Evidence-based support for autistic people across the lifespan: Maximizing potential, minimizing barriers, and optimizing the person-environment fit

Abstract

Autism is both a medical condition that can give rise to disability and an example of human neurological variation ('neurodiversity') that contributes to identity, with cognitive assets and challenges. We refer to this as the dual nature of autism. Enhancing adaptation and wellbeing is the ultimate goal for intervention/support. Evidence-based support for autistic people across the lifespan is emerging. Support should be collaborative between autistic individuals, their families, and service providers, taking a shared decision-making approach. To maximize the individual's potential, comprehensive early intervention and parent-mediated intervention, ideally taking a naturalistic approach, may help support the early development of adaptive, cognitive and language skills. Key words: autism, support, intervention, treatment, adaptation, development, lifespan, health, disability, neurodiversity OSF preprint first posted online July 19, 2018; https://dx.doi.org/10.31219/osf.io/8z5rv The copyright holders for this preprint (which was not peer-reviewed) are the authors Lai et al. (2018) Evidence-based support for autistic people across the lifespan 3The duality of autism Autism spectrum disorder/conditions (ASD or ASC (Lai and Baron-Cohen, 2015), henceforth 'autism') are atypical neurodevelopmental conditions that emerge early in life (Varcin and Jeste, 2017), with strong genetic aetiologies (Tick et al., 2016) shaped by subsequent gene-environmental interplays (Mandy and Lai, 2016). Autism has lifespan impact on an individual's development and adaptation (Howlin and Magiati, 2017). As a result of evolving diagnostic concepts, recognition of the spectrum and its multi-subgroup nature (Lai et al., 2013), along with increased awareness (Liu et al., 2010), autismformerly regarded as rare -is now considered relatively common. Globally, close to 1% of the population has a formal autism diagnosis (Baxter et al., 2015). In developed countries the prevalence is close to 1·5% (Lyall et al., 2017), with a male:female ratio of 3-4:1 (Loomes et al., 2017).Characteristics associated with autism (ie, 'autistic traits') fall along a spectrum in the general population across dimensions of social-communication, repetitive and stereotyped behaviours, and other non-clinical and cognitive features (Constantino et al., 2010, Ruzich et al., 2015, Skuse et al., 2009. Elevated autistic traits are particularly common in family members of people who have an autism diagnosis (Pickles et al., 2000, Piven et al., 1997, Wheelwright et al., 2010. Both clinical autism and the dimensional traits are associated with the additive effect of common and rare genetic variations (Geschwind and State, 2015, Robinson et al., 2016, Weiner et al., 2017, although their exact causal roles remain unclear.The dimensional nature of autistic traits makes it challenging to draw a clear diagnostic line, especially when genetic or other diagnostic biomarkers are not yet available (Constantino and Charman, 2016). From a medical perspective, a clinical diagnosi...

Big data approaches to decomposing heterogeneity across the autism spectrum

“…As in other fields of health care, person-level information that parses heterogeneity and achieves individual-level accuracy as a biomarker or predictor (e.g., BRCA gene mutations, the utility of which comes from big data science in oncology) is only part of the whole decision-making process in health care. Optimal care and support for autistic individuals has to be embedded in a person-centered, lifespan perspective that incorporates shared decision making and collaborative action planning [107]. Big data bring clarity to our understanding of individual differences on the autism spectrum and beyond the spectrum, yet in daily clinical practice, care and support can be improved only when such clarity is integrated with a perspective that respects the individuality of the autistic person and their personal contexts.…”

Physical activity participation among adolescents with autism spectrum disorder

“…The predominant focus on intervention during childhood, however, adversely impacted PA for some participants, as there was less time and exposure to develop sustained PA interests, habits, and patterns of participation. Our intent is not to criticize parents for prioritizing therapeutic interventions over PA, nor to downplay the widely documented benefits of various therapeutic interventions for children with ASD (Lai et al, 2018). Rather, the findings prompt us to reflect on, and bring attention to, thinking about how we can maximize therapeutic, developmental, and physical health outcomes without losing sight of other aspects of life such as PA participation.…”

The what, where, who, why, which, and how of collaborative play involving autistic children in educational context: a contextual inquiry

“…The presence of autistic children in inclusive educational environments is on the rise (Lindsay et al, 2013) where these children frequently engage with their neurotypical peers (O' Keeffe and McNally, 2023). Even though inclusive education seeks to grant autistic children sufficient opportunities to join with neurotypical peers, studies indicate that mainstream educational environments often struggle with these integrations (Humphrey and Symes, 2013;Lindsay et al, 2013;Lai et al, 2020;Linimayr et al, 2023). Play emerges as a natural mechanism to support social communication and facilitate the inclusion of autistic children in regular educational frameworks (O'Keeffe and McNally, 2023).…”