco, and again at INSAR 2018 in Rotterdam, and are hoping for another fruitful discussion this year during INSAR 2019 in Montreal, Canada.

AutINSAR will once again be a partnership between us and The Autistic Self Advocacy Network (ASAN), NOS Magazine, Autism Women and Nonbinary Network (AWN Network), AutChat, and We Are Like Your Child. We welcome new 2019 partners Flow Observatorium and Autistics 4 Autistics Ontario.

The Twitter logos for seven organizations:  The Autistic Self Advocacy Network: a spiraling rainbow heptagon on a white background;  Autism Women and Nonbinary Network logo: White circle on a gray background containing a pink lowercase "a" alit by an illustrated light blue butterfly, above black lowercase text reading "awn network," above two blue banners with lowercase black text reading "autism women & binary network" and "awnnetwork.org";  NOS Magazine: a black circle on a white background, with an illustration of an incandescent light bulb drawn in white and surround by a sunburst in dashed rainbow colors;  Thinking Person's Guide to Autism: All-caps black text on a white background reading "Thinking Person's Guide to Autism," with "Person's" in white text on a black arrow;  The autchat logo of a lowercase black letters a and c, divided by a black staff with curved serifs on top and bottom and strike through, on a white background;  Flow Observatorium logo of two boxes, the first white with black outline, black letters "Fl" followed by superscript number 33, the second a black box with white letters :"Ob" followed by superscript number 79; and the Autistic 4 Autistics logo of a white background with a red block font letter "A" next to a red number 4, followed by a second red block font letter "A"
#AutINSAR Partner Orgs: ASAN, AWN Network, NOS Magazine, TPGA, 
autchat, Flow Observatorium, and Autistic 4 Autistics Ontario
(Not pictured: We Are Like Your Child)
[image: The Twitter logos for seven organizations:
The Autistic Self Advocacy Network: a spiraling rainbow heptagon on a white background; 
Autism Women and Nonbinary Network logo: White circle on a gray background containing a pink lowercase "a" alit by an illustrated light blue butterfly, above black lowercase text reading "awn network," above two blue banners with lowercase black text reading "autism women & binary network" and "awnnetwork.org"; 
NOS Magazine: a black circle on a white background, with an illustration of an incandescent light bulb drawn in white and surround by a sunburst in dashed rainbow colors; 
Thinking Person's Guide to Autism: All-caps black text on a white background reading "Thinking Person's Guide to Autism," with "Person's" in white text on a black arrow; 
The AutChat logo of a lowercase black letters a and c, divided by a black staff with curved serifs on top and bottom and strike through, on a white background; 
Flow Observatorium logo of two boxes, the first white with black outline, black letters "Fl" followed by superscript number 33, the second a black box with white letters :"Ob" followed by superscript number 79;
and the Autistic 4 Autistics logo of a white background with a red block font letter "A" next to a red number 4, followed by a second red block font letter "A".] 
Autism research tends to focus more on causation, normalization therapies, and cures than on helping existing autistic community members. From both practical and human rights perspectives, this needs to change. Too many core matters affecting autistic people's health and quality of life are still under-researched, and, as a result, proper supports and understanding are too often lacking.

The #AutINSAR discussion hopes to help autism research better serve the interests of autistic people, and more fully address the research matters autistic people want addressed.

With this in mind, #AutINSAR is meant to connect autistic communities with autism research communities directly, during INSAR, the International Meeting for Autism Research. Such conversations don't happen often enough at INSAR due to a variety of barriers: costs, conference environment that are overwhelming from both sensory and social angles, confronting ableist people in the real world, the stress of traveling, etc.

If you are an autistic person who is interested in autism research and/or an autism researcher, we hope you will participate in this year's #AutINSAR.

#AutINSAR DETAILS
  • Thursday, May 2, 2019
  • 12:30-1:30 PM Eastern Time (9:30 AM PT / 5:30 PM GMT)
  • INSAR conference Press Room
    • Room 523B at Palais des congress de Montreal
      1001 Place Jean-Paul-Riopelle
      Montréal QC H2Z 1X7 Canada

HOW TO PARTICIPATE
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