New studies of autism
Today, I’m presenting three articles on autism, each available in full text and each challenging assumptions about autism. First, Long, Catmur & Bird (2025) published “The Theory of Mind Hypothesis of Autism: A critical evaluation of the status quo” in Psychological Review. Here are highly edited excerpts:
The theory of mind (ToM) hypothesis of autism is the idea that difficulties inferring the mental states of others may explain social communication difficulties in autism. In the present article, we critically evaluate existing theoretical accounts, concluding that none provides a sufficient explanation of ToM in autism. [W]e have outlined two key conceptual issues in the understanding of ToM: We have highlighted the lack of agreement between ToM researchers regarding what exactly constitutes a mental state and demonstrated that the common definition of ToM as “the ability to represent mental states” does not provide a complete description of the processes required for mental state understanding. . . . [T]he notion of ToM as representation alone is not in line either with existing evidence, which indicates that the ability to represent mental states is (near) universal in human adults with sufficient intelligence, or with currently used tests (which were developed to increase the sensitivity and rigor of ToM measurement).
Traditionally, it has been suggested that ToM is subserved by an innate neural mechanism, the ToMM. This mechanism allows an individual to understand and predict the behavior of a conspecific by representing their mental states, here defined as propositional attitudes. Importantly, the ToMM was said to be responsible for processing all metarepresentations, not solely others’ mental states. According to Leslie (1987), whereas a primary representation is “transparent,” meaning that the proposition it contains is considered to be a true representation of some aspect of the world, a metarepresentation is “opaque,” meaning that its propositional content does not suggest anything about the real world. For example, the primary representation “the sky is blue” implies that the sky truly is blue. By contrast, the metarepresentation “Sally believes that the sky is blue” only entails that this is Sally’s belief and thus leaves the possibility that the proposition “the sky is blue” is false. As such, holding the lower order proposition within the higher order metarepresentational context means that the representation no longer implies that the sky is blue.
Specifically, Leslie (1987) argued that an individual cannot gain an understanding of mental state concepts (necessary for ToM) without the capacity to hold metarepresentations, which itself requires the ability to decouple their propositional content. Therefore, the ToMM account suggests that autistic individuals cannot develop mental state concepts (i.e., informational relations such as “believe” or “desire”) due to an impairment in representing propositional content that is decoupled from the real world (Leslie & Thaiss, 1992). Since the proposal of the ToMM account, much theorizing around the ToM hypothesis of autism has centered on explaining evidence that the vast majority of autistic adults, and many autistic children, are able to pass tasks that require mental state representation (Baron-Cohen, 1989; Baron-Cohen et al., 1985; F. G. Happé, 1995).
False belief tests require individuals (usually children) to attribute a belief to a character, despite themselves knowing that the belief is false. When the Sally–Anne task, a classic false belief test, was given to typically developing children, children with Down’s syndrome, and autistic children, a high proportion of the former two groups passed (85% and 86% respectively), despite the intellectual impairments associated with Down’s syndrome. By contrast, only 20% of the autistic children passed (Baron-Cohen et al., 1985).
However, if it is acknowledged that only some autistic individuals have problems with representing mental states, then the ToMM account ceases to provide a cognitive theory of autism but rather becomes a description of a cognitive impairment seen in some individuals with autism that produces some of their symptoms.
[W]e claim that theories which posit that autism is characterized by an inability to represent mental states, are inconsistent with empirical evidence. Other models, such as those we described as “social processing theories,” require further specification of how the processes they identify are involved in mental state inference and thus how impairments in these processes result in ToM impairments in autism. We elaborated on issues with existing measures that prevent proper testing of psychological accounts of ToM. We highlighted conceptual inconsistencies between theory and evidence, which mean that tests often measure abilities that do not constitute ToM. We then examined tests of different aspects of ToM ability in turn, arguing that functional MRI-based tests of mental state representation cannot be properly interpreted, that tests of accuracy require a truly correct answer (which is absent from existing measures), and that tests of propensity should only require attribution of mental states to agents with minds (rather than objects that cannot hold mental states). The test we presented, . . . the Interview Task (Long et al., 2022), determines participant inferences against ground-truth information about real mental states and thus resolves the problems facing existing tests of ToM accuracy. However, further work developing a new measure of ToM propensity may be required to facilitate a full understanding of ToM in autism.
I love solid research that challenges previous conceptions. Here, we see that, not only do some people on the autism spectrum pass tests of TOM, the measures of TOM themselves are highly questionable. The next study similarly challenges assumptions about autism and creativity. Taylor, Gocłowska, Callan & Livingston (2025) published “Enhanced Creativity in Autism is Due to Co-Occurring Attention-Deficit/Hyperactivity Disorder” in Journal of Psychopathology and Clinical Science. Excerpts follow:
There has been longstanding speculation that enhanced creativity is associated with autism. Evidence for this association, however, is limited and derived from small-scale studies in nonclinical samples. Furthermore, nothing is known about autism-related creativity after accounting for general cognitive ability and attention-deficit/hyperactivity disorder (ADHD), that is, other factors known to predict creativity. Addressing these issues, we conducted preregistered comparisons of the creativity of autistic and nonautistic adults (N = 352), matched on age, sex, and general cognitive ability. We found clear evidence that there were no group differences on a divergent thinking creativity task. Autistic adults did self-report more real-world creative accomplishments and behaviors, but these differences did not hold after accounting for ADHD.
We found that autistic and nonautistic people performed comparably in terms of DT (divergent thinking); however, autistic people reported greater engagement in real-world creative behaviors and more creative accomplishments. Critically, however, after accounting for ADHD, autism was no longer predictive of creativity on these measures. Rather, the results revealed a pattern whereby ADHD was more predictive of creativity than autism. Overall, our results suggest that enhanced creativity may only be apparent in a subgroup of the autistic population with co-occurring ADHD.
We did not find evidence that autism was associated with a diminished ability to produce ideas (fluency) or enhanced originality. One explanation for the inconsistency with previous research could be that our groups were well matched on general cognitive ability, which was not measured or accounted for in the previous studies. [C]linical features unique to ADHD, such as impulsivity, are likely to be more relevant. Boot et al. (2020), for example, suggested that heightened extrinsic motivation for real-world creative achievements may be associated with atypical reward and impulsivity uniquely characteristic of ADHD.
Despite higher creative achievement and behaviors in the autism group, albeit due to co-occurring ADHD, there were no observed differences between autistic and nonautistic adults in creative self-efficacy, that is, subjective assessments of their own creative abilities. This suggests autistic individuals may underestimate their creative abilities, not appreciating their heightened creative accomplishments relative to others. Indeed, this was despite a potential positive bias expected due to the higher rates of ADHD in the autism group. This might be driven by the possibility that autistic adults show lower levels of self-efficacy and self-esteem more generally (e.g., Lorenz & Heinitz, 2014; Newark et al., 2016), and difficulties in accurately predicting their performance on tasks in other domains (e.g., decision making; Sahuquillo-Leal et al., 2020; Taylor et al., 2022). Given our findings, we speculate that neurodivergent people may need additional support to help identify their strengths and abilities which will in turn promote self-efficacy.
This study has wider implications, speaking to the importance of robust empirical testing of autistic and neurodivergent strengths. Indeed, our findings suggest that clinical and educational interventions, as well as employment strategies, grounded on autistic strengths in creativity may perhaps benefit a sizable subgroup of the autistic population (e.g., around 20%–30% with co-occurring ADHD) but not others. Consequently, we suggest that until such research is conducted, a more nuanced approach is taken to understanding autism-related strengths pertaining to creativity, whereby strengths are identified at an individual level to avoid making inaccurate generalizations regarding the autistic population (see also, Taylor et al., 2023).
In summary, following methodological advancements in previous research, we present evidence that enhanced creativity, where observed in autism, is fully explained by co-occurring ADHD. This challenges previous speculation that creativity is a fundamental strength linked to autism that should be incorporated into strengths-based clinical, educational, and occupational interventions to support autistic adults. Rather, it perhaps presents a strength that can be targeted for a specific subgroup of the autistic population—those with co-occurring ADHD and/or heightened ADHD traits. As a result, this work demonstrates the importance of further cross-condition research to understand the specificity of potential strengths associated with neurodevelopmental conditions. This is critical to ensure strength-based approaches in clinical science are grounded in empirical evidence.
This is a very rich article well worth reading in full because of the extensive conceptual and empirical work done. In the end, it, like Long et al., points to the importance of looking carefully at both the measures used to assess phenomena and the ways in which professionals work with people on the autism spectrum. The next article extends these first two by examining adults on the autism spectrum. Clarke, Singer, Schiltz & Lord (2024) published “Autism at 30: Conceptualizations for adult research and clinical practice” in American Psychologist. Again, highly edited excerpts:
Autism spectrum disorder is one of the most common neurodevelopmental conditions diagnosed in children. Most autism research, intervention, and policy focus exclusively on this condition in childhood, but autism often persists across the life course. This narrative review leverages data from 115 participants first diagnosed with autism between ages 2 and 3 years and subsequently followed for 3 decades (Mage = 30.93 years, SD = 3.41) to highlight key aspects of adult life and experiences for autistic individuals identified in early childhood. Compared to other autism samples, the participants described here are relatively diverse: 20% are Black or mixed race; 13% are female; 43% reside in Census-designated rural locations; and 37% have a primary caregiver without a college degree. Fifty participants have average cognitive abilities (mean intellectual quotient [mIQ] = 98.8, SD = 19.3) and are verbally fluent; the remaining 65 have an intellectual disability (mIQ = 28.5, SD = 17.7) and/or are minimally verbal. In some ways, the adult experiences of autistic individuals are quite distinct from those of the general population, but important similarities exist also, particularly related to quality of life. As the number of autistic adults continues to rise, and increasing numbers of autistic adults seek out clinical and community services, high-quality research and clinical services focused on this population should be a priority for psychological science and practice.
Symptoms of autism both change and are changed by development, so studying this condition across the lifespan is essential.
Symptoms of autism, which include challenges in social communication, the presence of sensory issues, and restricted, repetitive interests, are frequently lifelong (American Psychiatric Association, 2022). In the United States, between 70,000 and 110,000 autistic individuals turn 18 years old each year (Kogan et al., 2018). Yet, in the 8 decades since autism was first described, most empirical work has consisted of cross-sectional investigations of childhood. Existing literature on autistic adults disproportionately represents individuals without an intellectual disability (ID). A recent meta-analysis of all original research published in autism-specific journals in 2016 found that 94% of autistic participants did not have an ID (Russell et al., 2019). In contrast, prevalence data from the Autism and Developmental Disabilities Monitoring Network found that as of 2020, approximately 38% of autistic children in the United States had ID (Maenner et al., 2023).
Like all developmental conditions, the behavioral phenotype of autism is not static. Rather, symptoms of autism can change markedly across the life course. For example, findings from several longitudinal samples of autism have found that social communication challenges and restricted, repetitive interests often peak in mid-childhood and decline into late adolescence and adulthood. Similarly, outcomes can change repeatedly throughout adult life.
Often, existing literature on autism emphasizes differences between so-called “atypical” and “typical” development, which comes at the expense of considering similarities that supersede diagnostic criteria. As one example, many individuals with autism experience difficulties with attention and executive functioning even if they do not meet the diagnostic criteria for attention-deficit/hyperactivity disorder, and many individuals with depression and anxiety experience social challenges even if they do not meet the criteria for autism (Grzadzinski et al., 2016; Saris et al., 2017). Individuals with autism or attention-deficit/hyperactivity disorder are also more likely to exhibit symptoms of irritability and anxiety, though such symptoms do not fit neatly into diagnostic criteria for either condition and are also common in the general population (Thapar et al., 2017). As described in detail below, there are notable similarities between autistic adults in the LSA sample and adults in the general population with respect to their goals and hopes for the future.
Examining the attainment of normative outcomes is an imperfect means of understanding adult life—both in the general population and in neurodivergent populations such as autism. Furthermore, simply detailing challenges and negative experiences in adulthood does not provide a full or necessarily accurate picture of autistic adult life. For example, adults with autism may derive less pleasure from employment than adults in the general population, and some report little to no interest in pursuing social and/or romantic relationships (Pellicano et al., 2022).
The LSA originally began in 1992. Participants resided in North Carolina, the Chicago area, and Michigan. This review focuses on 115 participants (Mage = 30.93 years, SD = 3.41) recently active in the LSA (i.e., providing data within roughly 5 years of age 30) who met the criteria for an autism diagnosis. Of the active sample, 20% of participants are Black or mixed race; 13% are female, 43% reside in Census-designated rural locations, and 37% have a primary caregiver without a college degree.
To facilitate clarity, this sample can be divided into two categories of cognitive ability: adults who are more cognitively able (n = 50, defined as having a verbal IQ ≥ 70 at age 9, mean intellectual quotient [mIQ] = 98.8, SD = 19.3, referred to throughout as “MA”) and adults who are less cognitively able (n = 65, defined as having a verbal IQ < 70 at age 9, mIQ = 28.5, SD = 17.7, referred to throughout as “LA”). Two LA and two MA participants had IQ scores within 5 points of 70. However, the adult outcomes of these individuals were comparable to those of other participants in their respective categories. Work from this and other independent longitudinal samples of autism (Mason et al., 2021) suggests that the lives of LA individuals—who may also be described as minimally verbal or nonspeaking and/or as having high support needs—differ meaningfully from the lives of MA individuals. This may be particularly true in adulthood, as daily experiences, family dynamics, and outcomes increasingly diverge.
[A]pproximately 51% of American adults currently hold full-time employment (Bureau of Labor Statistics, 2024). By 33 years old, about half (49%) of MA participants were currently or had previously been employed full time. Another 31% of MA participants were currently or had previously been employed part time but have never held full-time employment. Only two LA participants have ever been employed full time: one as a dishwasher and the other as a gas station attendant. One quarter (25%) of LA participants are either currently employed part time or have been employed part time at least once. Strikingly, almost half (48%) of all participants have never been employed. This includes 20% of MA participants and almost three quarters (71%) of LA participants. Trajectories of vocational activities in this sample during the first decade of adulthood are described in recent work by Clarke et al. (2021).
The discrepancy between MA participants’ employment rates and academic achievement and cognitive ability is marked. Despite less than half of MA participants working full time in their early 30s, these individuals almost all have IQs in the average range or higher (mIQ = 98.8, SD = 19.3) as well as normative performance in reading and math at 19 years old (Kim et al., 2018). Further, the rate of college degree attainment among MA participants (56%) is comparable to that of the U.S. adult population (53%; United States Census Bureau, 2022).
Just over half (55%) of the LSA cohort live with one or more caregivers in their family home at 33 years old. In contrast, 15% of American adults aged 25–34 years old live with one or more caregivers in their family home (United States Census Bureau, 2023). Excluding one LA individual who lives independently, all LA participants are living with moderate to substantial support from family or staff. Among MA adults, 48% are living in their family home, a majority of whom have never lived independently. Fifty percent of MA participants are living independently (i.e., in their own home or with roommate/s and/or a romantic partner), and one MA participant in this sample resides in a supported living arrangement.
Considerable challenges to effectively studying well-being, quality of life, and similar outcomes in adults with autism remain. Chief among these is the lack of reliable measures validated for use across varying cognitive abilities and ages. To better understand and support autistic adults’ well-being and quality of life, measures that effectively quantify these constructs and capture change over time are essential. Ideally, to reflect the full range of adult experiences encompassed by the autism spectrum, such measures should be observational, or at the very least, not rely solely on self-report.
I thought this one was important because people on the autism spectrum grow up. Here we see contrasts between low and better functioning adults but, perhaps more importantly, an emphasis on a very nuanced examination of adult roles and goals for people as they move into adulthood.