Gray Atherton, Ph.D., details the socialization of the female gender experience and how that plays into autism gender biases. The speaker discusses the experiences of autistic women, highlighting that gender is a critical barrier to diagnosis and care. Atherton details recent investigations into implicit gender biases in autism and their impact on medical care and autism understanding. She evidences contemporary shifts in the zeitgeist of gender and autism and provides suggestions for future research. The presenter offers sources and acknowledgments before the Q&A, where she discusses masking, minorities and misdiagnosis, videogaming and autism, and much more. 

In this webinar:

1:00 – Agenda and introduction
4:40 – Gendered development & autism descriptions
8:00 – Female protective effect
10:00 – Male brain theory
12:35 – Gender and autism
16:20 – Masking
18:50 – Study 1: Age of diagnosis and quality of life
26:10 – Effects of late diagnosis
30:00 – Gender biases and a new ratio
35:12 – Study 2: Implicit gender biases against female autism
40:11 – Findings
42:40 – Study 3: The zeitgeist of gender and autism
44:50 – Summary and future research
48:08 – Q&A

Female gender experiences

Atherton discusses the construction and socialization of the female gender experience, underscoring observed differences in toys, colors, expectations, and language used with female versus male children (2:15). She explains that females show more relational aggression (indirect) compared to males by age four (4:40) and tend to consider hierarchies and reputation in social interactions and communication from a very young age (6:15). These differences, the speaker continues, result, in part, from contrasting developmental pressures and environments between females and males. 

Gender and autism

Historical descriptions of autism are skewed toward the male presentation due to classic gender biases (6:40). Atherton outlines two prominent hypotheses that aim to explain observed gender differences in autism: the Female Protective Effect (8:00) and the Male Brain Theory (10:10). While these theories have been widely investigated, contemporary understandings of gender and autism reveal them to be limited in scope and understanding. 

Atherton cites research showing higher rates of gender diversity in autism, where transgender and gender-diverse people are three to four times more likely to be autistic than cisgender people (12:35). She discusses masking (16:20), or the process of copying other people and learning how to socialize, and how repetitive behaviors and other signs of autism can be easily mistaken for the expected “nice” “quiet” or “organized” qualities of girls and women (13:35). 

Age of diagnosis and quality of life

The speaker details a recent investigation into the effect that age at autism diagnosis has on an individual’s quality of life (QoL) (18:50). The study found that women are significantly more likely to be diagnosed in adulthood compared to men and that women actually reported higher thresholds of autistic traits, but were still missed by practitioners (21:13). QoL scores were negatively associated with age of diagnosis and masking. In a subsequent interpretive phenomenological analysis of lived autistic experiences, participants reported that their gender kept them from receiving a diagnosis – that they would have received a diagnosis much younger if they were male (22:16). These findings suggest that women do have autism at least as frequently as men and that women are primarily underdiagnosed in adolescence, which leads to lower overall QoL (25:05).

A study by Rodgaard et al., 2021 found that women who received a late diagnosis were misdiagnosed at least once with depression, anxiety, sleep issues, etc. (28:35). Atherton underscores that without early diagnosis and proper medical care, individuals are more likely to develop co-occurring conditions. In fact, 26% of late-diagnosed women have co-occurring conditions compared to 13% of late-diagnosed males and 3% of the general population (26:10). 

Implicit gender biases

The presenter outlines a study by Burrow et al., 2022 where researchers conducted direct assessments of autism symptoms at six to nine (6-9), twelve to fifteen (12-15), twenty-four (24), and thirty-six to sixty months (36-60) (30:00). Data revealed a 1:1 gender ratio of male/female children with “high concern” for autism – a stark contrast to the historically accepted 4:1 ratio. Clinician notes often referenced ‘monitoring’ girls over time but not needing a diagnosis in the same way as the boys did (33:00). These findings, Atherton asserts, suggest that although there is no biological bias, there seems to be different symptoms in females, perhaps as a result of female socialization, and subsequent bias in autism understandings and diagnosis.

 To determine whether there are implicit biases held against female autism, Atherton and her team paired vignettes of autistic descriptors with male and female names and asked participants to say how autistic each vignette seemed (35:12). She explains that implicit biases may never be cognizantly acted upon, but that they still affect the way we understand and respond to information (38:15). Results from the study showed that participants were slower to respond and made more mistakes when autistic descriptors were paired with female names compared to male names. Item-by-item differences were also recorded, where words that were explicitly autistic were viewed as male, and those that were the opposite of autistic were considered female (40:11). The speaker asserts these findings show implicit biases associated with females being autistic. 

Conceptualizing autism

To properly care for autistic individuals, it is critical to understand the zeitgeist or cultural climate around autism and gender. To test this, the speaker collected photos that represented autism from 163 people. Many participants sent pictures of females and wrote about the struggles that autistic women face. Many participants also noted that we need to reimagine autism in accordance with gender (42:40). 

The speaker summarizes her presentation, highlighting the difficulties in diagnosis and care faced by autistic females, that women have the same amount or more autistic traits compared to men, that there are implicit biases against autism as a female experience, and that the cultural zeitgeist of autism and gender is changing according to the unique struggles and voices of autistic females (44:50). Atherton provides signup information for individuals interested in participating in future research projects about female autism trait presentation, gender diversity in autism, and adult experiences of neurodiverse people, specific to improving QoL (45:50). She provides references and thanks before the Q&A session (48:08). 

Peter Vermeulen, Ph.D., considers a positive approach to psychoeducation for autistic individuals. He draws on over 25 years of experience to illustrate contemporary changes in autism intervention focus and discourse. The speaker outlines critical characteristics of autism psychoeducation and underscores the need to create measurements and questionnaires based on well-being and happiness. He outlines a new psychoeducation program for autism, focusing on skill development, self-understanding, and quality of life. Vermeulen outlines critical understandings to inform positive psychoeducation before the Q&A session. 

Printable handouts (.pdf) are online HERE

This is a joint presentation by ARI and the World Autism Organisation.

In this webinar

0:00 – 6:20 – Introductions
6:40 – Psychoeducation and autism
9:27 – Self-knowledge in autism
12:00 – Shifting the focus of psychoeducation
14:50 – Pychoeducation must be meaningful and functional
18:15 – Pychoeducation must be positive
20:15 – Psychoeducation must be fun and interactive
23:28 – Pschoeducation must put autism into context
28:25 – Psychoeducation must focus on wellbeing
35:30 – Four pillars of psychoeducation for autism
39:00 – H.A.P.P.Y.
41:50 – Q&A

Introduction

Vermeulen defines psychoeducation as the “practice of explaining a diagnosis to people who have the diagnosis” and notes that this is a relatively new area of study within autism (6:40). He draws on past experiences to illustrate how the focus of psychoeducation has shifted over the last quarter century, highlighting that it is autistic people themselves who are entitled to learn about autism first (7:35). The speaker cites a study which found that autistic children “know” they are different and have some notion of what their differences and difficulties are. However, he continues, many have difficulty understanding and developing a nuanced and coherent concept of self (10:34). Vermeulen emphasizes the empowering potential of well-constructed psychoeducation. 

Characteristics of psychoeducation

The presenter describes his first published interactive psychoeducation program for autism, entitled, I Am Special (12:00). In the 25 years since its publication, Vermeulen continues, he realized that the focus of autism psychoeducation needed to shift from a clinical explanation and deficit-centered language to include information that autistic people actually need in a way that is easy for them to understand and empowers them to know themselves (13:55). He discusses four critical aspects of successful autism psychoeducation: 

Make it meaningful and functional

The word functional, in this sense, means that a given program is administered in a way that participants can relate to the information and, therefore, apply it to their lives almost immediately (14:50). He underscores that abstract and general information does not teach coping skills and that we must use language that reinforces self-understanding and builds navigating/coping skills (16:00). He provides this example: 

Instead of: You have difficulty with these kinds of situations.

We say: These kinds of situations can be difficult for you because of the sensory environment and… These are some things you can try that may help with …”

Make it positive

Vermeulen asserts the need to do away with the deficit perspective/discourse and focus on the positive aspects of autism. Individuals need to understand the benefits of their differences and their strengths. There are several positive autistic role models in the media. However, he continues, referring to things an individual can realistically achieve is also essential. Most people aren’t geniuses, so personal goals should be attainable – make it positive, but be honest (18:15). 

Make it fun and interactive

The presenter states that activities in autism psychoeducation programs should be interactive and encourage participants to do something. In his first publication, I Am Special, the activities were simple worksheets like those children receive in school, which can be boring and tedious (20:15). Vermeulen asserts the benefits of including activities that involve the surrounding environments. For example, he continues, have someone trace their body on a large piece of paper and then measure the lengths of each part (22:14).

Put autism into context

Vermeulen reminds viewers that autism is not the only title autistic people wear; it is not their sole defining characteristic. He urges families and practitioners not to make autism bigger than it is. This diagnosis is only part of each person, and psychoeducation programs must be sure to put this in context (23:28). The speaker recounts an interaction with someone who hated the I Am Special course because he didn’t want to be special; he wanted to be just like everyone else (25:00). 

Focus on wellbeing

He touches on the concept of neuroharmony and the need to focus on our commonalities instead of our differences (26:15). Maslow’s Hierarchy of Needs says that we all have physiological needs and safety needs, we all want to belong, have self-esteem, and be fulfilled (30:00). Vermeulen asserts that in terms of behavior, mind, and necessities, no one person is so different from the next. 

A recent study on autism intervention goals found that most investigations used DSM-5 criteria or other behavioral characteristics as success measurements. Such measurements have no correlation with quality of life (QoL), age, IQ, or symptom severity (32:00). Another study found that parents and autistic children would like intervention goals to include things like happiness, self-esteem, and mental health management (33:00). The presenter asserts the need to develop questionnaires and intervention goals based on what makes autistic people happy, not about their difficulties or differences (34:30). He urges families and practitioners to shift focus from being “less autistic” to being “autistically happy.”

H.A.P.P.Y.

Vermeulen describes his most recent psychoeducation program as an autism-friendly plan for well-being. It encompasses the aspects outlined above and has adapted evidence-based well-being strategies for autistic individuals (35:30). Vermeulen has created four pillars to inform programs for happiness and well-being for autistic people (37:40):

1. Happiness is within reach of all people with autism, regardless of the nature and profile of their autism, their intellectual abilities, and their age
2. Evidence-based scientific findings should underpin a program for happiness and well-being
3. A program for happiness and well-being should make evidence-based well-being interventions autism friendly
4. A program should be individualized and should be what works for you. 

His new program, H.A.P.P.Y., uses ten evidence-based well-being strategies, including accepting and loving yourself, Good Feeling toolbox, flow activities, physical exercise, problem-focused and emotion-focused coping strategies, positive thinking, gratitude, kindness, and personal projects (learning something new) (39:00). Versions (online and physical) for children and young adults are available for individuals or groups. There is no fixed number of sessions. The speaker provides concrete examples for a Good Feeling Box and flow activities. He reiterates the need for psychoeducation programs to be more than a list of all the things an individual must do or learn (40:00). Vermeulen summarizes his presentation, underscoring the five critical aspects of psychoeducation (41:15) before the Q&A where he discusses how H.A.P.P.Y. could work for individuals with intellectual disabilities and seniors, how to find what autistic people prefer, and much more (41:50). 

Dr. Gray Atherton, Ph.D., explores the connection between autism and anthropomorphism. She provides a brief historical and social context for anthropomorphism in our daily lives before diving into the prevalence and advantages of anthropomorphism in autism. The speaker details recent studies that challenge prevalent theories about socialization, Theory of Mind, and anthropomorphism in autism. Atherton asserts that many autistic people use anthropomorphism prolifically in everyday life and often outperform their non-autistic peers in this aspect of Theory of Mind. The presenter highlights anthropomorphism as a strength for many autistic individuals and suggests using it to support learning and interventions for autism. 

Handouts are online (.pdf) HERE

In this webinar:

1:58 – What is anthropomorphism?
5:00 – Importance of anthropomorphism
8:05 – Autism and anthropomorphism
10:00 – Social Motivation Theory of Autism
14:00 – Study 1: Theory of mind processes in autistic adolescents
18:50 – Study 2: Review of studies with anthropomorphic stimuli
23:45 – Study 3: Reading the Mind in the Eyes Test – anthropomorphized
29:00 – Study 4: Intellectual disability and emotion recognition
32:25 – Study 5: Verbal anthropomorphism and theory of mind
35:30 – Study 6: Pets and anthropomorphism in everyday life
39:50 – Recap
41:30 – Flip the narrative
46:00 – Applications and interventions
48:20 – Q & A session

History and importance of anthropomorphism

Atherton defines anthropomorphism as the attribution of human-like qualities, emotions, or behaviors to non-human entities, such as animals or objects (1:58). Examples of anthropomorphism are seen throughout history in our deities and legends, who often assume human characteristics. The speaker explains the importance of anthropomorphism in religion, connection, and socialization. She explains that wanting to understand something that isn’t human drives us to anthropomorphize and highlights that anthropomorphism is frequently related to loneliness (5:00). Atherton touches on the presence of anthropomorphism in childhood media and notes its increasing use in contemporary care work and technology (6:25). 

Autism and Anthropomorphism

The presenter discusses the Social Motivation Theory of Autism and outlines publications supporting the claim that autistic people are less socially motivated than their peers (9:00). Theory of Mind (ToM), or the capacity to ascribe emotions to other people based on facial expressions and personal characteristics, is closely related to anthropomorphism. Atherton outlines a study that tested ToM in relation to a video of moving shapes. Results showed that non-autistic respondents used human-like adjectives to describe the shape interactions, while autistic participants used more concrete descriptives and less mental state language (10:56). Given the contrast in responses, researchers concluded that autistic people have lower ToM and are less likely to anthropomorphize or use human-like descriptors. Atherton describes her own professional experiences with autistic individuals as totally contrary to these assumptions and asserts the need for further exploration into ToM and autism (12:10). 

Study 1: Theory of Mind processes in autistic adolescents 

To explore the Theory of Mind experiences of autistic adolescents, the speaker conducted an open-response interview and interpretive phenomenological analysis (14:00). The study revealed four overarching themes concerning how autistic people engage with ToM processes: honesty, humor, visualization, and anthropomorphism (15:00). Atherton presents sub-themes and quotes from participants that reflect their prolific use of anthropomorphism in daily life. She asserts that these findings challenge accepted notions that autistic people have low ToM and social motivation (17:23). 

Study 2: Review of investigations with anthropomorphic stimuli

Although anthropomorphism isn’t often explicitly studied, many investigations use anthropomorphic stimuli as a control in comparative studies (18:50). In reviewing such studies, the speaker found that autistic individuals perform significantly better on ToM tests when the stimuli are non-human instead of human (20:00). She outlines three publications that revealed:

1. Autistic people prefer anthropomorphized images over human ones.
2. Autistic people actually have an advantage in this area of ToM compared to their non-autistic peers.
3. This advantage may have to do with the expertise or familiarity that autistic people have with non-human social agents (22:30). 

Study 3: Reading the Mind in the Eyes test – anthropomorphized

Reading the Mind in the Eyes test (RME) is a classic ToM exercise where participants determine emotions based on photos of a person’s eyes. Atherton and colleagues created a cartoon (anthropomorphic) version of the RME and compared autistic and non-autistic group responses for both versions (23:45). Results showed that the non-autistic group had higher success on the human RME test but that the autistic participants outperformed their counterparts on the cartoon test (27:00). These results, the presenter posits, suggest that anthropomorphism may be a strength for autistic individuals, further challenging the preconceived notions that autistic people have low ToM and emotion recognition capabilities.

Study 4: Intellectual disability and emotion recognition

Around 40% of autistic individuals also have some co-occurring intellectual disability, and many are non-verbal. Atherton explains how communication barriers often exclude this part of the autistic community from research participation (28:00). She outlines a recent study that took these differences into account and assessed whether the prolific use of anthropomorphism revealed in previous studies defines the entire autism spectrum (29:00). Researchers used a combination of human faces and animal face filters to test ToM. They found a significant increase in correct answers for the photos with animal filters on them, suggesting participants better understand anthropomorphized stimuli compared to human faces (31:20). The presenter discusses study limitations, noting the aspect of visual salience. 

Study 5: Verbal anthropomorphism and theory of mind

To see if anthropomorphism extends beyond visual context, Atherton and colleagues used a verbal ToM Faux Pas test (32:25). They tested participants’ ability to determine whether someone said something awkward in both human and anthropomorphized stories provided in text. Similar results to previous studies were found: autistic people struggled with human-based wording but performed at the same level as, if not better than, the non-autistic group with anthropomorphized stories (34:00). Atherton asserts that these findings suggest anthropomorphism may play a critical role in how autistic people engage in perspective-taking and conceptualize ToM. 

Study 6: Pets and anthropomorphism in everyday life

As human beings, we often anthropomorphize our pets to relate to them and create connections. Atherton describes a study on differences between autistic and non-autistic groups in their anthropomorphism of pets. Results showed that the autistic group was equally attached to their pets and used similar amounts of anthropomorphism as their non-autistic counterparts. Interestingly, the presenter states, Autism Quotient scores correlated with anthropomorphism and autistic people were more likely to substitute pets for people (mediated by social avoidance) (35:30). Interpretive phenomenological analysis of 16 interviews with autistic pet owners showed that pets can often act as a social alternative and/or a social lubricant. Participants frequently noted that with animals, “you don’t have to wear a mask – they don’t know what social rules you may be breaking” (37:15). 

Atherton states that these real-life examples show how autistic individuals intentionally create anthropomorphic connections to compensate for social deficits or avoidance. These intentional connections manifest in various ways, from donating to animal charities to becoming a cat behaviorist. The speaker asserts that we need to understand anthropomorphism as a strength and something that autistic people may be particularly good at. Perhaps, she continues, they are engaging with and becoming experts in anthropomorphism because it’s a way to have connections that don’t feel judgmental or forced (39:00). 

The big picture

The speaker summarizes the presentation, highlighting that evidence suggests autistic people anthropomorphize at least to the same degree as their non-autistic peers and that anthropomorphism may play a role in the way autistic people conceptualize or engage in ToM and perspective-taking (39:50). She presents a diagram of the Social Motivation Theory and suggests that we flip the narrative. Instead of saying autistic people have decreased human/social motivation or recognition, we can say they have increased non-human attention to faces and understand non-humans much more (41:30). 

The presenter notes that anthropomorphism may vary across developmental stages and cites a multi-age study where anthropomorphism decreased with age (44:15). She suggests leveraging anthropomorphic stimuli, like cartoons, in educational and therapeutic settings with autistic individuals. For example, a pilot study using Hololens glasses is underway, which could allow for more meaningful interactions using anthropomorphism and digital projections (46:00). Atherton invites viewers to share their real-life experiences with anthropomorphism and provides her contact information (47:15) before beginning the Q & A session (48:20)

David B. Nicholas, Ph.D., examines the transition to adulthood and its implications for autistic individuals. He presents the ecosystem mentality and discusses recent findings supporting a holistic and future-oriented integrated care system. The speaker details potential areas of capacity building within post-secondary education and employment and highlights the need for cross-sector collaboration and lifelong care. Nicholas summarizes the presentation, underscoring changes in contemporary discourse, and considers future avenues of research before the Q&A session.

In this webinar: 

0:00 – Autism Research Insitute introduction
1:52 – World Autism Organization introduction
4:40 – Speaker introduction
6:30 – Objectives and background
9:00 – Ecosystem mentality
10:14 – Study: Transition experiences for individuals in the autism ecosystem
11:35 – Results
13:30 – Mental health accommodations
17:28 – Recommendations
19:45 – Capacity building
24:48 – Post-secondary education
30:00 – Employment
36:07 – A new discourse
45:40 – Summary and conclusion
51:50 – Q & A

Introduction

Nicholas defines the presentation objectives and summarizes current literature on the transition experiences of autistic individuals (5:30). Specifically, he notes that support needs are not well understood across care and that the process of transitioning to adulthood requires more community/system-level support and increased focus on the individual (7:29). The presenter uses the metaphor of a pathway to illustrate the ecosystem mentality and highlights the observable increase in focus on quality of life (QoL) and community/system-level factors within the discourse (8:00). 

Study: Transition experiences for individuals in the autism ecosystem

The speaker describes a grounded theory study that used 64 semi-structured interviews with autistic youth and young adults, parents, and service providers to assess the transition experiences of individuals across the autism ecosystem (10:14). Key challenges faced by many participants included the need to research, find, and wait for services, laborious and complicated application processes, and having to work extremely hard while often being unsure of how to proceed or what to seek out (11:35). Participants also reported that the adult care systems are notably distinct from child/youth services and that, when attained, adult services are often insufficient relative to the needs. Many also cited a notable lack of understanding about support needs across the diverse autism experiences, specifically surrounding mental health and autism (13:30). The presenter shares a quote to illustrate these challenges: 

“[The service provider] said, ‘Well, just call the police, and they’ll take her out of the house.’ I said that would be the last thing [that should be done]. I would never… have the cops take her on a mental health warrant… I knew that [individual] would kill herself if I had done that, and so that was a horrible lack of support. Complete lack of understanding of autism combined with mental health issues…. Just take her, grab her, and put her, you know, drag her to the clinic (15:10).”

Many participants also noted that services are often rooted in the medical approach or a “deficit” orientation, and many access restrictions are based on characteristics outside an individual’s control (i.e., IQ, age, level of functioning). Nicholas asserts the need for cross-sectoral support and a comprehensive approach to addressing the many challenges associated with transitioning to adulthood in autism (15:50). 

Recommendations and capacity building

Despite the discussed challenges, Nicholas continues, there is a growing awareness and willingness to adapt to the diverse needs of autistic people and other neurodiverse groups. For example, many airports, libraries, transportation systems, and employers are already making strides in creating more inclusive and accommodating spaces, programs, and policies (19:20). The speaker asserts that moving forward, supports need to focus on knowledge transfer, tangible help, navigational assistance, and training/skill development (17:28). He underscores the need for stronger relationships and collaboration among diverse stakeholders and outlines three levels of capacity building (19:45): 

• Micro: individual and family support
  • Personal acceptance and flexibility in targeting individual needs
  • Increased expectations for life achievements and aspirations
  • Peer mentorship and support for parents to the role of “life coach”
• Mezzo: program and personnel development
  • Capacity development in residential and community support
  • Staff training 
  • Stronger relationships across diverse stakeholder groups/sectors
• Macro: Policy 
  • Increased funding, with targeted programming to adult services
  • Autistic voices in service planning and priority setting

Post-secondary education (PSE)

Nicholas discusses challenges for autistic people in accessing post-secondary education (PSE) and outlines the micro, mezzo, and macro capacities for change within this context (24:48). He considers the campus ecosystem holistically and discusses potential adjustments to course design, career/employment support, residence life, and campus policies that would accommodate autistic students (27:40). Priorities for accommodation in PSE include mentorship and peer support, supportive engagement with others across sectors, and opportunities/choices in accommodation for individuals across the autism spectrum (29:20). 

Employment

The speaker emphasizes that we must think of the autism ecosystem over time as transitions occur throughout our lives (30:00). Another major transition is PSE to employment. Nicholas shares a quote (31:00): 

“What my son needs now is job skills… he needs to survive in this world as a young adult, with or without his parents. Help! Because not every young adult with autism has parents or has the supports, right? Whether it be parents or other family members, not everyone has that. So he needs job skills; he needs life skills and life training.”

Employment challenges reported by participants included emotional/psychological, focus/concentration, social/relational, and environmental/sensory (31:45). The presenter explains that these challenges make the pathway to adulthood much more complicated than needed. He outlines the ecosystem components of employment and highlights supports and capacity building at the individual, community, and policy levels (34:05). 

A new discourse

Nicholas discusses emerging principles from this work, including intentional access (adult-based resources), multisector integrated engagement, and flexibility in resources (36:07). He highlights some characteristics of integrated navigational services, including linked networks, stigma reduction, coordination of services, and lifespan care. Study respondents specifically mentioned resource information, peer support, and individualized service as important components of navigational support services (38:25). The speaker explains how these characteristics give rise to the idea of integrated or universal care, which gives attention to the social determinants of health and accommodates individual and family needs (37:00). 

Current discursive frameworks, he continues, consider transitions across the lifetime and maintain a holistic view of resources and service system interactions (40:13). Nicholas asserts that characteristics commonly associated with adulthood push the notion of a singular path, or only one way to become independent (42:10). He posits that the pinnacle of adulthood is not so much independence and as it is QoL, being, belonging, and becoming, and the pursuit of aims and dreams (44:30).

Conclusion

Nicholas summarizes the presentation and crucial points. He stresses the importance of future-oriented approaches that consider individual agency and self-determination and highlights that all of this must be done in the interest of supporting and pursuing a good life on one’s terms and belonging in community (45:40). To support these shifts in the autism ecosystem, we need timely mobilization of evidence to action, increased engagement from relevant systems and stakeholders, proactive engagement around social determinants of health, and a greater focus on QoL as the pinnacle in this journey towards adulthood (47:14). The speaker shares research recommendations and sources (48:45) before the Q & A (51:50)