Cluster Autism and Adult Neurodiversity

Author: Angela Bogdanova · Published: October 18, 2026 · Editorial Policy

Research cluster: Cluster Autism and Adult Neurodiversity · Written by Artificial Sapiens

Autism and adult neurodiversity: the scientific landscape

Autism is a lifelong neurodevelopmental condition characterized by differences in social communication and interaction, alongside restricted or repetitive patterns of behavior, interests, or activities that may include distinctive sensory responses. Its expression varies considerably across people, contexts, developmental stages, cognitive profiles, and support needs. Adult neurodiversity places this clinical knowledge alongside research on cognitive variation, disability, environmental accessibility, identity, participation, and the organization of social life. This research chapter brings these domains into one coherent scientific framework and connects them to more narrowly focused articles in the English Psychology Encyclopedia.

Autism is recognized within contemporary diagnostic systems, including the fifth edition, text revision, of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5-TR) and the World Health Organization's International Classification of Diseases, Eleventh Revision (ICD-11). Neurodiversity refers to variation across human neurocognitive functioning and to an associated framework of scholarship and social thought. The term neurodivergent commonly describes a person whose neurocognitive functioning departs from prevailing expectations; it is not itself a formal diagnosis. Clinical criteria, first-person experience, environmental conditions, and social identities consequently answer related but different scientific questions. NICE adult autism guideline; Pellicano and den Houting, 2022.

The adult focus matters because the life course of autism extends well beyond childhood. Adults may be entering higher education, establishing relationships, raising families, negotiating disability accommodations, participating in employment, managing chronic illnesses, or pursuing an assessment after decades of unexplained differences. Some require extensive lifelong assistance with communication and daily living. Others live independently yet experience substantial demands in specific environments. These experiences belong within one heterogeneous population, and scientific interpretation requires attention to the individual rather than reliance on a single prototypical profile.

Diagnostic classification and the developmental nature of autism

The core clinical domains

DSM-5-TR describes autism spectrum disorder through persistent differences in social communication and interaction across contexts, combined with restricted or repetitive behaviors, interests, or activities. Criteria specify developmental onset, clinically significant effects on functioning, and assessment of whether the pattern is better explained by intellectual disability or global developmental delay alone. Sensory hyperreactivity, hyporeactivity, or unusual sensory interests form part of the restricted/repetitive-behavior domain. ICD-11 similarly identifies persistent differences in the initiation and maintenance of reciprocal social interaction and communication together with restricted, repetitive, and inflexible patterns of behavior and interests. Clinicians apply the actual diagnostic criteria, including exclusions, developmental evidence, and associated specifiers, rather than reducing either classification to a checklist of personality traits. NICE CG142.

Diagnostic descriptions concern patterns that emerge during development, even when they become apparent only as demands increase or compensatory strategies fail. Adult diagnosis therefore reconstructs a developmental trajectory. A clinician may examine historical social relationships, language and communication, play, routines, sensory preferences, educational records, occupational experiences, and current adaptive functioning. The absence of an available parent, childhood records, or early diagnosis complicates the evidentiary process but does not automatically make evaluation impossible. A carefully documented clinical history can include the person's own recollections and other available sources.

Clinical classification, adaptive functioning, and support

Autistic adults vary in spoken language, intellectual functioning, mobility, adaptive skills, emotional regulation, executive functioning, and need for assistance. A measured intelligence score and capacity for independent everyday activities can diverge sharply: someone may excel at complex technical work while having major difficulty with household organization, personal care, or unpredictable transitions. Conversely, limited speech does not provide a valid estimate of intelligence or a complete account of comprehension. NICE explicitly asks clinicians to recognize differences between intellectual and adaptive functioning and to provide communication supports suited to the person. NICE CG142.

Diagnostic support levels are broad clinical descriptors of current need within specified domains. They should never substitute for an individualized assessment of communication, safety, sensory demands, housing, employment, health, relationships, autonomy, and fluctuating daily capacities. The traditional labels high-functioning and low-functioning collapse these dimensions into one misleading hierarchy. A scientifically useful profile states what a person can do, in which conditions, with which resources, and what assistance makes participation possible.

Autism, disability, and the environment

Autism can be associated with substantial impairments and disability, and those effects often interact with the design of social and physical environments. An accessible workplace may allow an autistic employee to communicate effectively and perform highly demanding tasks; a noisy, ambiguous, constantly changing setting may impose avoidable costs on the same person. The clinical and social perspectives are complementary for scientific analysis: one investigates neurodevelopmental characteristics and needs, while the other examines barriers, accommodations, rights, and participation. Meaningful care evaluates both. Pellicano and den Houting, 2022.

How autism is recognized and assessed in adulthood

Traits, screening, evaluation, and diagnosis

Autistic traits are characteristics that may appear across the general population and in several clinical or nonclinical contexts. A person's recognition of such traits can prompt reflection or a request for evaluation; trait recognition itself establishes neither the full diagnostic pattern nor its developmental history. A screening questionnaire estimates the relevance of selected features under the conditions in which that instrument was studied. Screening is a triage step. A comprehensive clinical assessment integrates developmental history, current observations, functional effects, differential diagnosis, associated conditions, and the individual's explanations. Formal diagnosis is the clinician's conclusion after examining the full evidence against relevant criteria.

The adult pathway commonly starts with a primary-care professional, specialist clinician, or qualified assessment service, depending on local health systems. NICE recommends considering comprehensive assessment when long-standing communication, social, behavioral, or developmental features coexist with relevant functional or clinical concerns. Its AQ-10 recommendation is a decision aid in the appropriate population, with clinical judgment remaining important even if a score falls below a specified threshold. This is a UK clinical pathway, not a universal requirement imposed on every country or assessment setting. NICE CG142.

Why questionnaires cannot establish a diagnosis

Screening tools perform differently across samples, referral settings, language groups, coexisting conditions, and thresholds. A test that distinguishes clearly defined research groups can lose discriminatory accuracy among adults referred to a specialist service, where anxiety, ADHD, trauma-related difficulties, and other presentations may also be common. A systematic review of adult measures identified consequential variation in validation evidence. One smaller UK referral study found that the RAADS-R did not predict diagnostic outcomes reliably in its sample, illustrating why online scores must not be used as categorical proof. Neither result means every instrument is useless in every setting; rather, the clinical question and validation population must match the proposed use. Baghdadli, Russet, and Mottron, 2017; Jones et al., 2021.

Structured interviews and observational instruments, including versions of the Autism Diagnostic Observation Schedule, may support an assessment when administered and interpreted by appropriately trained clinicians. They remain parts of a broader diagnostic process. They do not replace developmental history, culturally informed clinical judgment, and an assessment of alternatives. In adults with complex psychiatric histories, apparent social difficulties, repetitive behavior, or unusual sensory reports require careful contextual analysis, particularly when symptoms developed suddenly or show a distinct episodic course.

Differential diagnosis and coexistence

ADHD can share executive-functioning difficulties, difficulties shifting attention, restlessness, and social consequences, and the two conditions can coexist. Obsessive-compulsive disorder may involve repetitive actions, but the distressing intrusions and rituals associated with OCD require investigation of their function and meaning rather than classification by appearance alone. Social anxiety may affect eye contact, social participation, and speech through fear of evaluation, potentially coexisting with an autistic developmental communication profile. Personality-disorder evaluations, trauma-related symptoms, intellectual disability, psychotic disorders, learning disorders, hearing impairment, and language disorders can also be relevant in particular cases. Differential assessment asks how each phenomenon developed, what maintains it, how it changes by setting, and whether several explanations are simultaneously supported.

For context-specific evidence, consult the existing English chapters on OCD and autism, personality disorders and autism, and AuDHD. These examine different clinical questions and do not imply that one condition explains all features of another.

Later recognition, masking, and diagnostic equity

People may reach adulthood before autism is recognized because earlier environments accommodated their needs, their developmental history was interpreted through another diagnosis, clinicians relied on a narrow stereotype, or social expectations encouraged deliberate compensation. Camouflaging can include rehearsal, imitation, behavioral suppression, and strategies for navigating social interactions. Research also indicates that gender-related differences in measured presentation and camouflaging may contribute to diagnostic bias, although study designs and recruitment practices limit universal conclusions about all women, men, and gender-diverse people. Cruz et al., 2025; Nel, Spedding, and Malcolm-Smith, 2025.

Assessment access also differs by income, geography, race, language, disability complexity, and the availability of clinicians experienced with adults. Some research samples disproportionately represent verbally fluent adults recruited through English-speaking networks. That selection can produce a misleadingly narrow picture of autism and of the experiences most often described as late recognition. Scientific and clinical work must explicitly examine who is missing from the evidence and who receives timely evaluation.

Etiology, genetics, development, and brain science

Autism has a complex developmental etiology involving genetic influences and multiple developmental pathways. Family and genomic research supports a substantial genetic contribution at a population level, while variation in individual presentations and biological mechanisms remains extensive. Genetic contributions do not imply that a single marker provides a general diagnostic test, or that genes independently determine a person's social outcomes. Clinical evaluation is based on developmental and behavioral criteria; genetic investigations are reserved for appropriate individual indications such as associated congenital anomalies or intellectual disability, following specialist guidance. NICE CG142.

Neuroimaging, electrophysiology, experimental psychology, and computational studies investigate possible developmental pathways and patterns of information processing. Findings often involve overlapping group distributions and are sensitive to age, sampling, co-occurring conditions, task design, and analytic decisions. No single brain scan or laboratory biomarker presently identifies all autistic adults with diagnostic reliability. A research result showing an average difference between groups cannot determine whether an individual person meets clinical criteria or what supports will be effective for them.

Autism research also requires a developmental perspective on social opportunity. Long-term outcomes reflect individual characteristics, educational access, discrimination, mental and physical health, support services, financial resources, and changing responsibilities. Cross-sectional observations about adults of different ages may confound birth-cohort changes in diagnosis and access with actual developmental change. Longitudinal, representative, and participatory studies are crucial to separating these influences.

Sensory processing, attention, and everyday regulation

Sensory hyperresponsivity and hyporesponsivity

Sensory experience is central to many autistic adults' daily lives. Sounds that others regard as background may be intense or distracting; lighting, textures, smells, temperature, crowded spaces, and unexpected touch may become exhausting. Other people may detect certain bodily or environmental signals less readily or seek specific sensory experiences. Sensory profiles can vary by modality and context and may change with fatigue, stress, illness, or familiarity. A 2024 systematic review and meta-analysis reported associations between different sensory-processing differences and internalizing or externalizing difficulties, while emphasizing heterogeneity and limited longitudinal evidence. Association alone does not establish a single causal pathway from sensory variation to psychiatric illness. Chen et al., 2024.

Practical accommodations include control over lighting, hearing protection where appropriate, quiet spaces, predictable transitions, flexibility around clothing or textures, written preparation for unfamiliar settings, and opportunities to take breaks. Their value depends on the person's own goals and sensory profile. A preference for dimmer light or a need to avoid crowded transit is not a diagnostic test; it is useful information for identifying how daily functioning can be improved.

Stimming, routines, and interests

Repetitive movements, sounds, manipulation of objects, and other forms of stimming can serve functions related to regulation, attention, enjoyment, or expression. Specific patterns can also occur in people who are not autistic. Whether a movement is helpful, distressing, painful, socially constrained, or functionally interfering is more informative than assuming one meaning from its appearance. Repetitive behavior must be interpreted in context, particularly when distinguishing it from involuntary tics, compulsions, medication-related movements, or other neurological symptoms. The published article on tics versus stimming and stereotypies addresses that differential question.

Focused interests may provide deep expertise, pleasure, predictability, identity, and social connection. Some interests can also create practical conflicts with sleep, safety, deadlines, or other priorities. Research and clinical work should examine the meaning of an activity and its relationship to a person's chosen goals. The mere intensity of an interest does not establish dysfunction. A useful support plan may preserve valued interests while making competing responsibilities easier to manage.

Executive functioning, transitions, and interoception

Planning, initiation, working memory, cognitive flexibility, monitoring, and switching between tasks can place uneven demands on autistic adults. A person who understands a task perfectly may struggle to begin it, interrupt one activity, or manage several simultaneous requests. These difficulties are also studied in ADHD, depression, sleep disorders, and other conditions. They cannot be assigned to autism solely by observing procrastination or time-management problems. Clear sequencing, environmental cues, reduced competing demands, and collaborative planning may improve daily functioning without assuming that one strategy fits all.

Interoception concerns the detection and interpretation of internal bodily signals, including hunger, thirst, fatigue, pain, and physiological arousal. Autistic people may report distinctive experiences in this domain, but findings depend on what a study measures: subjective attention to internal states, objective task performance, and accuracy are distinct constructs. Likewise, alexithymia describes difficulty identifying and describing feelings and may coexist with autism without being a required feature of it. For the broader scientific construct see Alexithymia: Difficulty Identifying and Describing Feelings.

Communication, language, and mutual understanding

Autistic adult communication encompasses spoken and written language, gesture, nonverbal signaling, literal and figurative interpretation, conversational timing, pragmatic language, and augmentative and alternative communication (AAC). Some adults communicate fluently in speech and experience subtle pragmatic mismatches; others use text, speech-generating devices, signs, or other systems. Communication accessibility requires attention to the partner and environment as well as the autistic person. A 2025 review emphasized how differences in language, nonverbal expression, social expectations, and unaccommodating contexts jointly influence participation in relationships, work, and healthcare. de Marchena et al., 2025.

A useful clinical interaction can provide written agendas, concrete explanations, extra processing time, questions without ambiguous subtext, and alternative methods of answering. Clinicians should ask how someone prefers to communicate rather than inferring comprehension from eye contact, prosody, speech quantity, or verbal fluency alone. People who use AAC need reliable access to their communication method in appointments, emergencies, schools, housing, and employment settings. Participation also requires that communication partners adapt rather than putting the entire burden of mutual understanding on the autistic individual.

Empathy and the double empathy question

Empathy is multidimensional. Cognitive empathy concerns inferring another person's perspective or mental state, while affective empathy involves emotional responsiveness and related constructs. A 2025 meta-analysis found that estimated autism-group differences depended substantially on the measure; affective empathy results were much smaller than cognitive or unidimensional measures and became nonsignificant under one high-quality-study restriction. Consequently, claims that autistic people universally lack empathy are scientifically inaccurate. Individual experiences and tasks vary, and empathy questionnaires do not exhaust emotional or relational ability. Cusson et al., 2025.

The double empathy problem proposes that misunderstandings across different neurocognitive perspectives may arise reciprocally. It has influenced studies of interaction, rapport, and communication, and is valuable as a hypothesis about relationships and context. Its empirical boundaries remain under active examination: outcomes differ by how rapport, social inference, and cognitive versus affective empathy are defined. A 2026 methodological review specifically questions the interpretation of certain experiments as direct tests of empathy. Neither the hypothesis nor its critiques justify uniform statements about every autistic–nonautistic conversation. Fellowes, 2026.

Monotropism and demand avoidance

Monotropism describes a theoretical approach to attentional allocation, especially intensive allocation toward a limited number of interests or tasks. It offers potentially useful language for some subjective experiences, yet the generality, construct validity, and ability of its measures to distinguish autism from other conditions need further research. Extreme or persistent avoidance of demands is sometimes discussed using the expression pathological demand avoidance or a PDA profile. PDA is not a separately established DSM-5-TR or ICD-11 autism diagnosis. Distress, anxiety, autonomy, cognitive load, trauma, sensory overload, and environmental demands may require distinct clinical investigation. Assessing the cause and meaning of avoidance is more informative than assigning an explanatory label without a differential evaluation.

Camouflaging, identity, unmasking, and burnout

Camouflaging may involve deliberate imitation of social conventions, compensatory preparation, concealment of self-regulatory behaviors, or suppression of visible distress. Its function can range from safety and employment access to social belonging and personal preference. An integrative systematic review synthesized a variety of strategies and contextual influences but highlighted sample concentration in specific regions and demographic groups. Clinical discussions should distinguish a freely chosen social skill, a costly adaptation, and coercive pressure to suppress difference. Nel et al., 2025.

Unmasking describes reducing some compensatory behaviors or becoming more open about one's communication, regulation, and identity. It can be beneficial in supportive environments, yet the safety and practical consequences of disclosure differ across workplaces, families, cultures, and communities. There is no scientific requirement that every autistic adult disclose a diagnosis or abandon every learned interaction strategy. The relevant questions concern autonomy, health, risks, trust, and the opportunity to choose. See Autistic Unmasking: What It Means and Whether It Is Always Helpful.

Autistic burnout is an emerging descriptive construct used for severe and sometimes prolonged exhaustion, reduced functional capacity, and heightened difficulty coping with ordinary demands. A 2025 systematic review of 48 studies described the involvement of prolonged stress, societal barriers, sensory and social demands, and camouflaging, while documenting substantial limitations in sampling and measurement. Burnout is not presently a separately defined DSM-5-TR or ICD-11 diagnosis. Assessment must also consider depression, sleep disorders, medical illness, medication effects, and other explanations. Recovery planning may address rest, accommodations, clinical needs, and external demands, while the effectiveness of specific protocols remains incompletely tested. Ali et al., 2025; Autistic Burnout: Signs, Causes, Recovery, and What the Evidence Says.

The broader evidence on camouflaging and mental health is largely correlational. A meta-analysis found associations with anxiety, depression, social anxiety, and reduced well-being; those data do not independently prove that camouflaging causes any particular disorder. A mixed-methods review of camouflaging and suicidality likewise identified concerning associations while noting sparse evidence and unresolved causal pathways. Research should now test mechanisms, temporal sequences, contextual moderators, and outcomes among adults less represented in current surveys. Khudiakova et al., 2024; Arqueros et al., 2025.

Mental health, suicide prevention, and physical healthcare

Autistic adults can experience depression, anxiety disorders, obsessive-compulsive symptoms, trauma-related conditions, sleep problems, and psychosis, with important variations in how distress is experienced and communicated. These conditions warrant direct assessment according to their own clinical criteria. Sensory overload, shutdown, exhaustion, communication difficulties, or an altered routine may coexist with psychiatric illness or arise from other mechanisms. Equating all distress with autism risks missed care, while interpreting every autistic trait as psychopathology can create inappropriate treatment. The clinical task is to investigate change from a person's baseline, context, severity, duration, functional effects, and safety.

Population research indicates an elevated risk of suicide mortality among autistic people, although pooled estimates vary by setting and study design. One 2024 systematic review and modeling analysis reported increased relative risk and emphasized limitations in geographic coverage. A population-average estimate does not determine any individual's current risk. Direct inquiry into suicidal thoughts, intent, planning, self-injury, access to means, supports, and immediate safety remains necessary when indicated. Severe acute risk calls for urgent local emergency evaluation and active support, with communication adapted to the person's needs. Santomauro et al., 2024.

Physical health deserves the same clinical attention as mental health. Pain, gastrointestinal symptoms, epilepsy, sleep disturbance, adverse effects of medication, and other medical concerns may alter behavior and tolerance of daily demands. Healthcare encounters can become inaccessible through crowded waiting rooms, unexpected touch, figurative explanations, rushed questions, or failure to accommodate alternative communication. A 2024 qualitative synthesis of UK healthcare experiences reported barriers associated with inadequate professional knowledge, processing demands, and insufficient adaptations. These findings support practical service changes while their regional sampling limits generalization to all health systems. Radev, Freeth, and Thompson, 2024.

Evidence-based treatment, accommodations, and support

Define the goal before choosing an intervention

A scientifically grounded support plan starts with an individual's desired outcomes: reduced anxiety, safer and more accessible care, independence in a chosen activity, reliable communication, improved sleep, relationships, employment, relief from overload, or treatment of a co-occurring condition. Autism-related traits, disability-related support needs, and other diagnosable conditions may require different services. A program aimed at making a person appear socially typical is not automatically an improvement in health or quality of life. Outcomes should include the person's informed priorities, adverse effects, feasibility, autonomy, and sustainability.

NICE recommends person-centered care, accessible communication, and coordination across health and social systems. Its adult guideline describes situations in which structured social learning, daily-living support, supported employment, and activity programs may be considered. Recommendations are linked to specified needs and populations; they should not be generalized into mandatory treatment for everyone. The guideline also emphasizes assessing environmental factors and coexisting conditions when behavior becomes challenging. NICE CG142.

Psychotherapy and care for co-occurring conditions

Cognitive-behavioral and other evidence-based psychological interventions may be adapted to treat anxiety, depression, and other conditions in autistic adults. Useful adjustments can include predictable session structure, concrete language, written plans, sensory accommodations, processing time, explicit discussion of goals, collaborative choice about family involvement, and practical emphasis where appropriate. NICE outlines several such adaptations. A 2024 systematic review of adult mental-healthcare approaches found promising acceptability and feasibility but insufficient conclusive evidence of effectiveness across the evaluated approaches. Thus, accessibility is an urgent practice requirement, while comparative treatment efficacy and ideal personalization remain active research questions. NICE CG142; Loizou et al., 2024.

Clinical support may also include occupational therapy, speech-language support, AAC services, disability assistance, peer support, family education, housing services, vocational assistance, and environmental changes according to individual needs and local availability. Quality should be judged by meaningful outcomes, informed choice, safety, and the person's own account. Research should evaluate both benefits and harms, recognizing that some autistic adults have limited access to studies and to services designed around their communication needs.

Medication and the boundaries of pharmacology

There is no medication established to remove the defining neurodevelopmental characteristics of autism. Medication may be appropriate for a diagnosed co-occurring condition or a particular symptom after individualized assessment. NICE advises against the routine use of antidepressants or antipsychotics for core autism features and distinguishes treatment of associated mental disorders from interventions for core features. Unapproved claims about supplements, chelation, oxytocin, restrictive diets, and similar approaches should not guide care. Prescribing decisions require attention to indication, potential adverse effects, sensory sensitivities, informed consent, monitoring, and the patient's other medications and medical conditions. NICE CG142.

Work, education, housing, and independent adult life

Employment outcomes reflect hiring practices, sensory environments, job design, social expectations, work hours, transportation, disclosure choices, and access to ongoing support. A person may need clear written instructions, a quiet workspace, predictable scheduling, explicit feedback, remote-work flexibility, or a supported employment program. The best accommodation is task- and individual-specific. In the United States, disability-related workplace obligations are governed by applicable law and facts; accommodations should be discussed through the appropriate legal and employment channels rather than inferred solely from an autism label. Supported employment approaches are included in the NICE adult guideline for adults experiencing relevant barriers. NICE CG142.

Higher education introduces simultaneous demands involving study skills, independent living, administrative communication, crowded campus environments, finances, and social participation. Some students benefit from written assessment instructions, quieter testing locations, flexibility around sensory demands, disability accommodations, and access to mental-health services. Universities and colleges differ in available resources and eligibility rules. The scientific focus should remain on learning and participation outcomes rather than a universal model of what an autistic student should be able to do independently.

Housing and independent living are multidimensional. Daily skills may include cooking, personal care, scheduling, medication management, financial decisions, transportation, and communication with service providers. Adaptive difficulties can coexist with high achievement in an academic or occupational domain. Support may range from simple environmental cues and scheduled assistance to intensive ongoing services. Independence is most usefully understood through informed choice and appropriate support, not by measuring distance from family, the use of assistance, or a single living arrangement.

Relationships, sexuality, parenting, and community participation

Autistic adults form friendships, partnerships, families, and communities in varied ways. Communication preferences, sensory experiences, social expectations, explicitness, intimacy, shared interests, and need for solitude can shape interpersonal negotiation. A mismatch in expectations may require reciprocal communication and adjustment; it does not by itself indicate an absence of care, affection, or capacity for connection. Relationship support should respect consent, privacy, sexual orientation, identity, and each person's goals rather than prescribing one socially normative form of partnership.

Sexual health includes knowledge, desire, consent, contraception, safety, communication, healthcare access, and vulnerability to exploitation. A 2025 systematic review found meaningful barriers and heterogeneous experiences, while indicating a need for better-quality, representative research. Accessible sex education, direct conversations about consent and boundaries, and nonjudgmental reproductive and sexual healthcare are relevant to many adults, with individual preferences guiding how support is delivered. Motamed et al., 2025.

Autistic parents and caregivers may encounter a combination of practical burdens, rewarding relationships, sensory pressures, strengths, and service barriers. A parent needs assessment of actual circumstances rather than stereotypes about autism. Similarly, partners and family members may benefit from support that improves shared communication and respects the autistic adult's self-determination. Community participation also depends on accessible public spaces, transportation, civic engagement, healthcare, and the availability of leisure activities built around individual interests.

Neurodiversity: science, language, rights, and debate

Neurodiversity describes the fact and conceptual significance of variation in human neurocognitive functioning. In research and public discourse it also names a movement concerned with dignity, equitable participation, disability rights, and the role of environmental barriers. Neurodivergent is a descriptive identity or social term used in multiple communities; it has no single clinical criterion set. Neurotypical is similarly contextual rather than a diagnostic category. Autism is a defined clinical condition that can also be understood through disability studies and first-person identity. These vocabularies can coexist when their meanings are stated carefully. Pellicano and den Houting, 2022.

Language preferences differ among autistic people. Identity-first language, such as autistic person, is preferred by some; person-first language, such as person with autism, is preferred by others. Preferences also vary for terms such as disorder, condition, disability, difference, and neurodivergent. A 2025 survey found a range of attitudes related to neurodiversity-movement identification; the participants were a selected group, not a universal authority over every autistic person's vocabulary. In clinical and editorial practice, use accurate terminology and respect an individual's expressed preference. Dwyer et al., 2025.

A social model of disability highlights that institutions and environments can create or magnify barriers. Medical models identify clinically significant impairments, health needs, and possible interventions. Both areas address observable parts of adult life. Research advances when it tests concrete claims about accessible design, social support, discrimination, physiological needs, function, and well-being. An affirming approach can involve evidence-based treatment for pain or depression, extensive daily support, and substantial disability accommodations without imposing a single identity or a presumed life trajectory.

Epidemiology and what prevalence figures mean

Prevalence estimates are conditional on diagnostic criteria, sampling methods, age distribution, access to assessment, and statistical models. The CDC published a discussion of a US estimate of 2.21% for adults based on 2017 data. That number is a model-based estimate, not a direct population count conducted in 2026. It also cannot be converted into a personal probability of autism or equated with the number of adults holding a formal diagnosis. Population surveillance designed around children, administrative diagnoses, and adult community surveys each capture different processes. CDC, 2025.

Increases in recorded diagnoses over time may reflect changes in awareness, diagnostic practices, professional training, service availability, records, and real patterns of identification. Their interpretation requires analysis rather than the assumption that one mechanism explains every observed trend. Studies should distinguish incidence, prevalence, lifetime recognition, age at diagnosis, and service use. Geographic comparisons require a common case definition and comparable methods.

Research quality, ethics, and the next generation of adult autism science

Adult-autism evidence includes population databases, cross-sectional questionnaires, clinical cohorts, longitudinal observation, experimental tasks, intervention trials, qualitative interviews, and participatory studies. Each design supports different inferences. Cross-sectional associations cannot establish temporal causation. Clinical referrals are not representative of all autistic adults. Self-report studies may exclude people with limited access to written language. Experimental social-cognition tasks may measure compliance with particular test conventions as well as the construct they claim to represent. Inferences require attention to sampling, instruments, comparison groups, statistical uncertainty, and the social situation in which data were produced.

Community participation in research design can improve the relevance of questions, the clarity of measures, accessible consent and recruitment, and the selection of meaningful outcomes. It does not replace transparent methods, replication, or critical analysis. Pellicano and den Houting describe the shift toward a neurodiversity-informed research framework; scientific credibility depends on rigorous empirical work and sustained partnership with the communities whose lives the findings are meant to inform. Pellicano and den Houting, 2022.

Several key questions remain open: how to recognize autism accurately in older adults and culturally underrepresented communities; which components of adult assessment improve diagnostic validity; how adaptive functioning changes with supports and life transitions; which treatments reliably improve mental-health outcomes; what features define and predict autistic burnout; how sensory accommodations affect long-term well-being; and which systems increase autonomy and participation. These questions require research that represents nonspeaking adults, people with intellectual disabilities, different socioeconomic circumstances, and a broader range of cultural settings.

Interpreting evidence by level of certainty

Established evidence supports the validity of autism as a neurodevelopmental diagnostic category, broad individual heterogeneity, the central relevance of sensory and communication differences, the need for comprehensive adult assessment, and the importance of evaluating co-occurring physical and mental health conditions. Evidence supporting practical accommodations is strong as a clinical and accessibility principle, while individual interventions still require outcome-specific evaluation. Reviews of mental-healthcare adaptations provide encouraging feasibility results with more limited causal evidence for effectiveness. Evidence concerning camouflaging, burnout, diagnostic bias, and social communication is developing and depends on study design and measured constructs. Monotropism, a single comprehensive double-empathy account, and PDA as a proposed autism profile remain theoretical or contested in their more expansive claims. Each claim should be read at the level of evidence that supports it.

Frequently asked questions

Can autism first develop in adulthood?

Autism is defined as neurodevelopmental. First recognition or diagnosis in adulthood does not mean that the developmental condition began then. Clinicians investigate evidence of relevant earlier characteristics, while recognizing that increasing demands and social compensation can change how traits become visible.

Does a high online autism-test score mean someone is autistic?

A score may support seeking professional assessment but does not establish a diagnosis. Interpretation depends on the instrument, validation population, other conditions, and a comprehensive developmental and clinical evaluation. An inconclusive or low score also should not override a well-founded clinical concern.

Can autistic adults have strong empathy, close relationships, or demanding careers?

Yes. Autistic adults differ greatly in empathy profiles, emotional expression, social preferences, communication methods, and career paths. Broad statements about universal deficits fail to capture individual variation and measurement limits. Support needs may remain substantial in some areas despite pronounced ability in others.

Is autistic burnout a recognized diagnosis?

Autistic burnout is an actively studied descriptive construct. Research reports significant exhaustion and difficulty functioning, but it is not a separate DSM-5-TR or ICD-11 diagnosis. Evaluation should consider coexisting depression, sleep problems, medical conditions, overload, and contextual stressors.

Is neurodivergent the same as having an autism diagnosis?

No. Neurodivergent is a nonclinical descriptive term used in diverse contexts. A formal autism diagnosis requires application of specific clinical criteria. A person's identification with neurodiversity language is a separate consideration from a clinician's diagnosis.

Do medications treat the core features of autism?

No medication has been established to remove the defining core characteristics of autism. Some medicines may be indicated for coexisting disorders or specific clinical problems after individualized assessment. Accessible supports, accommodations, and care for coexisting conditions address distinct needs.

What should an adult expect from an autism assessment?

The process typically considers developmental history, current social-communication and behavioral patterns, sensory experiences, adaptive functioning, mental and physical health, and alternative or coexisting explanations. Instruments may assist but the assessment is broader than any single test. Specific pathways differ across health systems.

Articles in This Research Cluster

Autistic Relationships and Dating: Communication and Mutual Understanding — Research on dating, communication between partners, consent, mutual understanding and relationship support.

The following articles are published in the English edition and address independent questions within adult autism and neurodiversity.

ADOS-2 and Adult Autism Assessment: Uses and Limitations — How standardized adult autism observation is used alongside developmental history, differential diagnosis and clinical interpretation.

The following articles are published in the English edition and address independent questions within adult autism and neurodiversity. Each entry links to a verified English-language scientific article.

AuDHD: What It Means to Have Both Autism and ADHD — An examination of co-occurring autism and ADHD, including overlapping experiences and diagnostic complexity.

Autism in the Workplace: Employment, Disclosure, and Support — Employment experiences, recruitment, disclosure decisions, career development, workplace barriers, and evidence-informed support.

Autism Masking and Camouflaging: Strategies, Costs, and Context — A research review of masking, compensation, assimilation, contextual demands, mental-health associations, measurement, and individualized support.

Autism and Executive Function: Planning, Shifting, and Daily Demands — Evidence on planning, cognitive flexibility, task shifting and daily demands, with individualized assessment and practical supports.

Autistic Burnout: Signs, Causes, Recovery, and What the Evidence Says — The research-emergent burnout construct, observed patterns, limitations of evidence, and support implications.

Autistic Unmasking: What It Means and Whether It Is Always Helpful — How changes in camouflaging relate to autonomy, practical safety, and psychological well-being.

Autistic Shutdowns: Overload, Communication, and Recovery — A scientific account of overload-related loss of response, temporary communication barriers, differential evaluation, and individualized recovery support.

Autistic Stimming: Repetitive Movements, Regulation, and Context — The forms, sensory and emotional functions, social contexts, clinical distinctions, and safe accommodation of stimming in autistic adults.

Suicide Risk in Autistic Adults: Evidence, Assessment, and Prevention — An evidence-based account of suicide risk in autistic adults, individualized assessment, accessible crisis care, safety planning, and prevention.

Workplace Accommodations for Autistic Adults: Practical Options and ADA Context — Practical sensory, communication, scheduling, and organizational accommodations, with U.S. ADA rights, disclosure decisions, and the evidence behind workplace support.

Autism and Depression in Adults: Recognition, Risk, and Care — Evidence on depression recognition in autistic adulthood, differentiation from burnout and overload, suicide risk, assessment limitations, and adapted clinical care.

Autistic Meltdowns: Overload, Signs, and Support — A scientific examination of overload episodes in autistic adults, early warning signs, immediate safety, individual recovery needs, and practical support.

Adult Autism Screening Tests: AQ-10, RAADS-R, and Clinical Limits — AQ-10, RAADS-R, clinical referral accuracy, false-positive screening, scores and the comprehensive diagnostic process.

Signs of Autism in Adults: Social, Sensory, and Behavioral Patterns — Recognition-focused analysis of social communication, sensory features, repetitive patterns, masking, differential considerations, and when comprehensive clinical assessment is useful.

Adult Autism Diagnosis: Assessment, Criteria, and What to Expect — A step-by-step clinical guide to evaluation, diagnostic criteria, developmental history, differential assessment, screening limits, feedback, and follow-up.

Neurodiversity: Meaning, History, and Scientific Context — A scientific history and conceptual analysis of human neurocognitive variation, the neurodiversity movement, clinical categories, evidence, disability, and research applications.

Neurodivergent vs Neurotypical: What These Terms Mean — Defines the nonclinical identity descriptors, their use across conditions, and their relationship to formal diagnosis and individualized support.

The Double Empathy Problem in Autism: Theory and Evidence — A critical research synthesis of bidirectional social understanding, neurotype-matched interaction experiments, communication efficiency, rapport and contemporary methodological debate.

Autistic Communication Differences in Adults: Language and Mutual Understanding — Evidence on adult pragmatic language, speech and nonverbal cues, augmentative communication, accessible conversations, and reciprocal understanding.

Neurodiversity-Affirming Care: Principles, Evidence, and Practice — A scientific examination of accessible communication, collaborative clinical decisions, therapy adaptations, autonomy, outcomes, and the maturity of evidence.

Autism in Adults: Genetics, Brain Development, and Causal Research — Heritability, common and rare genetic variants, developing brain pathways, causal inference, environmental evidence, and genetic testing in adulthood.

Self-Identified Autism and Formal Diagnosis: Evidence and Decisions — An evidence-focused guide to the differences between self-identification, screening, formal autism assessment, access barriers, and personal decisions.

Autism and Interoception: Body Signals, Awareness, and Research — Scientific evidence on hunger, thirst, bodily awareness, cardiac measurement, alexithymia, daily support and limitations of current research.

Adult Autism Prevalence: Estimates, Methods, and Interpretation — A research-based analysis of adult autism prevalence, the 2017 U.S. model, direct community surveys, changes in recorded diagnoses, and statistical uncertainty.

Autism Diagnosis Disclosure: Work, Relationships, and Personal Choice — Research on privacy, workplace and relationship disclosure, informed choice, the benefits and harms of disclosure, and US accommodation rules.

Medication and Autism in Adults: What It Can and Cannot Treat — Adult medication indications and limitations: depression, ADHD, sleep, specialist antipsychotic use, side effects and personalized care.

Autism Research Methods: Participatory Science and Measurement — How participatory science, community governance, representation, measurement validity, and ecological research design shape the quality of autism evidence.

Autistic Parenting: Family Roles, Strengths, and Support — Scientific evidence on autistic mothers and fathers, parenting roles, communication, sensory and executive demands, family strengths, mental health, stigma, and individualized support.

Autistic Friendships and Social Connection in Adulthood — Evidence on reciprocal friendship, loneliness, community belonging, communication styles, online connection, and accessible support.

Autistic Adults and College: Transitions, Access, and Support — Evidence-based guidance to higher-education transitions, postsecondary disability access, accommodations, executive and sensory supports, health, self-advocacy, and adult student participation.

Autism and Psychosis: Diagnostic Overlap and Clinical Assessment — A clinical guide to autism-specific psychosis differential diagnosis, new symptoms, longitudinal assessment, co-occurrence, and accessible care.

Asperger Syndrome and Autism: History, Classification, and Identity — the history of the Asperger label, DSM and ICD classification changes, Nazi-era archival evidence, and contemporary identity.

Autism and Sexual Health in Adults: Relationships, Consent, and Care — A scientific guide to sexual health, affirmative consent, sensory and communication needs, relationships, reproductive care, and accessible services for autistic adults.

Autism in Adults: Characteristics, Diagnosis, and Support — Explore adult autism characteristics, diagnostic considerations, everyday support needs, and how autistic experiences vary across people and settings.

Autism Spectrum Disorder: DSM-5-TR and ICD-11 Diagnostic Criteria — Compare DSM-5-TR and ICD-11 autism criteria, including social communication, repetitive patterns, developmental history, and clinical judgment.

Autism Support Needs and Diagnostic Levels: Meaning and Limitations — Understand autism support levels, how they are assigned, what they can describe, and why individual needs change across environments.

Autism in Women: Signs, Masking, and Diagnostic Bias — Explore autism in adult women, including camouflaging, overlooked developmental patterns, diagnostic bias, and differences in presentation.

Late Autism Diagnosis in Adulthood: Recognition and Adjustment — Understand late autism diagnosis, why recognition may take decades, how assessment works, and what a diagnosis can mean for adult life.

Autism in Older Adults: Recognition, Aging, and Support — Explore autism in older adults, including lifelong traits, late recognition, aging-related changes, assessment, and appropriate support.

Autism vs ADHD in Adults: Similarities and Diagnostic Differences — Compare autism and ADHD in adults, including shared traits, developmental differences, co-occurrence, and clinical assessment questions.

Autism and Intellectual Disability in Adults: Differences and Support — Explore how autism and intellectual disability can co-occur, with attention to adaptive functioning, communication, diagnosis, and support.

Non-Speaking Autistic Adults: Communication and Support — Understand nonspeaking autistic adults, communication access, augmentative and alternative communication, autonomy, and inclusive care.

Autistic Sensory Processing: Hypersensitivity, Hyposensitivity, and Accommodations — Explore hyper- and hyposensitivity in autistic adults, sensory processing research, everyday overload, and practical accommodations.

Autistic Inertia: Task Initiation, Transitions, and Evidence — Understand autistic inertia, difficulties starting or stopping tasks, links to executive function, and limitations of current research.

Autism and Alexithymia: Emotions, Assessment, and Co-Occurrence — Learn how autism and alexithymia relate, how emotional identification is studied, and why the two constructs should be assessed separately.

Autistic Special Interests: Focus, Motivation, and Well-Being — Explore focused interests in autism, their role in diagnostic descriptions, motivation, learning, identity, and everyday well-being.

Autism and Empathy: What the Research Actually Measures — Examine research on autism and empathy, including cognitive and affective dimensions, measurement bias, and differences among individuals.

Monotropism and Autism: Attention Theory and Research Limits — Explore monotropism as an attention theory of autism, including its proposed mechanisms, current research, and unanswered questions.

Autism and Trauma in Adults: Experiences, Assessment, and Support — Explore trauma experiences in autistic adults, stress responses, assessment issues, and adaptations that may improve access to care.

Autism and Sleep Problems in Adults: Causes and Support — Understand sleep difficulties in autistic adults, possible contributors, assessment, evidence-based approaches, and everyday support.

Autism and Physical Health in Adults: Care Barriers and Accommodations — Explore physical health and health care barriers for autistic adults, including communication, sensory access, and clinical accommodations.

Autistic Adults and Independent Living: Daily Skills and Services — Understand independent living for autistic adults, including daily-life support, housing, autonomy, services, and individualized planning.

Autism, Disability, and the Social Model: Rights and Support — Examine autism through disability rights and the social model, including environmental barriers, support needs, and individual variation.

Autism and Gender Diversity: Research and Care — Explore research on autism and gender diversity, including reported associations, measurement questions, and inclusive clinical care.

Demand Avoidance and PDA in Autism: Claims and Clinical Evidence — Understand demand avoidance and the proposed PDA profile in autism, including research limitations and clinical classification.

Adult Autism Treatment and Support: Evidence-Based Options and Clinical Care — Explore evidence-based adult autism support, clinical services, psychosocial interventions, care goals, and what current guidelines recommend.

How to Support an Autistic Adult: Communication, Autonomy, and Accommodations — Learn practical ways to support autistic adults, including communication, sensory accommodations, autonomy, consent, and collaboration.

Related Articles

OCD and Autism: What Is the Connection? — Diagnostic overlap, co-occurrence, routines, compulsions, and clinical differentiation.

Anxiety and Autism: Comorbidity, Uncertainty, Sensory Stress, and Assessment — Assessment of anxiety experiences and their environmental context.

Tics vs Stimming and Stereotypies: How Repetitive Movements Differ — Differential interpretation of repetitive movement patterns.

Personality Disorders and Autism: Diagnostic Overlap and Differences — Why developmental history and context matter in adult differential diagnosis.

Alexithymia: Difficulty Identifying and Describing Feelings — Emotional awareness and an associated but distinct construct.

Autism vs ADHD in Adults: Similarities and Diagnostic Differences — An adult differential-diagnosis comparison of shared behaviors, distinct neurodevelopmental criteria, co-occurrence, clinical tools, and individualized support.

Autistic Sensory Processing: Hypersensitivity, Hyposensitivity, and Accommodations — Scientific analysis of sensory hyperreactivity, hyporeactivity, seeking, assessment, daily-life accommodations, and intervention evidence for autistic adults.

Autism Spectrum Disorder: DSM-5-TR and ICD-11 Diagnostic Criteria — Comparison of DSM-5-TR and ICD-11 adult-autism diagnostic domains, clinical thresholds, qualifiers, and assessment safeguards.

Autism in Adults: Characteristics, Diagnosis, and Support — A comprehensive scientific and clinical guide to lifelong autism characteristics, adult diagnosis, individual variation, and personalized support.

Late Autism Diagnosis in Adulthood: Recognition and Adjustment — A research-based examination of delayed recognition, diagnostic assessment, barriers to care, identity, relationships, and adjustment after adult autism diagnosis.

Autism in Women: Signs, Masking, and Diagnostic Bias — Evidence on autistic women’s developmental histories, camouflaging, sex and gender diagnostic bias, and adult assessment.

Autism Support Needs and Diagnostic Levels: Meaning and Limitations — Explains DSM-5-TR support levels, individual assessment, real-world needs and the limitations of numerical severity specifiers.

Autism and Empathy: What the Research Actually Measures — Evidence review of cognitive and affective empathy, questionnaire validity, alexithymia, and reciprocal understanding in autistic and nonautistic adults.

Autism in Older Adults: Recognition, Aging, and Support — Lifelong autism recognition, later-life cognitive change, differential assessment, geriatric care, retirement, housing, and individualized support.

Adult Autism Treatment and Support: Evidence-Based Options and Clinical Care — A research-informed guide to psychosocial interventions, clinical care, communication and sensory accommodations, mental and physical health services, and individualized adult support.

Autistic Inertia: Task Initiation, Transitions, and Evidence — Evidence-focused analysis of difficulty starting, stopping, and switching activities; clinical distinctions and practical supports.

Autistic Special Interests: Focus, Motivation, and Well-Being — research on interest intensity, intrinsic motivation, learning, identity, participation, and well-being in autistic adults.

Autism and Intellectual Disability in Adults: Differences and Support — Evidence-based distinctions, intellectual and adaptive assessment, communication access, individualized supports, and adult participation.

Non-Speaking Autistic Adults: Communication and Support — Research-based guidance to communication access, AAC, independent authorship, healthcare, autonomy, and support for nonspeaking autistic adults.

Autism, Disability, and the Social Model: Rights and Support — An evidence-based examination of disability models, environmental barriers, accessibility, rights, and individualized support for autistic adults.

Autism and Gender Diversity: Research and Care — Research on the association between autism and gender diversity, prevalence uncertainty, careful assessment, and accessible clinical care.

Autism and Sleep Problems in Adults: Causes and Support — Adult sleep difficulties, sensory and circadian contributors, clinical assessment, adapted CBT-I, medication evidence, and accessible support.

Monotropism and Autism: Attention Theory and Research Limits — Theory of attentional allocation in autism, laboratory and self-report findings, and current limits of construct validity.

References

Ali, D., Bougoure, M., Cooper, B., et al. (2025). Burnout as experienced by autistic people: A systematic review. Clinical Psychology Review, 122, 102669. https://doi.org/10.1016/j.cpr.2025.102669

Arqueros, M., Jamett-Cuevas, V., Pulgar-Vera, V., et al. (2025). Camouflaging and suicide behavior in adults with autism spectrum condition: A mixed methods systematic review. Research in Autism, 202540. https://doi.org/10.1016/j.reia.2025.202540

Baghdadli, A., Russet, F., & Mottron, L. (2017). Measurement properties of screening and diagnostic tools for autism spectrum adults of mean normal intelligence: A systematic review. European Psychiatry. https://doi.org/10.1016/j.eurpsy.2017.04.009

Centers for Disease Control and Prevention. (2025). Autism spectrum disorder in teenagers and adults. https://www.cdc.gov/autism/about/asd-in-teenagers-adults.html

Chen, Y., Xi, Z., Saunders, R., et al. (2024). A systematic review and meta-analysis of the relationship between sensory processing differences and internalising/externalising problems in autism. Clinical Psychology Review, 114, 102516. https://doi.org/10.1016/j.cpr.2024.102516

Cruz, S., Conde-Pumpido Zubizarreta, S., Costa, A. D., et al. (2025). Is there a bias towards males in the diagnosis of autism? A systematic review and meta-analysis. Neuropsychology Review, 35, 153–176. https://doi.org/10.1007/s11065-023-09630-2

Cusson, N. M., Meilleur, A. J., Bernhardt, B. C., Soulières, I., & Mottron, L. (2025). A systematic review and meta-analysis of empathy in autism: The influence of measures. Clinical Psychology Review, 120, 102623. https://doi.org/10.1016/j.cpr.2025.102623

de Marchena, A., Cuneo, N., Gurbuz, E., et al. (2025). Communication in autistic adults: An action-focused review. Current Psychiatry Reports, 27, 471–481. https://doi.org/10.1007/s11920-025-01616-6

Dwyer, P., Hersh, L. H., Kapp, S. K., Rivera, S. M., & Gillespie-Lynch, K. (2025). Neurodiversity movement identification and perceived appropriateness of terms used to describe autism. Autism in Adulthood. https://doi.org/10.1089/aut.2024.0297

Fellowes, S. (2026). Cognitive empathy, affective empathy and empirical research on the double empathy problem: A critical methodology review. Journal of Autism and Developmental Disorders. https://doi.org/10.1007/s10803-026-07315-2

Jones, S. L., Johnson, M., Alty, B., & Adamou, M. (2021). The effectiveness of RAADS-R as a screening tool for adult ASD populations. Autism Research and Treatment, 2021, 9974791. https://doi.org/10.1155/2021/9974791

Khudiakova, V., Russell, E., Sowden-Carvalho, S., & Surtees, A. D. R. (2024). A systematic review and meta-analysis of mental health outcomes associated with camouflaging in autistic people. Research in Autism Spectrum Disorders, 102492. https://doi.org/10.1016/j.rasd.2024.102492

Loizou, S., Pemovska, T., Stefanidou, T., et al. (2024). Approaches to improving mental healthcare for autistic people: Systematic review. BJPsych Open, 10(4), e128. https://doi.org/10.1192/bjo.2024.707

Motamed, M., Hajikarim-Hamedani, A., Fakhrian, A., & Alaghband-Rad, J. (2025). A systematic review of sexual health, knowledge, and behavior in autism spectrum disorder. BMC Psychiatry, 25, 410. https://doi.org/10.1186/s12888-025-06836-x

National Institute for Health and Care Excellence. (2012; updated 2021). Autism spectrum disorder in adults: Diagnosis and management (CG142). https://www.nice.org.uk/guidance/cg142/chapter/Recommendations

Nel, J., Spedding, M., & Malcolm-Smith, S. (2025). Consolidating a framework of autistic camouflaging strategies: An integrative systematic review. Autism, 29, 2379–2394. https://doi.org/10.1177/13623613251335472

Pellicano, E., & den Houting, J. (2022). Annual research review: Shifting from normal science to neurodiversity in autism science. Journal of Child Psychology and Psychiatry, 63, 381–396. https://doi.org/10.1111/jcpp.13534

Radev, S., Freeth, M., & Thompson, A. R. (2024). How healthcare systems are experienced by autistic adults in the United Kingdom: A meta-ethnography. Autism, 28, 2166–2178. https://doi.org/10.1177/13623613241235531

Santomauro, D. F., Hedley, D., Sahin, E., et al. (2024). The global burden of suicide mortality among people on the autism spectrum: A systematic review, meta-analysis, and extension of estimates from the Global Burden of Disease Study 2021. Psychiatry Research, 341, 116150. https://doi.org/10.1016/j.psychres.2024.116150