Premenstrual Dysphoric Disorder (PMDD) is thought to be a cyclical affective disorder affecting some women during the premenstrual or luteal phase of the menstrual cycle. Criticisms have been raised about the incremental validity of this disorder as a distinct entity from other mood and affective problems such as Major Depressive Disorder. The purpose of the current study was to investigate the validity of a premenstrual-phase-specific mood disorder and to investigate the role of two psychological constructs for women reporting premenstrual affective symptoms and women reporting general depressive symptoms. A multi-method approach to premenstrual affect assessment was used such that presence of premenstrual affective problems was retrospectively reported by participants and prospectively measured via daily diary across 30 days. Self-report measures collected at baseline assessed premenstrual affective symptoms, depressive symptoms, anxiety symptoms, rumination, and anxiety sensitivity. Daily measures of negative and positive affect and sexual behavior were also collected. Hierarchical linear modeling was utilized to examine the presence of a relationship between the menstrual cycle and daily affect as well as to investigate whether anxiety sensitivity and rumination influenced daily affect across the menstrual cycle. Primary analyses indicated that women with high scores on the baseline PMDD measure experienced high levels of negative affect irrespective of menstrual cycle phase. Women with high scores on a measure of general depressive symptoms did display a pattern of increased negative affect during the luteal phase. Exploratory analyses revealed the moderating effect of both anxiety sensitivity and rumination in predicting negative affect in the luteal phase; this effect was found in women reporting severe depressive symptoms and those reporting severe premenstrual affective symptoms. Further research is needed to clarify the presence of a premenstrual mood disorder separate from other mood disorders.

This project is the culmination of the author’s efforts to put into words, images, and videos, among other things, his attention-deficit hyperactive disorder (ADHD), which was diagnosed during his time at graduate school. This diagnosis afforded the author a new perspective on his education so far. It prompted him to research further into how neurodiverse thinkers adapt to life in the university, and how the university adapts to their presence, in a word: poorly. There are too few accounts from scholars with ADHD or autism spectrum disorder (ASD) just to name a couple of neurodivergent identities. It is the author’s hope that by reimagining the way a text may look in the field of Rhetoric and Writing Studies, we can begin to move the needle on how we think about thinking in the classroom. While this document does its best to simulate the original project, you will get the best experience by viewing this document in its original, hypertextual format, which will be linked to in the Appendix.

The purpose of this transcendental phenomenological study was to examine the perceptions of self-efficacy among neurodiverse students in STEM programs at four-year universities. Albert Bandara’s social cognitive theory (SCT) guided this study as it relates to the influence of environment, social interaction, and communication on learning development and academic mastery. Improving academic self-efficacy among neurodiverse students in STEM programs in higher education begins with understanding how these students encounter the academic world.  SCT provided the framework for this study to answer the central research question and sub-questions: (1) What are the self-efficacy experiences of neurodiverse students currently enrolled in a STEM program at four-year institutions in the United States?  (2) How do autistic students in STEM-related fields of study experience the social campus environment? (3) How do autistic students in STEM-related fields of study perceive the academic support and accommodations they receive?  This study reviewed the background of diversity and inclusion in higher education, research related to the experience of autistic and other neurodiverse students, and the need for a pedagogical approach in STEM programs that accommodates the varied needs of neurodiverse students.  The study involved eleven autistic students currently enrolled in STEM-related majors who have completed at least one year of higher education. The research took place at two four-year institutions in the United States: Greenwood University (pseudonym), a state-sponsored institution in the Northeast, and Hightower University (pseudonym), a private research institution in the South. Additional participants were identified through snowball sampling. Data were collected by individual interviews, anecdote discussions, and a focus group. Data analysis followed Moustaka’s modification of Van Kaam’s method of phenomenological analysis.

The purpose of this phenomenological study was to understand the K-12 educational experiences of females with autism spectrum disorder (ASD). The theory guiding this study is Bandura’s social cognitive theory, as it states that people are the operators of their lives, and not passive entities within their environment. However, individuals with ASD often have difficulties with social communication, communication interaction, and restricted, repetitive behaviors, which impact their ability to regulate themselves in various environments. The study used transcendental phenomenology to understand the K-12 educational experiences of females with ASD. A total of 10 participants were used. The participants and their experiences were the most significant aspect of this study, which was why the setting focused more on them than a location. Participants were recruited from anywhere in the United States, with a hope of being near southwestern Pennsylvania to allow for face-to-face individual interviews. The primary method of data collection was individual interviews. Questionnaires and responses to journal prompts were additional methods of data collection. Data was analyzed following the steps outlined by Moustakas (1994). The study revealed participants had feelings of relief upon receiving their diagnosis, they struggled with social interactions, and relationships were both a positive and negative impact on their experiences.

Maybe She’s Born With It, Maybe It’s Neurodivergency is an homage to my lived experience as a Queer-Neurodivergent individual navigating a world that was not made for me. It challenges the hegemonic notion of ‘normalcy’ and opens up a dialogue about the oppressive structures that we live within and are confined by. I impart the meaning of the grid as a symbol for neurotypicality, white supremacy, heteronormativity, and patriarchy. Alongside the grid is a hieroglyph of my own creation, a tight yet explosive gestural mark, a visual metaphor for my neurodivergent physical, mental and emotional discomfort. Combining these seemingly oppositional forms, I disrupt the grid visually and physically through a variety of print and papermaking processes. Through an interactive installation, the work calls attention to the importance of embracing intuition, relinquishing control, and audience participation in contemporary art— providing a platform to challenge the status quo both within the conventional art world and beyond.

The current state of autism spectrum disorder diagnoses reflects a skew towardmen which is due to a bias in the diagnostic criteria. The diagnostic criteria in the DSM-5 fail to properly assess for alternative-to-male expressions of the disorder; one specific factor that is not adequately addressed is masking. Masking pertains to an individual’s ability to hide and adapt their autistic traits to appear more neuro-typical. Though any autistic person may have the ability to mask their autistic traits, recent research shows that more women than men possess this ability, and to a higher degree. Masking is not exclusive to adults; it is seen in autistic girls from a very young age. The diagnostic criteria need to be amended to account for an expression of autism under the cover of masking. If we do not change the way we diagnose autism, and we keep the insensitive and biased current criteria, we will continue denying diagnosis to so many autistic women who deserve support and acknowledgement. The first step in this process is to gain a better understanding of masking, and the best way to do this is to ask autistic women themselves for their expertise, experience, and guidance. Self-report is necessary in this exploration. I recruited five autistic women through Instagram and then I conducted five semi-structured interviews with each of those women, separately. During the interviews I used an interview guide that consisted of 27 open-ended questions, all of which were aimed at gaining knowledge about the experience of autism and masking for each of these women. I found four themes in common across the interviews: gradual realizations, routine yet forced masking, burnout and comfort-seeking, and advocacy for self.

The thesis identified and elucidated the phenomena in the timing of diagnosis when autism and ADHD co-occur. This included understanding the delay in autism diagnosis when ADHD is present and provided possible evidence for where along a diagnostic pathway such a delay might be occurring. A biopsychosocial framework was also used to consider multiple psychological and social aspects of this process including the experiences of complex neurodevelopmental cases for families and clinicians. The experience for families and clinicians grappling with an imperfect diagnostic model suggests that multiple resources, time delays and stressful situations are common. This thesis concludes with theoretical and practical recommendations for an improved diagnostic pathway and experience for clinicians and families.

This thesis explores the relationship between theory of mind (ToM) and behaviour in childhood. It is presented in three parts. Part 1 is a systematic literature review examining the relationship between ToM and aggressive behaviour in childhood. The review focuses on studies of typically developing children which report correlation analyses between ToM and aggression. Using a meta-analysis, the review found a weak but significant relationship between better-developed ToM and lower levels of aggressive behaviour. Part 2, the empirical research paper, explores the profile of pathological demand avoidance (PDA) in autism spectrum conditions (ASC), and investigates the relationship between ToM and behaviours and traits associated with (1) ASC and (2) PDA. Quantitative data were collected via parent-report questionnaires and continuous and between-group analyses were conducted. Better parent-reported ToM was associated with lower levels of ASC traits, although no association was found between ToM and PDA traits. In addition, the findings support previous research arguing for the use of the PDA label to describe a set of symptoms within the autism spectrum. The results are discussed with reference to the wider literature and methodological limitations. This was part of a joint project with Anna Goodson, trainee clinical psychologist. Part 3 is a critical appraisal on the research as a whole. The methodological challenges and limitations of the study are discussed. Broader conceptual issues are considered before concluding with further reflections on my own personal experience of the research process.

In recent years, there has been a growing and high-profile movement for ‘global mental health’. This has been framed in ‘psych system’ terms and had a particular focus on what has come to be called the ‘Global South’ or ‘low and middle-income countries’. However, an emerging ‘Mad Studies’ new social movement has also developed as a key challenge to such globalising pressures. This development, however, has itself both being impeded by some of the disempowering foundations of a global mental health approach, as well as coming in for criticism for itself perpetuating some of the same problems as the latter. At the same time, we are also beginning to see it and related concepts like the UNCRPD being given new life and meaning by Global South activists as well as Global North activists. Given such contradictions and complexities, the aim of this paper is to offer an analysis and explore ways forward consistent with decolonizing global mental health and addressing madness and distress more helpfully globally, through a Mad Studies lens.

Ageing in autism spectrum conditions is a growing but still relatively under-researched field of enquiry. Changes in the diagnostic features, particularly social and communication difficulties, and emotional and mental health needs of autistic adults as they age is one area that is not well understood. This thesis presents a program of work encompassing both empirical and theoretical research.  Firstly, it used an exploratory qualitative methodology to investigate the social and emotional functioning of cognitively able older autistic adults. Secondly, using theoretical analysis it outlines and provides empirical evidence for the application of the theory of lifespan psychology to the developmental trajectory of autism across the lifespan. The aim of this research was twofold: to explore older autistic adults’ experiences and perspectives of ageing, with particular focus on social-emotional functioning; and to investigate the relevance of lifespan developmental psychology as a theoretical framework for understanding adaptive change and the potential for successful ageing in autism. The first part of this research program used Interpretative Phenomenological Analysis, a psychological experiential methodology, that lends itself to participatory research and is well-suited to generating theory, particularly in under-researched areas such as ageing in autism. Semi-structured interviews with ten autistic adults (age range 53-74 years) explored their life history and experiences of autistic identity, social interaction, mental health and coping, and concerns for the future. Analyses revealed four overarching themes: negotiating diagnosis and an autistic identity in later life; social instinct; mental health problems and solutions; and positive outlook. Participants’ insights highlighted that respect for, and accommodation of, diverse experiences is critical in autism research, and in treatment and support contexts. Further, despite experiencing many life difficulties, participants suggested older age brought with it resilience and a generally positive outlook on life. This finding contrasts with other studies of autistic adults that report a steady and unchanging life trajectory of isolation, loneliness and longing for connection, and suggests that older autistic adults with low support needs might attain normative developmental gains in later life despite their autistic characteristics. Negative misconceptions about the inevitability of decline and loss in old age abound in society and the literature on autism and ageing. But there is a paradox of ageing – most typically developing adults experience a peak in their life satisfaction and emotional wellbeing in later life that is fundamental to successful ageing. The resilience and positive outlook of older autistic adults revealed in the first part of this research program was an unexpected finding, and raised the tantalising question: could it be that the paradox of ageing is true for older autistic adults too? Although autism has been analysed in the context of many theoretical frameworks, most take as their starting point impairment and disability even as they advocate for a positive neurodiverse conceptualisation of autism. By contrast, there has been no attempt to consider ageing in autism from the perspective of lifespan psychology and developmental models that guide much of the contemporary gerontological research on social and emotional development and successful ageing.  The second part of this research addressed this gap in the literature by exploring how lifespan psychology, and the developmental model of selective optimisation with compensation, might inform our understanding of the developmental trajectory of autism across the lifespan and in later life. Drawing on evidence from the autism literature and the case studies of three older autistic adults in the current program of research, it is contended that lifespan psychology provides a novel conceptualisation of successful ageing in autism as the outcome of lifelong adaptive processes in the pursuit of personal meaning and goals. The program of research described here adds to our knowledge of autism and ageing by providing unique and nuanced insights into social and emotional functioning across the lifespan from the perspectives of older autistic adults. Further, it proposes lifespan developmental psychology as a novel evidence-based theoretical framework that challenges existing negative expectations and offers an opportunity to reframe future autism research and clinical practice. Overall, this body of work extends our understanding of ageing in autism and offers a fresh and creative direction for future research that focuses on the potential for growth, wellbeing, and successful ageing in autism. Limitations of the research and areas for future research are also discussed.

BACKGROUND: Eating and mealtime problems are among the most common problems in individuals with autism spectrum disorder (ASD). Despite this, no systematic way of exploring these problems has been available for persons with ASD and normal intelligence. Furthermore, little is known about the prevalence of traditional eating disorders (EDs) such as anorexia nervosa (AN), bulimia nervosa (BN) and binge eating disorder (BED), and eating pathology in individuals with Early Symptomatic Syndromes Eliciting Neurodevelopmental Clinical Examinations (ESSENCE, which describes the overlap between neurodevelopmental conditions, e.g. ASD and attention-deficit/hyperactivity disorder (ADHD)). A link between EDs and ESSENCE is highly topical but the knowledge about the similarities between the two conditions in terms of eating behaviours and potential neurobiological commonalities is scarce. AIMS: The overall aim of this thesis was to incorporate knowledge from different angles in order to better understand the coexistence of ESSENCE and EDs. The specific aim of each study was as follows: (I) to validate a newly developed instrument, the SWedish Eating Assessment for Autism spectrum disorders (SWEAA); (II) to examine the prevalence of EDs and eating pathology in adults with ASD and/or ADHD; (III) to examine cortical grey matter volume in brain areas connected to social cognition in AN, and compare these data with matched healthy comparison cases and ASD patients; (IV) and to examine the presence of “autistic eating behaviours” among female patients with AN. METHODS: The following individuals have been examined; adolescents and adults with ASD and/or ADHD, current AN patients (at admission and at 1-year follow-up), partially recovered (weight restored) AN patients, and healthy matched comparison groups in all but one study. The SWEAA has been validated and information on autistic eating behaviours in patients with ASD, patients with AN and matched healthy comparison cases has been investigated. Differences in grey matter volumes have been examined with magnetic resonance imaging (MRI) in patients with AN and compared with the volumes of matched healthy individuals and patients with ASD. All studies used validated psychiatric questionnaires and interviews. RESULTS: The validation of the SWEAA showed good psychometric properties. Patients with current AN scored higher on the SWEAA than patients with ASD. At 1-year follow-up AN patients still had high scores on the autism specific items and partially recovered AN patients had the same total score as patients with ASD. In a large sample of adults with ASD and/or ADHD a total of 8% had a current or previous eating disorder and the male to female ratio was 1:2.5. The most common EDs were AN and BED. The MRI study showed specific grey matter reductions in brain areas connected to social cognition both in females with AN and in females with ASD. CONCLUSIONS: The compilation of the studies in the present thesis gives further support to the notion of common denominators between EDs and ASD, both in terms of behaviour and neurobiological deviations. This knowledge is important not only to researchers but also to clinicians to enable individually tailored treatment, using strategies from both the eating disorder and the ASD realm.

Intervention and education programs for autistic individuals have been greatly informed by the medical model of disease/disability. Under this model, autism is seen as something to be fixed or remediated, and interventions have often focused on reducing autistic traits in an effort to get the autistic person to appear more “typical.” Autistic advocates have denounced this, and there is still much debate on what kind of interventions are best for autistic individuals. A viable alternative to the medical model is the neurodiversity approach, where neurological differences such as autism are seen as a valuable contribution to human diversity and should be accepted. Though it has been argued that early intervention can in fact be compatible with the neurodiversity approach, the field still has much work to truly become neurodiversity-affirming. This dissertation discusses three ways to ensure interventions move toward being more neurodiversity-affirming: considering intervention social validity (i.e., acceptability) from the autistic perspective, gathering feedback on interventions from autistic adults, and assessing professionals’ attitudes toward neurodiversity. The first paper herein is a systematic review of social validity assessment in Pivotal Response Treatment research, with an emphasis on assessment of the autistic point of view. The second is a qualitative investigation of 214 autistic adults’ feedback on common intervention goals for young autistic children. The third paper presents the development and validation of an instrument designed to measure professionals’ attitudes toward neurodiversity. Findings from the first two studies suggest that autistic perspectives need to be included much more frequently when designing and implementing interventions, and that professionals need to consider the importance of developing autistic identity, autonomy, and self-advocacy skills. Finally, the neurodiversity attitudes questionnaire (NDAQ) presents a valid way of measuring professionals’ attitudes such that neurodiversity training needs can be assessed, which will hopefully ultimately lead to more neurodiversity-friendly interventions.