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This chapter reviews speech rhythm in the context of prosodic entrainment in speakers with autism, and then presents data on speaking-rate entrainment obtained from conversations of children and adolescents with and without autism. The study focuses in particular on speaking rate entrainment at the level of the conversational turn and compares patterns of speaking rate entrainment to patterns in entrainment of fundamental frequency. The relationship between local entrainment at the conversational turn level is furthermore compared to global conversational entrainment that occurs over the course of the entire conversation. Results show no differences in entrainment in speaking rate at the turn level between speakers with and without autism. Furthermore, speaking rate and fundamental frequency entrainment behavior are correlated at the level of the conversational turn for both groups. Lastly, results suggest that turn-level entrainment is not correlated with global entrainment in fundamental frequency, possibly indicating that local and global entrainment serve different conversational functions.
This chapter introduces Bayes’ theorem and uses it to ask critical questions about the diagnosticity of evidence – its ability to distinguish between competing hypotheses. It applies this framework to two controversies: whether vaccines cause autism and whether Biden legitimately won the 2020 US election. In both cases, one side relied exclusively on nondiagnostic evidence, facts that have alternative explanations. A key focus is the likelihood ratio, a term in Bayes’ theorem that can represent how much trust we should place in various sources of evidence (e.g., scientific experts, election officials) and in processes like peer or judicial review. The chapter critically examines the peer review system through the case of Andrew Wakefield’s retracted study linking vaccines to autism. Peer review failed to detect misreporting of data and a conflict of interests – highlighting the need to supplement peer review with scientific replication. Together, these examples underscore the importance of public understanding of epistemic institutions and the use of deliberative argumentation to explore alternative hypotheses.
Children are active learners: They selectively attend to important information. Rhythmic neural tracking of speech is central to active language learning. This chapter evaluates recent research showing that neural oscillations in the infant brain synchronize with the rhythm of speech, tracking it at different frequencies. This process predicts word segmentation and later language abilities. We argue that rhythmic neural speech tracking reflects infants’ attention to specific parts of the speech signal (e.g., stressed syllables), and simultaneously acts as a core mechanism for maximizing temporal attention onto those parts. Rhythmic neural tracking of speech puts a constraint on neural processing, which maximizes the uptake of relevant information from the noisy multimodal environment. We hypothesize this to be influenced by neural maturation. We end by evaluating the implications of this proposal for language acquisition research, and discuss how differences in neural maturation relate to variance in language development in autism.
In typical development, conventional metaphors are supposed to be stored as related senses within a single lexical entry, unlike homonyms, whose meanings are represented in separate entries. Autistic individuals often face challenges in understanding metaphors, raising the possibility that they process conventional metaphors more like homonyms—as unrelated meanings. In this study, we tested this hypothesis by comparing autistic and non-autistic adults on a lexical decision task involving both homonyms and conventional metaphors. We predicted that autistic participants would show inhibition effects (slower access) for both subordinate homonym meanings and metaphorical senses, while non-autistic participants would show inhibition only for homonyms. Our results partially confirmed these predictions. Non-autistic participants exhibited inhibition for both homonyms and conventional metaphors, suggesting that accessing metaphorical senses is more effortful than previously assumed. In autistic participants, metaphorical senses were even more difficult to access than subordinate homonym meanings and more difficult than for non-autistic participants. These findings indicate that autistic individuals experience particularly strong inhibition from the literal meaning when processing conventional metaphors, suggesting that these metaphorical senses may not be fully integrated as related senses in their mental lexicon.
Edited by
Liz McDonald, East London NHS Foundation Trust,Roch Cantwell, Perinatal Mental Health Service and West of Scotland Mother & Baby Unit,Ian Jones, Cardiff University
Autism research and clinical practice is a rapidly evolving branch of psychiatry. This chapter explores autism through the lenses of the neurodiversity paradigm, challenging the deficit-based model whilst remaining stark about significant healthcare inequalities and challenges that autistic people face. It considers the perinatal journey from an autistic perspective, highlighting some of the common challenges autistic mums (to be) can face, and makes suggestions for approaches to take when working with autistic patients.
This study investigated mental health diagnoses in autistic adults to determine whether there were any sex differences in presentation. Autistic adults attending the neurodevelopmental service at Surrey and Borders Partnership NHS Foundation Trust were included.
Results
As part of a service audit, 150 random adults (75 males and females) were selected and their case notes were reviewed. Mental health diagnoses were common: 36% had current suicidal ideation, 20% had attempted suicide, 40% had a past or current diagnosis of anxiety and 62% had a past or current diagnosis of depression. There were more women diagnosed with an eating disorder (9% female, 0% male) and with a historical suicide attempt (21% female, 9% male). However, using a Holm–Bonferroni correction, there were no statistically significant sex differences between mental health diagnoses. Among both sexes, a significant number had been exposed to prenatal and early childhood trauma, nearly 10% had experienced physical trauma, abuse, neglect or assault, and nearly a third had been through parental separation.
Clinical implications
This demonstrates that autistic people presenting to a National Health Service diagnostic clinic are more at risk of experiencing trauma, which subsequently increases their risk of mental illness, alongside any neurological predisposition.
Stigma towards individuals with mental, neurodevelopmental, and neurological conditions is associated with problems accessing healthcare (e.g. schizophrenia) and gaining employment (e.g. epilepsy). In Ireland, stigma differs towards different conditions, with previous research showing that schizophrenia is viewed more negatively than bipolar disorder or autism. More detailed understanding of stigma in Ireland requires replication of these findings in a larger, population-representative sample.
Methods:
1,232 participants around Ireland completed a survey examining knowledge, attitudes, and behaviours towards schizophrenia, bipolar disorder, autism, and epilepsy as a comparator. Knowledge, attitudes, and behaviours towards these groups were compared using cumulative link mixed models.
Results:
Perception of others’ stigma and participants’ own self-reported behaviour were more negative towards schizophrenia compared to any of the other groups. Familiarity with mental health issues was associated with more positive self-reported behaviour towards those with schizophrenia. This improvement in behaviour was mediated by reduced perception of danger of this group. In contrast, greater mental health knowledge had no such impact on behaviour. Bipolar disorder was the second-most negatively perceived condition, followed by autism and epilepsy.
Conclusions:
These findings support our recent pilot study and provide further evidence that stigma differs towards different conditions in Ireland, with Irish people perceiving more negative societal attitudes, and self-reporting more negative behaviour, towards schizophrenia. The finding that familiarity with schizophrenia predicted more positive behaviour and that this was mediated by reduced perception of danger suggests targets for future anti-stigma interventions.
Across psychiatry, neurodivergence is highly prevalent yet under-recognised. Psychiatric vulnerability, treatment response and prognosis are critically shaped by co-occurring neurodevelopmental conditions, including attention-deficit hyperactivity disorder, autism and tic disorder. Clinical recognition of neurodivergence and effective management can mitigate mental illness, prevent suicide and reduce societal costs. Services and training should adapt accordingly.
This chapter addresses the role of oxytocin and vasopressin in shaping social behavior, reviewing both human and animal studies. The chapter critiques the early optimism around oxytocin’s ability to foster trust and emotional understanding, providing evidence from failed replication studies and highlighting the effects of sex, context, and brain region-specific interactions. It also assesses clinical research on oxytocin as a potential treatment for autism spectrum disorder, pointing out the limitations of current approaches and the complexity of translating animal research into human applications.
This article offers a DE SE THEORY of person indexicals, wherein first- and second-person indexical pronouns indicate REFERENCE DE SE (also called SELF-ASCRIPTION). Long observed for first-person pronouns (Castañeda 1977, Kaplan 1977, Perry 1979, inter alia), self-ascription is extended here to second person as well. The person feature of a pronoun specifies the speech-act roles that must be played by the self-ascribers: the speakers (uttering a first-person pronoun), the addressees (interpreting a second-person pronoun), or both (for first-person inclusive). Other agents who are not among the designated self-ascribers for a given pronoun interpret the pronoun indirectly by inferring the self-ascriber's interpretation, a process requiring THEORY OF MIND, that is, the cognitive ability to impute mental states to others (Premack & Woodruff 1978). This de se theory is supported by convergent evidence from multiple domains: (i) It explains a typological universal: first- and second-person plurals always allow associative semantics (‘speaker(s) plus others’, 'addressee(s) plus others') rather than requiring regular plural semantics ('speakers only', ‘addressees only‘) (Greenberg 1988, Noyer 1992, Cysouw 2003, Bobaljik 2008). (ii) It belongs to a family of approaches that solve the problem of the essential indexical (Perry 1979). (iii) It correctly predicts observed patterns of indexical pronoun production and comprehension by two populations lacking a fully developed theory of mind: typically developing children in the stage before theory of mind has developed, and children with autism. (iv) It correctly predicts the interpretation of second-person pronouns in utterances with multiple addressees.
Parental prenatal mood and anxiety disorders (PMADs) are linked to child neurodevelopmental disorders (NDDs), but evaluations of the magnitude and mechanisms of this association are limited. This study estimates the strength of the association and whether it is impacted by genetic and environmental factors.
Methods
A systematic search of PubMed, CENTRAL, PsycINFO, OVID, and Google Scholar was performed for articles published from January 1988 to September 2025. Of 2,420 articles screened, 74 met the inclusion criteria. Meta-analyses were conducted on 21 studies, and 53 were included in the narrative synthesis. We conducted random-effects meta-analyses, along with tests for heterogeneity (I2) and publication bias (Egger’s test). The review followed PRISMA and MOOSE guidelines.
Results
Maternal PMADs were associated with a significantly increased risk of attention-deficit/hyperactivity disorder (ADHD; odds ratio [OR] 1.91, 95% confidence interval [CI] 1.45–2.52) and autism spectrum disorder (ASD; OR 1.75, 95% CI 1.43–2.14) in children. Paternal PMADs were also associated with the risk of NDDs, with combined odds for ASD and ADHD (OR = 1.23, 95% CI 1.14–1.33). Several studies suggested that the link between parental PMADs and offspring NDDs might be impacted by both genetic and environmental factors, including the impact of ongoing parental depression on child behavior.
Conclusions
Parental PMADs are associated with increased risk of NDDs in children. These findings likely reflect a combination of inherited liability and environmental processes; clarifying mechanisms will require genetically informed designs. Regardless of mechanism, offering optional, family-centered developmental support may help promote child well-being in families where a parent is experiencing PMADs.
Neurodivergence encompasses neurodevelopmental conditions including autism, attention-deficit hyperactivity disorder (ADHD) and Tourette syndrome. Particular physical traits, notably those linked to joint hypermobility, have an established association with both neurodivergence and bipolar affective disorder.
Aims
This case-control study tested, first, whether the presence of joint hypermobility predicted bipolar affective disorder and, secondly, whether neurodivergent characteristics were important in understanding this relationship.
Method
Data were collected from 52 participants with self-reported clinical diagnoses of bipolar affective disorder and from a comparison group of 54 participants without diagnosis of bipolar affective disorder. All participants were assessed on screening instruments for autism (Ritvo Autism Asperger Diagnostic Scale; RAADS-R), ADHD (Wender Utah Rating Scale; WURS) and joint hypermobility. Group differences were explored, and odds ratios calculated for the presence of bipolar and neurodivergence given the presence of hypermobility. A mediation analysis was performed to determine the contribution of neurodivergent characteristics to the relationship between joint hypermobility and bipolar affective disorder.
Results
The presence of joint hypermobility significantly predicted the presence of bipolar disorder (odds ratio 5.1; 95% CI = 2.1, 12.4). In the bipolar affective disorder group, the prevalence of likely autism and ADHD was greater (84.6 and 65.4% respectively) than in the comparison group (22.2 and 3.7% respectively). The odds ratio for a diagnosis of bipolar affective disorder was 18.2 (95% CI = (6.70, 49.41)) in those meeting the threshold for likely autism; and 46.89 (95% CI = 9.96, 220.74) in participants meeting the threshold for likely ADHD. Mediation analysis showed that autistic, ADHD and pooled neurodivergent characteristics mediated the link between joint hypermobility and bipolar affective disorder.
Conclusions
This suggests a potential mechanism for affective pathophysiology, through developmental characteristics associated with joint hypermobility. The appreciation of interacting physical and neurodivergent traits to the expression of psychiatric illness has implications for diagnostic formulation, personalised medicine and service design.
Some individuals may compensate for their underlying social cognitive vulnerabilities, therefore exhibiting adaptive real-world social behavior through enhanced attentional mechanisms despite underlying social cognitive challenges. From a developmental psychopathology framework, adaptive behaviors vary dimensionally in the community and across development to promote compensation. Yet, compensation in the broader community of children without categorical clinical diagnoses has not yet been studied. Moreover, the extent to which compensation demonstrates stability versus change is unknown. This study examines childhood social compensation longitudinally in a community-ascertained sample (N = 315) of 7–17 year-old (M = 12.15, SD = 2.97) children (33% non-white, 44% female). Compared to children with equally poor emotion recognition but substantially more real-world social behavior challenges, high compensators demonstrated better attentional alerting (d = 0.81, p < 0.001) without the “cost” of internalizing symptoms. Results showed both stability and instability in compensation group membership over time, with the high compensation group more likely to have unstable classification relative to the no compensation group (OR = 0.26, p = 0.001). Taken together, this study clarifies the processes underlying social compensation in the community and suggests a developmental psychopathology perspective is valuable in understanding how compensation develops across the lifespan. Such work has the potential to inform practices and policies that support social adaptation and promote resilience.
The goal of this article is to provide a balanced assessment of the significance autism has for the scientific study of language. While linguistic profiles in autism vary greatly, spanning from a total absence of functional language to verbal levels within the typical range, the entire autism spectrum is robustly characterized by lifelong disabilities in intersubjective communication and persistent difficulties in adopting the perspective of other people. In that sense, autism constitutes a unique profile in which linguistic competence is dissociated from communication skills. Somewhat paradoxically, autism is often mentioned to underscore the importance of mind reading for language use and of intersubjective communication for the emergence of language. Yet experimental studies on pragmatics in autism indicate that many pragmatic processes unfold without adopting one's conversational partner's perspective. Moreover, the patterns of language acquisition and learning in autism represent a strong challenge to the central role constructionist theories assign to socio-communicative skills. Data on autism thus force a reconsideration of the a priori conceptual boundaries on language learnability that shape the foundational debates between constructionist and nativist linguistic theories.
In his target article, ‘Autism, constructionism, and nativism’, Kissine (2021) argues that data from autism should be taken into consideration in the debate about L1 acquisition. This paper responds to Kissine's piece by pointing out several of its underlying assumptions and suggesting directions for future research on the topic. Traditional framings of autism as a deficit have recently been challenged in favor of an identity-based approach, the neurodiversity paradigm, which suggests that autistic speech should not be measured in terms of its resemblance to nonautistic speech and that literature on intercultural miscommunication may offer insights into autistic communication. There are some indications that distinct autistic discourse practices may be identifiable in communities of practice, and studies on autistic literacy could benefit from considering the theoretical perspectives found in literature on multimodality and translanguaging. Finally, research on language acquisition might be strengthened by the incorporation of holistic neurocognitive theories about autistic minds.
Despite policy calling for compulsory education in China, many children with autism are not in school. This article examines the establishment of autism-related non-governmental organizations (NGOs) in China to meet needs not being met by the state. We focus on the background and motivation in founding and running these NGOs, after first considering the broader context of state decentralization and NGOs roles in supplementing welfare needs in reforming societies, and the educational policy context of China. This study used mixed methods, including questionnaires with open-ended and limited choice questions, and follow-up discussion email. The goals of NGO leaders—more than 50% of whom are parents of children with autism—are to make up for where government implementation of educational policy is insufficient; help others and advocate for inclusion in society; and do meaningful work. Implications from these findings are discussed.
The constructionist approach argues that communication is central to language learning, language use, and language change. We argue that the approach provides a useful perspective on how autistic children learn language, as it anticipates variable outcomes and suggests testable predictions. First, a reduced ability and interest in tracking the attention and intentions of others should negatively impact early language development, and a wealth of evidence indicates that it does. Second, and less discussed until recently, a hyperfocus on specifics at the expense of generalizations, common among people on the spectrum, should also negatively impact language development, and recent evidence suggests this is also the case. Pace Kissine's 2021 target article, it is unsurprising that children can learn some second language from watching videos, and it is unclear how an appeal to ‘innate’ language-specific knowledge could explain the range of outcomes of individuals on the autism spectrum.
This article defends a new type of preferential hiring. Rather than compensating groups for past or present employment-related discrimination, it seeks to ensure that groups with disproportionate unemployment rates that are due significantly – but not necessarily wholly – to their members having relatively narrow competencies, such as autistic individuals and people with hearing loss, ADHD and lower education levels, are prioritized for jobs that match their abilities. After defending such competency-based preferential hiring based on its benefits for persons with narrower competencies and for societies more broadly, I address several criticisms, including concerns that this approach may be stigmatizing.
Transgender and gender diverse (TGD) people show different trajectories after gender transition. While some continue to transition, others detransition (DT), that is, stop or reverse the process. Both populations experience poor mental health, but no study has compared whether they have different psychological profiles and needs. This exploratory study compared TGD and DT participants in terms of psychopathological symptoms, personality variables, and the possible presence of eating disorders (ED) and autism spectrum disorders (ASD). A total of 29 TGD participants (M age = 28.28, 72.4% female at birth) and 21 DT participants (M age = 29.19, 66.7% female at birth) completed the Personality Assessment Inventory (PAI), the Sick-Control-One stone-Fat-Food (SCOFF), and the 10-item Autism Quotient (AQ-10). Of these, 28% screened positive for ED and 28% for ASD, and the percentage for ASD was higher in the DT group. TGD participants had elevated scores on borderline features and mania, whereas DT participants had elevated scores on anxiety-related disorders. The TGD group showed significantly higher scores on antisocial features, alcohol problems, and dominance, and significantly higher rates of self-harm; the DT group had significantly higher scores on phobias and significantly higher rates of social detachment. Both groups exhibited elevated scores on suicidal ideation, stress, and nonsupport. The results suggest that TGD and DT participants may have different psychological profiles, with TGD participants exhibiting more externalizing symptoms and DT participants reporting more neurodiversity and internalizing symptoms. The findings highlight common and distinct vulnerabilities and needs that should be considered in clinical practice.
In this chapter, we examine the foundations of the development of social cognition—how children come to understand themselves and others. We begin by looking at the development of theory of mind– how children come to understand that people’s behavior is influenced by their beliefs and desires. We then examine the development of social learning, the acquisition of social information and behavior, which is responsible for humans’ ability to transfer information with such high fidelity from one person (and generation) to another. We then examine the development of the self, including self-concept, self-esteem, and self-efficacy. We conclude the chapter by looking at a related topic, identity formation in adolescence, including the development of ethnic identity.