Research summary: Anxiety and Depression from Adolescence to Old Age in Autism Spectrum Disorder

[Excerpt] Our team recently published a journal article reporting on a study that looked at the relationship between anxiety and depression, age, sex (male, female), and autism symptoms in autistic adults. So far there has been little research into mental health challenges such as anxiety and depression across the lifespan of autistic individuals. To inform and provide appropriate supports we need to better understand the challenges experienced by autistic individuals and looking at mental health across the lifespan can help us do that. It is also important to understand what factors can be related to good and poor mental health, so we can investigate that relationship and understand it

Factors influencing the research participation of adults with autism spectrum disorders

The recruitment and retention of adults with autism spectrum disorders (ASD) into research poses particular difficulties; longitudinal studies face additional challenges. To date, factors influencing the participation of adults for ASD research have been unexamined. This article draws on a study conducted in 2014 to identify factors influencing the participation of adults in longitudinal autism research. Quantitative and qualitative data was obtained from 167 participants across Australia in four categories: adults with either high-functioning autism or Asperger syndrome; adults with ASD and an intellectual disability; carers of these adults; and neuro-typical adults. This article includes results for adults with ASD and their carers. Factors influencing participation were found to differ both between and within participant categories. These factors were classified as those arising from a participant’s values, which acted as either a motivator or a deterrent; and those based on convenience, which acted as either an enabler or inhibitor. While helping others was a key motivator for all, participants also sought personal benefits, which differed between categories. Belonging to a research community of like-minded people was also a motivator and enabler. The inconvenience of time and travel required was a key inhibitor; insensitivity to an individual’s needs and preferences for engaging with the world a key deterrent; maximising choice in all aspects of participant involvement a vital enabler; and the use of financial and other extrinsic rewards was found to be problematic

Interrelationship between insistence on sameness, effortful control and anxiety in adolescents and young adults with autism spectrum disorder (ASD)

Background Both self-regulation and insistence on sameness (IS) are related to anxiety, which is a common feature of individuals with autism spectrum disorder (ASD). Here, we aimed to characterise the IS-self-regulation-anxiety interrelationship by investigating the potential contribution made by self-regulation, assessed via effortful control (EC), to the IS-anxiety relationship in a sample of adolescents and young adults with ASD. Method Seventy-one older adolescents and younger adults with ASD (49 males, 22 females; M age = 18.71 years, SD = 2.51, range 14.42–24.81) completed the Adult Repetitive Behaviour Questionnaire-2, Effortful Control Scale of the Adult Temperament Questionnaire and the DSM-5 Dimensional Anxiety Scales. Results IS was associated with both EC (r = −.39, p = .001) and anxiety (r = .45, p < .001), and anxiety was in turn associated with EC (r = −.44, p < .001). To characterise the nature of this interrelationship, two mediation analyses were performed using the serial mediation model in PROCESS with 5000 resamples in bootstrapping. There was a significant indirect effect of EC on anxiety, through IS (b = −.06; BCa 95% CI [−.13, −.02]), and indirect effect on anxiety through EC (b = 1.62; BCa 95% CI [.59, 3.24]) with the mediators accounting for 29.07 and 26.04% of the total effect, respectively. Conclusions Our study provides the first exploration of the IS-anxiety-self-regulation link in ASD. The finding that lower levels of self-regulation are related both to anxiety and IS behaviours points to self-regulation as a viable intervention target for both anxiety and IS behaviours

A randomised controlled trial of an iPad-based application to complement early behavioural intervention in Autism Spectrum Disorder

Background Technology-based interventions for Autism Spectrum Disorder (ASD) have proliferated, but few have been evaluated within the context of a randomised controlled trial (RCT). This RCT evaluated the efficacy of one technology-based early intervention programme (Therapy Outcomes By You; TOBY) in young children with ASD. Methods TOBY is an app-based learning curriculum designed for children and parents as a complement to early behavioural intervention. Eighty children (16 female) were recruited to this RCT within 12 months of receiving a diagnosis of ASD (M age = 3.38; SD = 0.69) and randomised to receive either treatment-as-usual (community-based intervention, n = 39) or the TOBY therapy (at least 20 min/day) plus treatment-as-usual (n = 41) for a period of 6 months. Outcomes were assessed at 3 and 6 months postbaseline. (Australian New Zealand Clinical Trials Registry: ACTRN12614000738628; www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=365463). Results Children in the TOBY intervention group averaged 19 min/day engaging with the app in the first 3 months, but only 2 min/day during the second 3 months. There was no group difference in scores on the primary outcome, the Autism Treatment Evaluation Checklist, at either the 3- or 6-month follow-up. However, significant improvements at the 6-month follow-up were observed in the TOBY intervention group relative to the treatment-as-usual group on three secondary outcomes: the Fine Motor and Visual Reception subscales of the Mullen Scale of Early Learning and the Total Words Understood scale of the MacArthur-Bates Communicative Development Index. Statistical trends towards improvement in the TOBY intervention group were observed on measures of adaptive function, although these decreased in magnitude from the 3- to 6-month follow-up. Conclusions This study provides evidence that technology-based interventions may provide a relatively low-cost addition to existing therapist-delivered interventions for children with ASD. However, sustained use of the app over the full 6-month period was a challenge for most families.No Full Tex

The Adult Repetitive Behaviours Questionnaire-2 (RBQ-2A): A Self-Report Measure of Restricted and Repetitive Behaviours

In two studies we developed and tested a new self-report measure of restricted and repetitive behaviours (RRB) suitable for adults. In Study 1, The Repetitive Behaviours Questionnaire-2 for adults (RBQ-2A) was completed by a sample of 163 neurotypical adults. Principal components analysis revealed two components: Repetitive Motor Behaviours and Insistence on Sameness. In Study 2, the mean RBQ-2A scores of a group of adults with autism spectrum disorder (ASD; N = 29) were compared to an adult neurotypical group (N = 37). The ASD sample had significantly higher total and subscale scores. These results indicate that the RBQ-2A has utility as a self-report questionnaire measure of RRBs suitable for adults, with potential clinical application

Language and literacy subtypes in young children with a high-functioning autism spectrum disorder

Individuals diagnosed with an Autism Spectrum Disorder (ASD) present with language and reading abilities that range from far below average to far above average. There is a lack of research investigating the classification of children diagnosed with a high-functioning ASD (HFASD) according to language and reading ability. The present study aimed to explore the language and reading profiles within a group of young children diagnosed with a HFASD and to establish whether or not the language and reading profiles identified within this group were similar to those seen in age-matched children without a diagnosis of ASD. The results showed that children diagnosed with a HFASD present with language and reading ability profiles similar to those of non-ASD peers. Furthermore, regression analyses revealed that the predictors of decoding and also reading comprehension were similar for children with HFASD and their non-ASD peers

Predicting literacy in children with a high-functioning autism spectrum disorder

The most commonly reported reading profile for children with a high-functioning autism spectrum disorder (HFASD) is one of intact decoding combined with reduced reading comprehension. Whether or not the variables that predict decoding and reading comprehension for children with a HFASD are exactly the same as those identified for a non-ASD population is unknown. Therefore, the ability of cognition, phonological processing, oral language, and vision to predict decoding and reading comprehension was investigated. Regression analysis revealed that cognition, phonological processing, and syntax predicted decoding and reading comprehension for the HFASD and non-ASD groups. One notable difference was that semantics predicted literacy for the non-ASD children but not their HFASD peers

Examining subjective understandings of autistic burnout using Q methodology: A study protocol.

BackgroundEarly research indicates that autistic burnout is a chronic, debilitating condition experienced by many autistic people across the lifespan that can have severe consequences for their mental health, wellbeing, and quality of life. To date, studies have focused on the lived experiences of autistic adults, and findings suggest that a lack of support, understanding, and acceptance by others can contribute to the risk of autistic burnout. The study outlined in this protocol will investigate how autistic people with and without experience of autistic burnout, their families, friends, healthcare professionals and non-autistic people understand the construct of autistic burnout to identify commonalities and gaps in knowledge.Study and designQ methodology will be used to investigate participants' subjective understandings of autistic burnout. Q methodology is a mixed-methods design that is well-suited to exploratory research and can elucidate a holistic and comprehensive representation of multiple perspectives about a topic. Participants will complete a card sorting activity to rank how strongly they agree or disagree with a set of statements about autistic burnout and participate in a semi-structured interview to discuss their responses. A first-order factor analysis will be conducted for each participant group, followed by second-order factor analysis to compare the groups' viewpoints. The interview data will provide additional insights into the factors.ConclusionQ methodology has not previously been used to examine autistic and non-autistic people's perspectives about autistic burnout. Projected study outcomes include enhanced understanding of the characteristics, risks, and protective factors of autistic burnout. The findings will have practical implications for improving detection of autistic burnout and identifying strategies to support autistic adults with prevention and recovery. The results may also inform the development of a screening protocol and identify potential avenues for future research

Exploring the nature of anxiety in young adults on the autism spectrum: a qualitative study

Background: Research exploring the nature of anxiety symptoms in autism spectrum disorder (ASD) has thus far focused on children and adolescents, providing evidence for both typical and atypical anxiety symptom presentations associated with ASD. This study builds on previous research by focusing on young adults, and comparing anxiety presentation between individuals with ASD and non-ASD individuals with anxiety disorders. We anticipated that while the non-ASD group would report only typical anxiety symptoms, and the ASD group would report both typical and atypical presentations of anxiety symptoms. Method: Ten individuals with ASD and anxiety (M = 21.8 years, SD = 6.76), and 10 individuals with anxiety (M = 24.4 years, SD = 4.17) participated in focus groups. Participants responded to semi-structured interview questions specifically developed using the DSM-5 criteria for each of the anxiety disorders, Illness Anxiety Disorder, and Obsessive-Compulsive Disorder. These questions focused on carefully elucidating experiences of anxiety including DSM-5 anxiety symptomatology and ASD-specific anxiety symptomatology. Results: Thematic analysis revealed a theme structure for the ASD group composed of both DSM-5-related (e.g., social anxiety themes) and ASD-specific anxiety presentations (i.e., related to core ASD symptomatology). In contrast, the non-ASD group described predominantly DSM-5-related anxiety symptomatology. Conclusions: Our findings support the predicted outcome that there are both ASD-specific anxiety and DSM-5-related anxiety symptomatology in young adults with ASD, compared with young adults with anxiety who show only DSM-5 symptomatology. Future research elucidating the relationship between ASD symptomatology and anxiety in ASD, utilising both quantitative and qualitative measures, is crucial to enable a more comprehensive understanding of the nuances of anxiety in ASD. Gaining this knowledge is a crucial step for the development of more accurate and appropriate assessment and treatment tools that can target their specific anxiety experiences