Fostering inclusion in clinical and research procedures in autistic youth through augmentative and alternative communication: a narrative review and a proposal for visual aids application in brain stimulation
This narrative review synthesizes the use of AAC to enhance compliance in healthcare and clinical research contexts for autistic children and adolescents and suggests that AAC aids can reduce stress and anxiety, thereby improving adherence to healthcare protocols.
Abstract
Autistic children and adolescents often experience medical and neurocognitive co-occurrences that necessitate regular healthcare monitoring. Language difficulties, often observed in autistic individuals, can impede effective communication and participation in medical settings, potentially reducing treatment compliance. Communication barriers also pose challenges in involving autistic youth in research protocols, such as those including Non-Invasive Brain Stimulation (NIBS). Augmentative and Alternative Communication (AAC) strategies could facilitate the participation of autistic individuals in both healthcare and research settings. This narrative review synthesizes the use of AAC to enhance compliance in healthcare and clinical research contexts for autistic children and adolescents. Findings suggest that AAC aids can reduce stress and anxiety, thereby improving adherence to healthcare protocols. However, no studies were identified that specifically address AAC’s role in enhancing compliance during clinical research procedures involving autistic children and adolescents. Based on the current literature, here we propose a set of AAC aids to improve understanding and compliance with NIBS in autistic individuals.
The feasibility of yoga nidra as a complementary intervention for autistic children is supported and directions for future research are suggested, including larger trials and further co-design with the autistic community.
Tundi Loftus, Shu H Yau, Sophia Soares et al.· Research in Developmental Di...· 1 citation
Many autistic people experience clinically-significant motor differences that pose lifelong physical health risks including physical inactivity, cardiometabolic disease, falls and injuries, and chronic pain. These differences amplify existing cognitive and social-emotional features of autism and limit daily living skills, which in turn negatively impacts mental health and participation. Yet, professionals often overlook or mischaracterize autistic people’s motor difficulties, in part because non-motor factors can affect assessment outcomes. Most standardized motor assessments presume typical communication, sensory processing, regulation, and tolerance of unfamiliar testing environments, leading to construct-irrelevant variance and potential misinterpretation of results. This risk increases when examiners lack autism-specific experience or use rigid administration practices without appropriate adaptation. Adopting a neurodiversity-affirming framework improves validity, equity, and uptake of motor assessment across research, education, and clinical contexts. Here, we present an Adapted Motor Assessment Toolkit for Autism with implementation examples grounded in the Movement Assessment Battery for Children–Third Edition. An interdisciplinary team of clinicians and researchers developed and refined the toolkit in partnership with autistic people and parents of autistic children. The toolkit enables preservation of core task demands and scoring while adapting assessment practices to support accessibility and improve validity of results. Adaptations span five domains: pre-assessment preparation, sensory supports, procedural adaptations, communication supports, and motivation/engagement. The toolkit helps examiners to identify support needs, implementing adaptations, interpreting results, and determining whether normative comparisons remain appropriate. Neurodiversity-affirming assessment practices enable earlier identification of motor differences, inclusion of more diverse participants in research, and tailored intervention and prevention planning to advance physical health equity across the lifespan.
Haylie L. Miller, Priscila M Tamplain, M. Tal-Saban et al.· Autism in Adulthood· 0 citations
Background: Children with Autism Spectrum Disorder (ASD) often experience challenges related to sensory processing, emotional regulation, social participation, and engagement within traditional educational environments. Increasing attention has been given to nature-based educational and therapeutic approaches as supportive contexts that may promote regulation, participation, and learning through multisensory, flexible, and meaningful experiences.
Objective: This narrative review explores the role of nature-based activities in supporting the educational, developmental, and well-being needs of children with ASD, with particular emphasis on sensory regulation, social interaction, anxiety reduction, physical activity, executive functioning, and inclusive participation.
Methods: A narrative synthesis of relevant literature was conducted, focusing on studies and theoretical contributions examining nature exposure, outdoor play, gardening, hiking, structured nature-based programs, and related educational or therapeutic interventions for autistic children. The review also considers barriers to implementation, including limited access to natural environments, insufficient professional training, and variability in children’s individual sensory and developmental profiles.
Results: The literature suggests that nature-based activities may provide meaningful opportunities for sensory modulation, emotional calmness, social engagement, and active participation. Natural environments appear to offer rich but often less overwhelming sensory input, while activities such as gardening, outdoor exploration, and structured play may support cooperation, communication, attention, autonomy, and motor engagement. However, the evidence base remains heterogeneous, with variation in intervention design, outcome measures, and methodological quality.
Conclusions: Nature should not be viewed merely as an alternative setting for education or therapy, but as a dynamic, occupation-rich environment that can support children with ASD in regulation, participation, and learning. Future research should prioritize longitudinal designs, clearer intervention protocols, individualized approaches, and stronger collaboration between educators, occupational therapists, families, and multidisciplinary teams. Integrating nature-based practices into inclusive educational frameworks may represent a promising direction for supporting the holistic development and well-being of children with ASD.
Georgia Katsiaflaka, Pantelis Pergantis, Konstantinos Georgiou et al.· World Journal of Advanced Re...· 0 citations
Background Autism intervention research has largely prioritized children and adolescents, with limited guidance for adults. Social virtual environments (SVEs; e.g., VRChat) are widely used by autistic adults for connection, yet their role as intervention settings remains under-examined. This study explores clinicians’ perspectives on feasibility, risks, and essential design requirements for clinician-informed SVE-based socio-relational interventions for autistic young adults with low support needs. Methods We conducted nine semi-structured focus groups with Italian clinicians (N = 26) across three regions (Veneto, Trentino, Lazio) and five semi-structured international interviews (U.S. n = 4; Australia n = 1). Transcripts were analyzed via inductive, codebook-informed thematic analysis grounded in reflexive qualitative principles. Because the study involved four coders working across two linguistically distinct datasets, a shared coding framework was used as a pragmatic coordination tool to support transparency, interpretive consistency, and auditability across the research team (the intent was not to establish positivist inter-rater reliability or eliminate researcher subjectivity). Datasets were first coded separately and then integrated through matrix-based synthesis to identify contextually situated points of convergence and divergence. Results Italian clinicians emphasized neurodiversity-affirming aims, context-dependent social difficulty (including anxiety/overwhelm), structured scaffolding and mediation, ecological generalization, and SVEs as conditional tools requiring boundaries. International clinicians foregrounded autonomy and choice, emotional safety in relation to masking, neurotype composition as an ingredient for belonging, identity-affirming collaboration, and regulation/repair practices. Across datasets, clinicians emphasized safety-contingent participation, non-negotiable personalization/controllability of demands (i.e., sensory, social), and the protective value of supported pauses and exits. Contextual differences centered on the dominant logic of support (competence-building scaffolding vs. liberation/identity integration), mediator-led structure vs. neurotype-aligned spaces, intersectionality as primary vs. contextual framing, and distinct risk emphases (avoidance/overuse vs. relational ambiguity and rejection). Conclusion Clinicians conceptualize SVEs not as inherently therapeutic technologies but as conditional social infrastructures whose potential value depends on how safety, autonomy, and identity are supported. Clinician-informed SVE-based interventions for autistic adults may therefore require integrating structured mediation with explicit autonomy- and identity-affirming safeguards, offering a pathway beyond the traditional’ skills vs. acceptance’ divide in autism intervention research.
V. D. Grillo, Gaia Tanini, Federica Ciuciulla Rana et al.· Frontiers in child and adole...· 1 citation
Evidence is offered for the feasibility of delivering the psychoeducation CFT-based program within U.K. health care services and perceived benefits in social support, well-being, and self-efficacy, which reflects the perceived usefulness and appropriateness of the program to the participants.
Jessica Stacey, Hayley S Thompson, Chris Ashwin· Families, Systems & Health· 0 citations
Autism is a lifelong condition, and autistic individuals experience distinct social, educational, and vocational demands across different stages of life. Technology-enabled assistive tools have the potential to support these needs, from improving diagnostic accuracy to facilitating social interactions and promoting independent living. However, most existing technology research in autism is largely focused on autistic children and their needs (e.g., early diagnosis and communication support). As autistic children transition into adulthood, their needs evolve toward areas such as higher education, employment, independent living, and community participation. Despite this shift, technology research specifically focused on autistic young adults (ages 18-25) remains limited. To bridge this gap, our research aims to identify the current state of autism technology research pertaining to autistic young adults. This paper reports our findings from a systematic literature review $(\mathbf{N}=\mathbf{8 3})$ of autism technology research collected from the ACM Digital Library. Some of our important findings indicate that while many systems reduce social pressure through paced or asynchronous communication, only a few support everyday peer relationships, romantic connections, or real-world social interaction. Recurring design gaps include limited support for sensory safety, insufficient user control over interaction pacing, unclear visibility boundaries, and continued reliance on corrective or training-based models. Our research identifies critical gaps in existing approaches and provides an evidence-based foundation for developing more inclusive technologies for autistic young adults. We derived actionable design guidelines that prioritize the ability of autistic young adults, as these would enable them to make their own choices and control their own actions, and provide emotional safety and flexible communication structures. We further demonstrate how these guidelines can inform the design of structured interaction flows in social technology systems.
Aishwarya Manjunath, Alex Wolf, Hanze Aggabao et al.· Annual International Compute...· 0 citations
