Rethinking Social Communication Support: Exploring Communication Partner Training for Autistic Adults and Their Neurotypical Communication Partners

Abstract

Autistic and neurotypical people often have difficulty communicating effectively with one another and understanding each other's experiences. Despite evidence that communication breakdowns occur at the interactional level, most social communication interventions focus only on behaviors to be changed by autistic adults, and rely heavily on teaching neurotypical social skills. In this Perspective, we draw on our experiences as a mixed-neurotype team of clinicians, researchers, and advocates to argue that a new framework for social communication support is needed. Specifically, we propose that communication partner training (CPT), an umbrella term for programs that teach strategies to people with communication differences and communication partners alike, is an appropriate framework to guide future social communication support for autistic adults and their neurotypical communication partners. We provide an overview of how CPT is currently used with adults with acquired communication differences (e.g., aphasia, traumatic brain injury) and their communication partners. We highlight three key components of such programs: (i) promoting increased knowledge and understanding of communication differences and each person's unique communication profile; (ii) adapting the communication environment; (iii) and identifying collaborative strategies that people with communication differences and their communication partners can use to foster meaningful interactions. We acknowledge that there are important fundamental differences between autistic adults and people with acquired communication differences; however, we propose that CPT can be used to inform social communication support for autistic adults and their neurotypical communication partners. We provide recommendations for future CPT program development within autism research. Some recommendations include the need to acknowledge each person's intersecting identities and the dynamic impact of intrinsic and extrinsic factors on communication. We also recommend future research to explore ways that CPT can be applied to newly diagnosed autistic adults, as well as autistic youth, and their communication partners. Finally, we highlight the importance of foregrounding future program development in the lived experience of autistic adults and their communication partners.

Community brief

Why is this topic important?

Autistic and neurotypical communication partners often have difficulty understanding each other's experiences and communicating effectively with each other. Most social communication interventions currently available focus only on changing autistic people's behaviors, which can be harmful to their wellbeing, and do not consider the role of the communication partner.

What is the purpose of this article?

The purpose of this article is to explore how an alternative type of social communication support, communication partner training (CPT), can be used to enhance communication effectiveness between autistic adults and their neurotypical communication partners. CPT is an evidence-based service delivery model in the field of speech–language therapy that provides education and training to people with communication differences and their communication partners. We propose that CPT may be an appropriate framework to guide future social communication supports for autistic adults and their neurotypical communication partners.

What personal or professional perspectives do the authors bring to this topic?

We are a team of mixed-neurotype professionals (psychologist and speech–language therapist), researchers, and advocates with experiences supporting autistic adults and their communication partners across a range of clinical, educational, and residential settings.

What is already known about this topic?

Past research has shown that many autistic adults want better social communication support that focuses on the interactional nature of mixed-neurotype miscommunications. CPT is commonly used with adults with traumatic brain injuries, dementia, aphasia, and other acquired communication differences and their communication partners. Three common principles of CPT include (i) promoting increased knowledge and understanding of communication differences and individual communication profiles; (ii) increasing awareness of and adapting the communication environment; (iii) identifying collaborative strategies that people with communication differences and their communication partners can use to minimize communication breakdowns.

What do the authors recommend?

We recognize that there are important differences between autistic adults and people with acquired communication differences; however, we propose that helpful CPT techniques within the acquired communication differences literature can be used to inform social communication support for autistic adults and their neurotypical communication partners. Future research should be codesigned with autistic adults and their communication partners, and should consider how people's communication preferences may fluctuate, and how intersectionality impacts communication experiences. We also recommend future research to understand ways that CPT can be used to support newly diagnosed autistic adults, as well as autistic youth, and their neurotypical communication partners.

How will these recommendations help autistic adults now or in the future?

We hope that our recommendations will encourage researchers and clinicians to codevelop new social communication supports to improve communication success for autistic adults and their neurotypical communication partners.

Social communication can be defined as how and why language is used to allow “individuals to communicate or interact with others within a societal framework.”¹ Autism has historically been described within a medical model by pathologizing autistic peoples' contributions to social communication with neurotypical communication partners.^2,3 Specifically, autistic people have been described as having deficits in social–emotional reciprocity, nonverbal communication, and developing, maintaining, and understanding social relationships.⁴ These presumed deficits are posited to lie within the autistic person and are described as being associated with a range of poor health, vocational, educational, and social outcomes for autistic adults.^5–7

Moving away from a medical model and deficit-based approach, Milton's theory of the double empathy problem⁸ provides a paradigm shift on social communication, suggesting that autistic and neurotypical communication partners have mutual difficulty understanding each other's experiences. That is, the double empathy problem acknowledges that communication challenges occur at the interactional level and create barriers for both autistic and neurotypical communication partners.⁸ This can lead to difficulties empathizing with one another due to differences in how the social world is experienced.⁸

Indeed, emerging research shows that differences in communication styles across neurotypes (e.g., autistic and neurotypical communication partners) and the ensuing interactional miscommunications may be key factors driving perceived autistic social communication challenges. Autistic-to-autistic communication partners may experience more effective, comfortable, and rewarding interactions as compared with cross-neurotype communication dyads.^9–12 Conversely, neurotypical people may interact less successfully with autistic, compared to neurotypical, communication partners.¹¹ Such research highlights the need to interpret social communication challenges as context-dependent, and emphasizes the interactional challenges both autistic and neurotypical communication partners may face when communicating with each other.¹³

Currently, the social communication support literature for autistic adults largely lacks a framework that focuses on the autistic person and their neurotypical communication partners at the interactional level. Most interventions instead place a strong emphasis on changing autistic people through neurotypical social skill instruction and a reduction in autistic traits.¹⁴ In doing so, many social communication interventions for autistic adults, either directly or indirectly, further perpetuate the stigmatization of autism by inhibiting authentic autistic social communication behaviors.¹⁵ Moreover, many social communication interventions for autistic adults lack robust research designs, diverse samples, and generalizability of meaningful outcome measures.^14,16–18

Many social communication interventions instruct autistic adults to comply with neurotypical social communication standards, and encourage camouflaging, either implicitly or explicitly.¹⁷ Camouflaging, also referred to as adaptive morphing, masking, or impression management, is often necessary to mitigate the harms of living in a society that imposes neurotypical expectations upon neurodivergent people.^13,19–21 However, these behaviors (e.g., suppressing stimming, using inauthentic conversation scripts, making eye contact even when it feels aversive) are described as extremely stressful and are associated with heightened anxiety, depression, and suicidal ideation and behaviors among autistic adults.^22–24

As a mixed-neurotype team of advocates, clinicians, and researchers, we are encouraged by recent calls in the literature asserting the need for novel social communication support frameworks for autistic adults and their neurotypical communication partners.^13,17,25 These calls are in line with a neurodiversity-affirming support framework, which prioritizes intervention goals centered on supporting autistic strengths, and creating social environments that foster them.²⁶ In this Perspective, we draw from similar paradigm shifts in the rehabilitation field from adults with acquired communication differences,²⁷ and explore a possible alternative method of supporting autistic adults and their neurotypical communication partners. Specifically, we propose that communication partner training (CPT) aligns with our neurodiversity-affirming values and warrants future research within the autism literature.

Communication Partner Training Principles

CPT is an umbrella term for programs that teach strategies to communication partners and people with communication differences to facilitate more successful communication interactions.^28,29 Working within a framework of optimizing person-environment fit,³⁰ CPT recognizes that social communication is interactional and multifactorial, and that interventions should work toward a shared goal of improved understanding and connection for both parties, rather than only focus on skill building for the person with communication differences.²⁹ CPT is a well-established framework to support social communication success for diverse populations with communication differences, including adults with aphasia, traumatic brain injury (TBI), and those living with dementia and their communication partners.^{28,29,31–33} These programs target the awareness, knowledge, and skills of familiar (e.g., family and friends) and/or unfamiliar (e.g., health care providers and law enforcement officials) communication partners.

Principles of CPT are consistent with the World Health Organization's recognition of the environmental context, including the social environment, as a determinant of health and wellbeing.^33,34 Participation in CPT programming is associated with positive improvements in communication partners' skills and knowledge, as well as improvements in the quality of life of people with communication differences.^28,35

Formats and delivery methods of CPT differ across specific programs. Programs include both the person with communication differences and their communication partner in knowledge-focused and hands-on training, with the aim of improving communication at the interaction level.^31,35 CPT program length ranges widely, from 90 minutes to 35 hours reported in the literature.³¹ Materials used in CPT programming often include videos and written information integrated within direct teaching sessions, group discussions, and role play.³⁶ These programs are usually led by professionals with specific qualifications, usually speech–language therapists or psychologists.³¹ People with lived experience of having communication differences are also often directly involved in program facilitation and provide opportunities for practice and feedback.³⁶

While specific content varies widely across CPT programs and target populations, most programs are comprised of similar components, including three key features: (i) promoting increased knowledge and understanding of communication differences and individual communication profiles; (ii) increasing awareness of and adapting the communication environment; and (iii) identifying collaborative strategies that communication partners and people with communication differences can use to foster meaningful interactions with fewer communication breakdowns.^29,31,37

Increasing knowledge and understanding of communication profiles

A lack of public education, awareness, and personal experience with disability are major factors contributing to negative communication experiences of people with communication differences, with education and training proposed as tenable solutions.³⁸ Accordingly, CPT programs often include a didactic portion focused on increasing communication partners' knowledge and understanding of their partner's needs and preferences. For example, CPT programs for people with aphasia and their communication partners typically provide education to raise awareness of implicit attitudes toward people with aphasia, as well as information on aphasia presentations and associated communication profiles.³⁶ A central tenet of CPT for people with aphasia is acknowledging their inherent competence, which can be masked by challenges accessing and expressing language.²⁸ CPT outlines the essential role communication partners can play in enabling people with aphasia to reveal their competence.²⁸

Increasing awareness of and adapting the communication environment

The International Classification of Functioning, Disability, and Health recognizes that a person's physical, social, and attitudinal environment can either facilitate, or serve as a barrier to, their functioning and participation.³⁴ Considering and modifying the communication environment is a key component of CPT programs for adults with acquired communication differences and their communication partners.³¹ For example, for people living with dementia, communication partners are encouraged to reflect on how the cognitive (e.g., spaces, signs, objects of reference), visual (lighting, visual organization, contrast, glare), and auditory (e.g., background noise, reverberation) aspects of the environment can impact communication, and to consider environmental modifications to facilitate shared understanding.³⁹

Identifying collaborative strategies to foster meaningful communication

Many CPT programs provide neurodiversity-affirming strategies at the interactional level, with the goal of giving both people in the communication dyad the skills needed to improve the success of their communication interactions.⁴⁰ For example, in a CPT program for people with TBI and their communication partners,⁴⁰ pretraining interviews take place with both members of a communication dyad, asking both parties about their communication strengths and difficulties, and how they approach communication breakdowns. Conversation practice resources teach skills for both parties, including working together, shared decision making, and effective listening.⁴⁰

Furthermore, many CPT programs help both people within a communication dyad identify collaborative principles they can use to adapt to the needs and abilities of people with communication differences, including strategies to enhance communication, as well as negative communication behaviors to avoid.^{31,33,35,41–43} Collaborative features commonly taught in CPT programs for people with TBI and their communication partners include explicitly clarifying a topic of conversation, presenting one piece of information at a time, allowing ample time for responses, and using a multimodal communication approach (e.g., spoken words, gestures, visuals).^31,36,40 Examples of negative communication behaviors to avoid include speaking too slowly or in an infantilizing manner, repeatedly checking the accuracy of information shared by the person with TBI, and failing to show interest in the topics introduced by the person with TBI.^33,42,43 These strategies are shared with both the person with TBI and their communication partner, focusing on collaborative interactions.³⁵

Potential Applications of CPT with Autistic Adults and Their Neurotypical Communication Partners

The effectiveness of CPT in the acquired communication differences literature is well established.^28,29,31,44 While we acknowledge important fundamental differences between autistic adults and people with acquired communication differences, we propose that helpful information can be extrapolated from CPT techniques within the acquired communication differences literature to inform social communication support for autistic adults and their neurotypical communication partners. Certain principles found in CPT programs have already been examined in the autism literature; however, to our knowledge, CPT programming has yet to be comprehensively studied with autistic adults and their neurotypical communication partners. We highlight below how three key components of CPT from the acquired communication differences literature are evident in the extant autistic adult literature, and explore areas for future development.

Increasing knowledge and understanding of communication differences

Mixed neurotype miscommunications and stigma are contributing factors to the disparities that autistic adults often experience across health care, educational, employment, and social settings.^45–47 A limited number of programs exist that aim to reduce stigma and increase knowledge about autism for unfamiliar communication partners across a variety of settings (e.g., postsecondary education, health care, law enforcement).^48–51

In health care, for example, most autism-related training programs targeting physicians' knowledge are focused on pediatric providers, although a handful include health care providers for autistic adults.⁴⁸ These educational programs encompass similar components as those found in CPT programs for people with acquired communication differences and their communication partners (e.g., providing information about clinical characteristics and presentations).³¹ Such programs, as well as the lessons learned from neurodiversity-informed frameworks promoting health care accessibility (e.g., Autistic SPACE)⁵² would be a key foundation to build from for more comprehensive CPT programming targeting health care providers working with autistic adults.

In addition to discussing common preferences and experiences of autistic adults, education sessions must be tailored to each person's unique profile given the heterogeneous nature of autism. This is consistent with CPT programs offering background information on relevant diagnoses, but focusing on individualized and tailored education based on the strengths, challenges, and preferences of each person within a communication dyad.^29,35,40 This education on individual characteristics lays the groundwork for using CPT to support communication at the interactional level, as both parties can approach the interaction with a deeper understanding of one another's lived experiences and preferences.

Increasing awareness of and adapting the communication environment

The built environment plays an important role in facilitating and/or hindering participation and inclusion of autistic people.^53,54 Recent literature has started to identify common factors in the broader communication environment that may impact successful participation. For instance, autistic adults have outlined the importance of considering the length of time of social interactions, the noise level of the conversation, background noise, and how many people are speaking, among other environmental considerations.^55,56 In a CPT program, neurotypical communication partners could be trained to identify potential barriers and facilitators in communication environments for autistic adults and learn how to facilitate possible modifications (e.g., reduce sensory overwhelm, adjust conversation volume).⁹

Future CPT programs should also consider environmental factors impacting the neurotypical communication partner, as conflicting access needs may not align with those of the autistic adult (e.g., volume, lighting). Moreover, CPT could support autistic adults and neurotypical communication partners alike in advocating for necessary environmental modifications across settings (e.g., health care, law enforcement, education).

Identifying collaborative strategies to foster meaningful communication

Important work to date has focused on tool creation to help autistic adults identify and share their communication needs and preferences with their neurotypical communication partners in the hope of reducing miscommunications, such as the use of autism health passports in health care settings.⁵⁷ Limited evidence exists, however, that supports the effectiveness of these tools.⁵⁷ Recognizing the interactional nature of communication, neurotypical communication partners may need to adapt and/or modify their communication strategies when interacting with autistic adults to foster communication success and vice versa.

Research to date has highlighted potential modifications for neurotypical communication partners, such as encouraging access to augmentative and alternative communication and opting for other communication mediums besides speaking on the phone.^52,58 Additional strategies that have been documented in the literature include encouraging neurotypical communication partners to allow time for immediate clarification/feedback in conversation, as well as for neurotypical communication partners to explicitly seek clarification, rather than make assumptions about the intent of the autistic person's communication if they are unsure.⁵⁵ Negative behaviors for neurotypical communication partners to avoid may include speaking quickly and using abstract language.^55,56

While a basic understanding of commonly helpful strategies when interacting with autistic adults is important, future CPT programming will need to prioritize the heterogeneous and individualized communication needs of each person within the communication dyad. To this effect, future CPT programming could include explicit opportunities for both autistic adults and their neurotypical communication partners to express their personal needs and preferences.

Considerations for Future CPT Research with Autistic Adults and Their Neurotypical Communication Partners

It will be important for future work to take a holistic and nuanced approach to understanding how personal and contextual factors shape the social communication needs of diverse autistic adults and their neurotypical communication partners, as well as address potential inequity that can stem from the intersections of various social identities. Different aspects of personal identity may be more salient across time and various contexts for both people within a communication dyad.⁵⁹ For example, autistic adults' communication preferences and needs may depend on a range of factors at any given time, including the traits and actions of communication partners, sensory environments, mental and physical health, and camouflaging abilities.^60,61 Autistic adults experiencing stress, sensory overload, and/or burnout have described transient experiences of extreme fatigue and fluctuating communication abilities.^56,62,63 During these experiences, a person's communication needs and the roles of their communication partners may temporarily differ from their baseline communication profile.

It is important for future work to consider the dynamic impact of both intrinsic and extrinsic factors on autistic adults to ultimately improve the communication success between autistic adults and their neurotypical communication partners.

Personal and contextual factors must also be considered for neurotypical communication partners; however, future CPT programming may wish to put a greater emphasis on teaching strategies to neurotypical communication partners, given the inequitable expectations placed on autistic adults within neurotypical society.⁸ As noted by Milton,⁸ “many autistic people have indeed gained a greater level of insight into [neurotypical] society, and more than vice versa, perhaps due to the need to survive and potentially thrive in [neurotypical] culture.”^8(p886) The training needs of autistic adults and their neurotypical communication partners will need to be clearly defined while acknowledging the extant inequities autistic people face as a neurominority.

It will also be important for future CPT programming to target a range of unfamiliar and familiar communication partners of autistic adults. For instance, autism is increasingly being identified in adulthood⁶⁴ and inadequate knowledge and understanding of autism by families and friends has been identified as a major concern after receiving an autism diagnosis in adulthood.⁶⁵ CPT for familiar communication partners of newly diagnosed autistic adults is an area ripe for future development.

While the current Perspective focuses on autistic adults and neurotypical communication partners, the principles of CPT may apply to other aspects of neurodivergence across the lifespan. For instance, future CPT programming may wish to explore how CPT principles could apply to neurodivergent–neurodivergent pairings. Future CPT programming should also study how principles can apply to autistic youth, in addition to adults.

Finally, it is imperative for future efforts in this area to prioritize the lived experience of autistic adults and involve them throughout the research process. A recent review found most psychosocial interventions to date are not tailored to the needs of autistic adults, and often do not consider the priorities of autistic adults.⁶⁶ Future research focused on CPT development and evaluation will need to be coproduced with autistic adults to optimize outcomes.

Conclusion

It is necessary to move away from traditional social skill-focused programming for autistic adults toward neurodiversity-affirming supports that prioritize autistic wellbeing and authenticity in communication interactions. CPT carries the potential to build equitable partnerships between autistic adults and their neurodiverse communication partners, reduce communication barriers, and foster meaningful mixed neurotype communication. Many of the key components of CPT are already being studied in isolation within the autism literature and a more fulsome approach is warranted. We propose that further study of the feasibility and effectiveness of comprehensive CPT programming with autistic adults and their communication partners is needed.

Footnotes

Authorship Confirmation Statement

M.A.: Conceptualization, writing—original draft preparation, and writing—reviewing and editing. I.C.: Conceptualization, and writing—reviewing and editing. A.T.: Conceptualization, writing—original draft preparation, writing—reviewing and editing, and supervision.

Author Disclosure Statement

No competing financial interests exist.

Funding Information

The authors did not receive any funding for this work.

Acknowledgements

Our team gratefully acknowledges Ian Roth and Dr. Lyn Turkstra, who provided guidance on key considerations when conducting this work.

References

American Speech-Language-Hearing Association. Components of social communication. n.d. www.asha.org/practice-portal/clinical-topics/social-communication-disorder/components-of-social-communication/ (Last accessed: March 8, 2024).

Kapp

How social deficit models exacerbate the medical model: Autism as case in point. Autism Policy Pract. 2021; 2(1):3–28.

Kapp

, Gillespie-Lynch

, Sherman

, Hutman

. Deficit, difference, or both? Autism and neurodiversity. Dev Psychol. 2013; 49(1):59–71. doi: 10.1037/a0028353

American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. 5th ed. Washington D.C.; 2013.

Friedman

, Sterling

, DaWalt

, Mailick

. Conversational language is a predictor of vocational independence and friendships in adults with ASD. J Autism Dev Disord. 2019; 49(10):4294–4305. doi: 10.1007/s10803-019-04147-1

Hendricks

, Wehman

. Transition from school to adulthood for youth with autism spectrum disorders. Focus Autism Other Dev Disabil. 2009; 24(2):77–88. doi: 10.1177/1088357608329827

Tobin

, Drager

, Richardson

. A systematic review of social participation for adults with autism spectrum disorders: Support, social functioning, and quality of life. Res Autism Spectr Disord. 2014; 8(3):214–229.

Milton

. On the ontological status of autism: The “double empathy problem.”. Disabil Soc. 2012; 27(6):883–887.

Black

, Clarke

PJF

, Deane

, et al. “That impending dread sort of feeling”: Experiences of social interaction from the perspectives of autistic adults. Res Autism Spectr Disord. 2023; 101:102090.

10.

Crompton

, Ropar

, Evans-Williams

, Flynn

, Fletcher-Watson

. Autistic peer-to-peer information transfer is highly effective. Autism. 2020; 24(7):1704–1712.

11.

Crompton

, Sharp

, Axbey

, Fletcher-Watson

, Flynn

, Ropar

. Neurotype-matching, but not being autistic, influences self and observer ratings of Interpersonal Rapport. Front Psychol. 2020; 11. doi: 10.3389/fpsyg.2020.586171

12.

Rifai

, Fletcher-Watson

, Jiménez-Sánchez

, Crompton

. Investigating markers of rapport in autistic and nonautistic interactions. Autism Adulthood. 2022; 4(1):3–11. doi: 10.1089/aut.2021.0017

13.

, Cunningham

, Lai

. Reconsidering autistic “camouflaging” as transactional impression management. Trends Cogn Sci. 2022; 26(8):631–645. doi: 10.1016/j.tics.2022.05.002

14.

Monahan

, Freedman

, Pini

, Lloyd

. Autistic input in social skills interventions for young adults: A systematic review of the literature. Rev J Autism Dev Disord. 2021. doi: 10.1007/s40489-021-00280-9

15.

Cage

, Troxell-Whitman

. Understanding the reasons, contexts and costs of camouflaging for autistic adults. J Autism Dev Disord. 2019; 49(5):1899–1911. doi: 10.1007/s10803-018-03878-x

16.

Bishop-Fitzpatrick

, Minshew

, Eack

. A systematic review of psychosocial interventions for adults with autism spectrum disorders. J Autism Dev Disord. 2013; 43(3):687–694. doi: 10.1007/s10803-012-1615-8

17.

Bottema-Beutel

, Park

, Kim

. Commentary on social skills training curricula for individuals with ASD: Social interaction, authenticity, and stigma. J Autism Dev Disord. 2018; 48(3):953–964. doi: 10.1007/s10803-017-3400-1

18.

Santhanam

, Hewitt

. Perspectives of adults with autism on social communication intervention. Commun Disord Q. 2020; 42(3):152574012090550. doi: 10.1177/1525740120905501

19.

Cook

, Hull

, Crane

, Mandy

. Camouflaging in autism: A systematic review. Clin Psychol Rev. 2021; 89:102080. doi: 10.1016/j.cpr.2021.102080

20.

Lawson

WB.

Adaptive morphing and coping with social threat in autism: An autistic perspective. J Intellect Disabil Diagn Treat. 2020; 8(3):519–526. doi: 10.6000/2292-2598.2020.08.03.29

21.

Pearson

, Rose

. A conceptual analysis of autistic masking: Understanding the narrative of stigma and the illusion of choice. Autism Adulthood. 2021; 3(1):52–60. doi: 10.1089/aut.2020.0043

22.

Bradley

, Shaw

, Baron-Cohen

, Cassidy

. Autistic adults' experiences of camouflaging and its perceived impact on mental health. Autism Adulthood. 2021; 3(4):320–329. doi: 10.1089/aut.2020.0071

23.

Hull

, Levy

, Lai

, et al. Is social camouflaging associated with anxiety and depression in autistic adults?. Mol Autism. 2021; 12(1). doi: 10.1186/s13229-021-00421-1

24.

Cassidy

, Gould

, Townsend

, Pelton

, Robertson

, Rodgers

. Is camouflaging autistic traits associated with suicidal thoughts and behaviours? Expanding the interpersonal psychological theory of suicide in an undergraduate student sample. J Autism Dev Disord. 2020; 50(10):3638–3648. doi: 10.1007/s10803-019-04323-3

25.

Silver

, Parsons

. Perspectives of autistic adults on the strategies that help or hinder successful conversations. Autism Dev Lang Impair. 2022; 7:239694152211011. doi: 10.1177/23969415221101113

26.

Lerner

, Gurba

, Gassner

. A framework for neurodiversity-affirming interventions for autistic individuals. J Consult Clin Psychol. 2023; 91(9):503.

27.

MacDonald

Introducing the model of cognitive-communication competence: A model to guide evidence-based communication interventions after brain injury. Brain Inj. 2017; 31(13–14):1760–1780. doi: 10.1080/02699052.2017.1379613

28.

Simmons-Mackie

, Raymer

, Cherney

. Communication partner training in aphasia: An updated systematic review. Arch Phys Med Rehabil. 2016; 97(12):2202–2221.e8. doi: 10.1016/j.apmr.2016.03.023

29.

Wiseman-Hakes

, Ryu

, Lightfoot

, Kukreja

, Colantonio

, Matheson

. Examining the efficacy of communication partner training for improving communication interactions and outcomes for individuals with traumatic brain injury: A systematic review. Arch Rehabil Res Clin Transl. 2019; 2(1):100036. doi: 10.1016/j.arrct.2019.100036

30.

Lai

, Anagnostou

, Wiznitzer

, Allison

, Baron-Cohen

. Evidence-based support for autistic people across the lifespan: Maximising potential, minimising barriers, and optimising the person–environment fit. Lancet Neurol. 2020; 19(5):434–451. doi: 10.1016/s1474-4422(20)30034-x

31.

O'Rourke

, Power

, O'Halloran

, Rietdijk

. Common and distinct components of communication partner training programmes in stroke, traumatic brain injury and dementia. Int J Lang Commun Disord. 2018; 53(6):1150–1168. doi: 10.1111/1460-6984.12428

32.

Tessier

, Power

, Croteau

. Paid worker and unfamiliar partner communication training: A scoping review. J Commun Disord. 2020; 83:105951. doi: 10.1016/j.jcomdis.2019.105951

33.

Ylvisaker

, Turkstra

, Coelho

. Behavioral and social interventions for individuals with traumatic brain injury: A summary of the research with clinical implications. Semin Speech Lang. 2005; 26(4):256–267. doi: 10.1055/s-2005-922104

34.

World Health Organization. International Classification of Functioning, Disability and Health. Geneva: World Health Organization; 2001.

35.

Togher

, McDonald

, Tate

, Power

, Rietdijk

. Training communication partners of people with severe traumatic brain injury improves everyday conversations: A multicenter single blind clinical trial. J Rehabil Med. 2013; 45(7):637–645. doi: 10.2340/16501977-1173

36.

Cruice

, Blom Johansson

, Isaksen

, Horton

. Reporting interventions in communication partner training: A critical review and narrative synthesis of the literature. Aphasiology. 2018; 32(10):1135–1166. doi: 10.1080/02687038.2018.1482406

37.

Clay

, Beeke

, Volkmer

, Dangerfield

, Bloch

. A communication partner training program delivered via telehealth for people living with Parkinson's (better conversations with Parkinson's): Protocol for a feasibility study. JMIR Res Protoc. 2023; 12:e41416. doi: 10.2196/41416

38.

Solarsh

, Johnson

. Developing communication access standards to maximize community inclusion for people with communication support needs. Top Lang Disord. 2017; 37(1):52–66.

39.

Brush

, Sanford

, Fleder

, Bruce

, Calkins

. Evaluating and modifying the communication environment for people with dementia. Perspect Gerontol. 2011; 16(2):32–40. doi: 10.1044/gero16.2.32

40.

Rietdijk

, Power

, Brunner

, Togher

. A single case experimental design study on improving social communication skills after traumatic brain injury using communication partner telehealth training. Brain Inj. 2019; 33(1):94–104. doi: 10.1080/02699052.2018.1531313

41.

Folder

, Power

, Rietdijk

, Christensen

, Togher

, Parker

The effectiveness and characteristics of communication partner training programs for families of people with dementia: A systematic review. Gerontologist, 2023. doi: 10.1093/geront/gnad095

42.

Togher

, McDonald

, Tate

, Power

, Ylvisaker

, Riedijk

. TBI Express: A Social Communication Training Manual for People with TBI and Their Communication Partners. Sydney: Australian Society for the Study of Brain Impairment; 2011.

43.

Togher

, McDonald

, Tate

, Rietdijk

, Power

. The effectiveness of social communication partner training for adults with severe chronic TBI and their families using a measure of perceived communication ability. NeuroRehabilitation. 2016.

44.

Shrubsole

, Power

, Hallé

. Communication partner training with familiar partners of people with aphasia: A systematic review and synthesis of barriers and facilitators to implementation. Int J Lang Commun Disord. 2023; 58(2):601–628. doi: 10.1111/1460-6984.12805

45.

Romualdez

, Heasman

, Walker

, Davies

, Remington

. “People might understand me better”: Diagnostic disclosure experiences of autistic individuals in the workplace. Autism Adulthood. 2021; 3(2). doi: 10.1089/aut.2020.0063

46.

Walsh

, Lydon

, O'Dowd

, O'Connor

. Barriers to healthcare for persons with autism: A systematic review of the literature and development of a taxonomy. Dev Neurorehabil. 2020; 23(7):1–18. doi: 10.1080/17518423.2020.1716868

47.

White

, Hillier

, Frye

, Makrez

. College students' knowledge and attitudes towards students on the autism spectrum. J Autism Dev Disord. 2019; 49(7):2699–2705. doi: 10.1007/s10803-016-2818-1

48.

Clarke

, Fung

. The impact of autism-related training programs on physician knowledge, self-efficacy, and practice behavior: A systematic review. Autism. 2022; 26(7):1626–1640. doi: 10.1177/13623613221102016

49.

Gillespie-Lynch

, Brooks

, Someki

, et al. Changing college students' conceptions of autism: An online training to increase knowledge and decrease stigma. J Autism Dev Disord. 2015; 45(8):2553–2566. doi: 10.1007/s10803-015-2422-9

50.

Holloway

, Munro

, Cossburn

, Ropar

. A pilot study of co-produced autism training for police custody staff: Evaluating the impact on perceived knowledge change and behaviour intentions. Policing. 2022 (ahead-of-print). doi: 10.1108/pijpsm-11-2021-0159

51.

Waisman

, Williams

, Cage

, et al. Learning from the experts: Evaluating a participatory autism and universal design training for university educators. Autism. 2023; 27(2):356–370. doi: 10.1177/13623613221097207

52.

Doherty

, McCowan

, Shaw

. Autistic SPACE: A novel framework for meeting the needs of autistic people in healthcare settings. Br J Hosp Med (Lond). 2023; 84(4):1–9. doi: 10.12968/hmed.2023.0006

53.

Black

, McGarry

, Churchill

, et al. Considerations of the built environment for autistic individuals: A review of the literature. Autism. 2022; 26(8):1904–1915. doi: 10.1177/13623613221102753

54.

Tola

, Talu

, Congiu

, Bain

, Lindert

. Built environment design and people with autism spectrum disorder (ASD): A scoping review. Int J Environ Res Public Health. 2021; 18(6):3203. doi: 10.3390/ijerph18063203

55.

Cook

, Crane

, Mandy

. Dropping the mask: It takes two. Autism. 2023. doi: 10.1177/13623613231183059

56.

Cummins

, Pellicano

, Crane

. Autistic adults' views of their communication skills and needs. Int J Lang Commun Disord. 2020; 55(5):678–689. doi: 10.1111/1460-6984.12552

57.

Ellis

, Williams

, Brown

, Healer

, Grant

. A realist review of health passports for autistic adults. PLoS One. 2023; 18(9):e0279214. doi: 10.1371/journal.pone.0279214

58.

Howard

, Sedgewick

. “Anything but the phone!”: Communication mode preferences in the autism community. Autism. 2021; 25(8):2265–2278. doi: 10.1177/13623613211014995

59.

Shoemaker

, Tobia

. Personal

Identity

. In: Vargas

, Doris

, eds. Oxford Handbook of Moral Psychology. Oxford University Press: Oxford, England; 2022.

60.

Zisk

, Dalton

. Augmentative and alternative communication for speaking autistic adults: Overview and recommendations. Autism Adulthood. 2019; 1(2):93–100. doi: 10.1089/aut.2018.0007

61.

Dorsey

, Tsi

A therapist's guide to supporting authentic, autistic social communication with Rachel Dorsey and V Tisi. Learn Play Thrive. July 5, 2023. https://learnplaythrive.com/podcasts/73-a-therapists-guide-to-supporting-authentic-autistic-social-communication-with-rachel-dorsey-and-v-tisi/ (Last accessed: March 8, 2024).

62.

Higgins

, Arnold

, Weise

, Pellicano

, Trollor

. Defining autistic burnout through experts by lived experience: Grounded Delphi method investigating #AutisticBurnout. Autism. 2021; 25(8):2356–2369. doi: 10.1177/13623613211019858

63.

Raymaker

, Teo

, Steckler

, et al. “Having all of your internal resources exhausted beyond measure and being left with no clean-up crew”: Defining autistic burnout. Autism Adulthood. 2020; 2(2):132–143. doi: 10.1089/aut.2019.0079

64.

Russell

, Stapley

, Newlove-Delgado

, et al. Time trends in autism diagnosis over 20 years: A UK population-based cohort study. J Child Psychol Psychiatry. 2022; 63:674–682.

65.

Huang

, Arnold

SRC

, Foley

, Trollor

. A qualitative study of adults' and support persons' experiences of support after autism diagnosis. J Autism Dev Disord. 2024; 54(3):1157–1170. doi: 10.1007/s10803-022-05828-0

66.

Curnow

, Rutherford

, Maciver

, et al. Mental health in autistic adults: A rapid review of prevalence of psychiatric disorders and umbrella review of the effectiveness of interventions within a neurodiversity informed perspective. PLoS One. 2023; 18(7):e0288275. doi: 10.1371/journal.pone.0288275