Dr Lucy Waldren

The 10-item Autism Spectrum Quotient (AQ10)1 is used internationally for autism screening, in line with the National Institute for Health and Care Excellence (NICE) guidelines.2 We have found a worrying discrepancy between the clinical cutoff recommended by NICE and the research informing their guidance.1,3 The NICE Guideline Development Group examined the suitability of the AQ10 for autism screening, on the basis of research indicating that a cutoff score of 6 or higher should inform referrals for specialist diagnostic assessment.1 However, NICE incorrectly recommend that a score above 6 (ie, 7 or higher) should be used for screening purposes. This cutoff of a score of 7 or higher was, in fact, examined and rejected by the NICE Guideline Development Group in favour of the 6 or higher value,3 which leads us to conclude that NICE have erroneously recommended the higher cutoff. This discrepancy in the AQ10 cutoff scores is concerning because of its far-reaching effect on clinical practice and research. Screening accuracy is intrinsically related to cutoff values, whereby the 7 or higher cutoff set by NICE is less sensitive than the correct 6 or higher value. Because the AQ10 is used by general practitioners (typically the first to identify people who might have autism), the insufficiently sensitive implementation of this screening tool will be contributing to missed referrals, diagnoses, and opportunities for intervention. Some researchers are also using the incorrect 7 or higher cutoff,4 often misattributing this value to the original AQ10 research.1 Others use the correct 6 or higher cutoff, but mistakenly attribute this value to NICE guidance.5 Erroneous NICE guidance thus underlies several inconsistencies in the use and reporting of the AQ10, raising broader concerns about the robustness of recent research on autism and co-occurring psychiatric conditions. In consideration of these issues, the NICE guidance on autism should be revised, emphasising the correct 6 or higher AQ10 cutoff. NICE recommendations are deeply embedded into resources for clinicians, particularly general practitioners, who should be made aware of the correct clinical cutoff. We hope that this Correspondence will initiate this process and, until there is revised NICE guidance on autism, clinicians should use the 6 or higher instead of the 7 or higher cutoff value in their practice. Furthermore, the extent to which the 7 or higher cutoff has resulted in the misinterpretation of research is unknown. Where required, researchers should reanalyse previously published data and future studies should use the correct AQ10 cutoff. It might, thereby, be possible to establish the extent to which the (mis)use of different cutoff values has been consequential, which could prompt corrigenda to published research. In sum, we call for the urgent review of and move towards the correct use of the AQ10 in clinical practice and research. We declare no competing interests.

Autism and Attention Deficit Hyperactivity Disorder (ADHD) are both linked to internalising problems (e.g., anxiety, depression) but their frequent co-occurrence makes these relationships difficult to disentangle. We, therefore, adopted a trait-based approach to examine the unique associations of autism and ADHD with internalising problem diagnoses in a large general population sample of adults from the United Kingdom and United States (N = 4996). We then assessed whether these associations would conceptually replicate in a clinical sub-sample (n = 292) using a case-control design. We found that, across the whole sample, ADHD traits were an overall stronger predictor of internalising problem diagnoses than autistic traits. The case-control analyses revealed that both autistic adults and adults with ADHD had greater odds of being diagnosed with anxiety, depression and an overall internalising problem (i.e., depression and/or anxiety) than neurotypical adults. Although the clinical groups did not significantly differ from each other in their associations with mental health diagnoses, having and ADHD diagnosis was more closely linked with depression while having an autism diagnosis was more closely linked with anxiety. We discuss potential psychological mechanisms underlying these findings and the implications for research and clinical practice concerning neurodevelopmental conditions.

The male preponderance in autism diagnoses is widely reported, yet the psychological mechanisms underlying this sex difference is poorly understood. The present study investigated the mediating role of emotional processing differences in the relationship between sex (as assigned at birth) and autistic traits, in two large general population studies. Results showed that emotion processing differences mediated the relationship between sex and autistic traits, whereby being male was associated with more emotion processing differences, which were subsequently linked with greater levels of autistic traits.

The overlap between Autism and Attention-Deficit Hyperactivity Disorder (ADHD) is widely observed in clinical settings, with growing interest in their co-occurrence in neurodiversity research. Until relatively recently, however, concurrent diagnoses of Autism and ADHD were not possible. This has limited the scope for large-scale research on their crosscondition associations, further stymied by a dearth of open science practices in the neurodiversity field. Additionally, almost all previous research linking Autism and ADHD has focused on children and adolescents, despite them being lifelong conditions. Tackling these limitations in previous research, 5504 adults - including a nationally representative sample of the UK (Study 1; n = 504) and a large pre-registered study (Study 2; n = 5000)completed well-established self-report measures of Autism and ADHD traits. A series of network analyses unpacked the associations between Autism and ADHD at the individual trait level. Low inter-item connectivity was consistently found between conditions, supporting the distinction between Autism and ADHD as separable constructs. Subjective social enjoyment and hyperactivity-impulsivity traits were most condition-specific to Autism and ADHD, respectively. Traits related to attention control showed the greatest Bridge Expected Influence across conditions, revealing a potential transdiagnostic process underlying the overlap between Autism and ADHD. To investigate this further at the cognitive level, participants completed a large, well-powered, and pre-registered study measuring the relative contributions of Autism and ADHD traits to attention control (Study 3; n = 500). We detected age- and sex-related effects, however, attention control did not account for the covariance between Autism and ADHD traits. We situate our findings and discuss future directions in the cognitive science of Autism, ADHD, and neurodiversity, noting how our open datasets may be used in future research. (c) 2024 The Authors. Published by Elsevier Ltd. This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/).

The 10-item Autism-Spectrum Quotient (AQ10) is frequently used to screen adults for high autistic traits in clinical practice and research. For the past decade, however, the National Institute for Health and Care Excellence has recommended the use of a suboptimal ≥7 cutoff value, instead of the optimal ≥6 value specified during the AQ10’s development. A comprehensive review into the use and reporting of the AQ10 cutoff suggests that this discrepancy has proliferated across the literature, with over 58% of reports citing a suboptimal (27.15%) or ambiguous (31.13%) cutoff value. After examining the use of the AQ10 cutoff in previous research, we drew on 25 published data sets (N = 13,692) to test how applying different AQ10 cutoffs can influence research. Our analyses suggest that a striking 36.80% of the participants classified as having high autistic traits using the ≥6 cutoff would be classified as having low autistic traits using the ≥7 cutoff. The ≥6 cutoff was also found to provide a better balance between the sensitivity and specificity of the AQ10 with respect to a clinical autism diagnosis. Most critically, our analyses showed that even a 1-point difference in the AQ10 cutoff—the error made in the National Institute for Health and Care Excellence guidelines—can meaningfully change both the statistical significance and the magnitude of autism-related effects. These findings demonstrate that the suboptimal use of the AQ10 cutoff can be consequential for research, and we discuss the urgent need to establish and apply appropriate autism screening cutoff values in the future.

Observational studies have found loneliness and social isolation to mediate the relationship between childhood maltreatment and schizophrenia. Limitations with observational studies (e.g., confounding and reverse causation), however, have meant the robustness of these relationships has thus far not been explored. To address this gap, the current study utilized genomic structural equation modeling (genomic SEM) and Mendelian randomization (MR) to perform a genetic mediation analysis between childhood maltreatment, loneliness/isolation, and schizophrenia, using summary statistics from three genome-wide association studies (sample sizes 105,318–487,647). While we observed a putative effect of both childhood maltreatment (inverse variance weighted OR = 3.44 per standard deviation increase, 95% confidence interval [CI] [1.66–7.13], p < .001) and loneliness/isolation (OR = 2.98, 95% CI [1.37–6.46], p = .006) on schizophrenia, our hypothesis that loneliness/isolation would mediate the relationship between childhood maltreatment and schizophrenia was not supported (genomic SEM indirect effect = −0.05, SE = 0.05, p = .255; MR indirect effect = 0.10, SE = 0.11, p = .369). Furthermore, reverse mediation analysis indicated that the effect may be in the opposite direction (genomic SEM indirect effect = 0.11, SE = 0.02, p < .001; MR indirect effect = 0.01, SE = 0.00, p < .001), accounting for 20.3%–28.9% of the total effect. The current results suggest that intervening in loneliness/isolation in individuals with a history of childhood maltreatment is unlikely to reduce schizophrenia risk. On the contrary, targeting loneliness/isolation in individuals with a genetic predisposition toward schizophrenia may diminish childhood maltreatment risk.

Autism Spectrum Disorder (ASD) and Attention-Deficit Hyperactivity Disorder (ADHD) are both linked to internalising problems like anxiety and depression. ASD and ADHD also often co-occur, making their individual statistical contributions to internalising disorders difficult to investigate. To address this issue, we explored the unique associations of self-reported ASD traits and ADHD traits with internalising problems using a large general population sample of adults from the United Kingdom (N = 504, 49% male). Classical regression analyses indicated that both ASD traits and ADHD traits were uniquely associated with internalising problems. Dominance and Bayesian analyses confirmed that ADHD traits were a stronger, more important predictor of internalising problems. However, brief depression and anxiety measures may not provide a comprehensive index of internalising problems. Additionally, we focused on recruiting a sample that was representative of the UK population according to age and sex, but not ethnicity, a variable that may be linked to internalising disorders. Nevertheless, our findings indicate that while ASD and ADHD uniquely predict internalising problems, ADHD traits are a more important statistical predictor than ASD traits. We discuss potential mechanisms underlying this pattern of results and the implications for research and clinical practice concerning neurodevelopmental conditions.

There is growing research interest in autism-related sex differences. Many behavioural and cognitive sex differences have been identified, with implications for research and clinical practice. Much of this research has relied on self-report autism measures, which are assumed to measure autistic traits equally in males and females. However, robust evidence for this assumption is lacking. Previous findings have not been replicated and no study has directly compared sex differences across multiple self-report autism measures in the same sample. To address this gap in research, a large sample of adults (N = 1000, 500 female) completed a series of self-report autism measures (AQ-50, −28, −26, −20, −10, −9, BAPQ, CATI). Following pre-registered measurement invariance analyses, only the AQ-9, AQ-28, and CATI showed good-to-acceptable invariance to sex when specifying a multi-factor structure, and all 8 measures showed non-invariance to sex when capturing a general autism construct. We discuss the implications of these findings for investigating autism-related sex differences in future research. •Few studies have tested if self-report autism measures can capture autistic traits equally across sex.•We tested eight self-report autism measures in a large, nationally representative sample.•Most measures did not capture the same autism constructs in males and females.•The consequences of these findings for research are discussed.

Improving our understanding of autism, ADHD, dyslexia and other neurodevelopmental conditions requires collaborations between genetics, psychiatry, the social sciences and other fields of research.

Numerous studies have detected associations between poor housing quality and increased risk for mental illness. However, it currently remains unclear in associations between poor housing quality and increased risk for women's mental illness which housing quality indicators drive this association and hence which specific indicators should be prioritised in housing quality assessments or improvements. In a sample of up to 9,669 pregnant women, we used a network analysis to investigate cross-sectional associations between poor housing quality indicators (e.g., house size, facilities, leaks or condensation/mould, decorations, and feelings towards the home) and depressive symptoms (assessed at age 28). All 36 edges showed non-zero associations, whereby when considering all poor housing quality indicators 'feelings-towards-the-home' had the strongest association with depressive symptoms, and 'feelings-towards-the-home', in turn, was most strongly associated with house problems, size, and facilities. Our findings highlight the importance of using multiple (or composite) person-centred measures of housing quality in the context of maternal mental health.

Drawing on just-world theory and theories of psychological distance, we tested the idea that people respond to injustice by symbolically distancing themselves from innocent victims. Across 12 studies using varied victimization contexts and spatial arrangement methods, we examined whether perceived injustice motivates people to place victims further from the self in visual space based on perceived value or personality similarity. Participants distanced themselves from victims receiving unjust (vs. just or neutral) outcomes by placing a symbolic self-representation farther from the victims' names in 2D space (Studies 1a-1c). Study 2 found that this distancing effect was independent of victim derogation and blame, while Study 3 demonstrated that distancing was especially pronounced for traits central (vs. peripheral) to the self-concept. Studies 4a/4b revealed that distancing depends on victims' innocence and perceived injustice, ruling out a general avoidance account. Studies 5a/5b confirmed that spatial distancing corresponds to perceived dissimilarity, and Studies 6a/6b showed the reverse process: identical outcomes were judged as more unjust when they befell spatially close versus distant others. Finally, Study 7 extended these findings to self-relevant contexts, showing that participants distanced their current self from past selves who experienced unfair (vs. fair) events, over and above subjective and objective temporal distance. Taken together, these findings highlight the reciprocal relationship between experiences of injustice and symbolic social distancing, revealing how people mentally represent victims as more or less distant from the self, and contribute to the broader understanding of social and spatial representations of self-other (dis)similarity.

Although the built environment has been identified as a risk factor for depressive symptoms, it is unclear whether these associations are driven by specific environmental features and whether they remain stable over time. In 10,310 ALSPAC women living in Bristol city, we conducted preregistered network analyses to investigate cross-sectional and longitudinal associations between built environment features (e.g., population density, green space and walkability) and depressive symptoms (at ages 28, 32 and 48 years). Contrary to our hypotheses, associations between individual built environment variables and depressive symptoms were consistently weak. Exploratory factor analyses indicated a built environment factor associated with depressive symptoms at baseline (β = 0.148,< .001) and 4-year follow-up (β = 0.114, = .011), but not at 18-year follow-up (β = -0.005, = .950). These findings suggest the combined influence of built environment features may explain depressive outcomes better than individual built environment measures alone.

Although personal relative deprivation (PRD; feelings of resentment and dissatisfaction that arise from making unfavourable comparisons to similar others) has been linked to increased aggressive affect and behaviour, the socio-cognitive mechanisms underpinning this association have been largely overlooked. The current study aimed to investigate the role of a sense of personal control in this relationship, given its unique links with both PRD and psychological distress. In a sample of 311 UK currently employed adults, parallel and multiple indicator mediation analyses revealed that the association between PRD and aggression is mediated by perceived constraints (but not personal mastery), and in turn by psychological distress. The results of this study bolster previous literature outlining the specific association between PRD and perceived constraints, offer novel insights into the relationship between PRD and psychological distress and advance our understanding of the links between PRD and aggressive tendencies.