There is limited research on Autism Spectrum Disorders (ASD) in females.  Although the empathy construct has been examined thoroughly in autism, little attention has been paid to empathy in adult women with this condition or to gender differences within the disorder.  Self-reported empathy in adult women with ASD was examined and compared to that of typically developed men and women as well as to men with this condition. Online databases were searched for articles investigating self-reported empathy among adult women with ASD.  Only six studies comparing women to men were identified.  All studies found women with an ASD to report lower levels of empathy than typically developed women, and typically developed men, but similar levels to men with this condition.  The self-reported empathic ability of women diagnosed with ASD resembles that of their male counterparts most closely; they show a hypermasculinisation in empathy.  This is particularly surprising considering the large gender difference in empathy in the general population.  One of the limitations of this review is that the current diagnostic criteria for ASD are oriented towards male-specific behaviour and fail to integrate gender specific characteristics.  Hence, women diagnosed with ASD are likely to be at the male end of the continuum.  The suggested hypermasculinisation of women on the spectrum, as evident from this review, may therefore be exaggerated due to a selection bias.

The intersection of gender diversity and neurodiversity is a focus of considerable interest, discussion, and research. As reflected in the contents of this special issue, literature has explored this intersection both clinically and conceptually. The opinions, integrations, and new data presented in this volume support the presence of a complex relationship between gender diversity and neurodiversity, but suggest that the common framing of gender dysphoria and autism spectrum disorder being ‘comorbid’ is limited. As described in the letter by Diane Ehrensaft, individuals who are both gender and neurodiverse bring to life new conceptualizations of gender as fluid and intersectional. This articulates with the hypothesis that gender diversity is an expected outcome in individuals who are less contingent on social information for identity development. Correspondingly, Jack Turban argues as to the potential for gender diverse youth to have reversible challenges with social functioning related to their experience of minority stress, potentially limiting the value of screening and diagnostic instruments to make strict, categorical statements. The important work by Nobili et al. is unique in this literature by its inclusion of a control group—remarkably, autism caseness based on Autism Quotient scores was found to be comparable in both the transgender and cisgender group, although the subgroup of transgender individuals assigned female at birth were twice as likely to have clinically significant scores. Consistent with the argument made by Turban, this difference was related mainly to the presence of additional social difficulties in this group, highlighting both the limitations of screening instruments, and the need for more detailed conceptualizations that better capture the complexity of these youths’ experience and identity. Where better to start than with the individuals themselves? Strang et al. describe a remarkable study that sought to understand the experience of gender in youth with diagnoses of Autism Spectrum Disorder through an in-depth qualitative approach. The participants are given a clear voice in a study that emphasized the challenges of both defining and communicating gender identity for neurodiverse youth, and the need for clinicians to create supportive spaces in which this can occur. Participants showed discomfort at simplistic reframing of their gender as a superficial ‘obsession,’ describing an altogether different and more complex character for their gender experiences. Additional manuscripts in this issue describe a range of related issues, including sexual orientation, gender differences and ASD symptoms, and gender preferences in friendships for children with ASD. Overall, this special issue touches on key themes at the intersection of gender and ASD and should prove to be an invaluable resources to clinicians and researchers hoping to further their understanding in this area. It is clear that gender is an important issue in understanding neurodiversity, and that individuals who are neurodiverse may place importance on gender. Further work is needed to understand how these individuals may be best supported, but enough is known to provide a clear impetus for a clinical approach rooted in the knowledge that neurodiverse youth may have complex gender narratives that warrant affirmation and support.

Objective:  Autism, attention deficit hyperactivity disorder (ADHD), and tic disorder (Tourette syndrome; TS) are neurodevelopmental conditions that frequently co-occur and impact psychological, social and emotional functioning. Vulnerability to chronic physical symptoms, including fatigue and pain, are also recognised.  The expression of joint hypermobility, reflecting a constitutional variant in connective tissue, predicts vulnerability to psychological symptoms alongside recognised physical symptoms.  Here, we tested for increased rates of joint hypermobility, autonomic dysfunction and pain in 109 adults with neurodevelopmental diagnoses.  Method: Rates of generalized joint laxity in those individuals with neurodevelopmental conditions were compared to those in the general population in UK. Levels of orthostatic intolerance and musculoskeletal symptoms were compared to a neurotypical control group.  Results: Adults with neurodevelopmental diagnoses manifest elevated rates of joint hypermobility (50%) compared to the general population rate of 20% and a matched control population of 10%.

Eating disorders (EDs) commonly co-occur with other psychiatric and neurodevelopmental disorders including attention-deficit/hyperactivity disorder (ADHD) and autism spectrum disorder (ASD); however, the pattern of family history and genetic overlap among them requires clarification. This study investigated the diagnostic, familial, and genetic associations of EDs with ADHD and ASD. The nationwide population-based cohort study included all individuals born in Denmark, 1981–2008, linked to their siblings and cousins. Cox regression was used to estimate associations between EDs and ADHD or ASD, and mediation analysis was used to assess the effects of intermediate mood or anxiety disorders. Polygenic scores (PGSs) were used to investigate the genetic association between anorexia nervosa (AN) and ADHD or ASD. Significantly increased risk for any ED was observed following an ADHD or ASD diagnosis. Mediation analysis suggested that intermediate mood or anxiety disorders could account for 44%–100% of the association between ADHD or ASD and ED. Individuals with a full sibling or maternal half sibling with ASD had increased risk of AN compared to those with siblings without ASD. A positive association was found between ASD-PGS and AN risk whereas a negative association was found between AN-PGS and ADHD. In this study, positive phenotypic associations between EDs and ADHD or ASD, mediation by mood or anxiety disorder, and genetic associations between ASD-PGS and AN and between AN-PGS and ADHD were observed. These findings could guide future research in the development of new treatments that can mitigate the development of EDs among individuals with ADHD or ASD.

Families seeking support for their autistic children face systemic bias from services where decision making is influenced by family profile rather than the disability need of the child. Research undertaken with over 1000 families of autistic children shows that neurodivergent, lone mothers are more susceptible to parental blame from supporting professionals. Parents of autistic children have reported widespread use of blame, gaslighting and safeguarding investigations by professionals when attempting to advocate for their children. Autism authors Alice Running and Danielle Jata-Hall – themselves parents to neurodivergent children – surveyed 1016 families of autistic children with additional PDA profiles (Pathological Demand Avoidance).

Avoidant/restrictive food intake disorder (ARFID) includes age-inappropriate feeding behaviors in eating patterns, including food neophobia, defined as refusal or reluctance to eat new or unknown foods.  This study aimed to assess the prevalence of ARFID and food neophobia among adults and determine the related characteristics of these risks. The study used an anonymous survey questionnaire consisting of three parts as the research tool.  The first part of the questionnaire was a metric and concerned socio-demographic data.  The Food Neophobia Scale (FNS) and the Nine-Item Avoidance/Restrictive Food Disorder Screen Questionnaire (NIAS) were used to evaluate the eating disorders.  The survey included 309 people (60.2% women, 39.8% men) aged 18-77 years.  NIAS results indicated that 15.2% of the subjects showed food selectivity, and 11.0% had food anxiety.  In the FNS assessment, 42.4% had a low risk of food neophobia, 38.2% a medium risk, and 19.4% a high risk.  A higher risk of food neophobia correlated with higher NIAS scores, indicating a higher risk of ARFID (p = 0.00231).  The NIAS score increased with the risk of food neophobia (p = 0.000).  Respondents at low risk of neophobia were most likely to avoid several products (83.97%), while in the high-risk group, 56.67% did not want to eat a favorite food enriched with a new ingredient.  A higher risk of neophobia was correlated with more food avoidance and adverse reactions to new foods (p = 0.000).  A higher risk of food neophobia is strongly correlated with a higher risk of ARFID.  Although demographics did not significantly impact NIAS results, some trends were noted, such as higher scores among older and underweight people.  Those with a higher risk of food neophobia show more food avoidance and a greater reluctance to experiment with new ingredients.  Public education should emphasize that eating disorders affect both sexes equally, with tailored interventions for high-risk groups such as the elderly, rural populations, and those with lower education.  Health policies should promote access to nutrition education, psychological support, and diverse food options, while further research is needed to improve targeted interventions.