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

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

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

Resting heart rate variability, emotion regulation, psychological wellbeing and autism symptomatology in adults with and without autism

Heart rate variability (HRV) has been separately shown to be associated with ASD symptomatology, psychological wellbeing and emotion regulation (ER) in specific samples consisting of either individuals with ASD, those without ASD, or combined. However, no study has examined these constructs together or incorporated habitual ER strategy use. Hence, the aim of this study was to examine the relationships between resting HRV, ASD symptomatology, ER strategy use (reappraisal and suppression), and psychological wellbeing (anxiety, depression and positive wellbeing) in a combined sample of adults with and without ASD. Twenty-four adults with ASD (M = 31.36; SD = 14.84) and twenty without ASD (M = 35.45; SD = 12.19) completed the ER Questionnaire (ERQ), Diagnostic and Statistical Manual of Mental Disorders-5 Cross-cutting Dimensional Scale, Patient Health Questionnaire-9, Warwick-Edinburgh Mental Well-being Scale, and Autism-Spectrum Quotient-Short. Participants’ resting HRV data were also collected via short-term electrocardiogram. Self-reported use of reappraisal was associated with higher resting HRV. Additionally, reappraisal predicted variance in all three HRV indices above and beyond ASD symptomatology and medication use. These preliminary findings can inform the design of future studies to determine the extent to which reappraisal impacts autonomic flexibility

Brief Report: Inter-Relationship between Emotion Regulation, Intolerance of Uncertainty, Anxiety, and Depression in Youth with Autism Spectrum Disorder

The aim of this study was to examine the inter-relationship between emotion regulation (ER), intolerance of uncertainty (IU), and symptoms of anxiety and depression in adolescents and young adults diagnosed with autism spectrum disorder (ASD). Sixty-one individuals aged 14-24\ua0years (M age = 18.19; SD age = 2.19) completed the ER Questionnaire, IU Scale-12, Diagnostic and Statistical Manual of Mental Disorders-5 Dimensional Anxiety Scales, Patient Health Questionnaire-9, and Autism-Spectrum Quotient-Short. Correlation and mediation analyses were conducted. Results indicated all key variables were associated with each other and IU mediated the relationships between ER and symptoms of anxiety and of depression. Findings have implications for the design of future interventions targeting affective disorders in ASD

How Does Emotion Regulation Strategy Use and Psychological Wellbeing Predict Mood in Adults With and Without Autism Spectrum Disorder? A Naturalistic Assessment

The aim of this study was to identify emotion regulation (ER) strategies that most strongly impact momentary mood in a sample of 23 adults with and 19 without autism spectrum disorder (ASD). Participants completed cognitive and behavioural assessments, online questionnaires, and experience sampling methodology questions. In the ASD group, the use of dampening and other-blame reduced mood while savouring and emotional acceptance improved mood. The use of self-blame and avoidance negatively impacted mood only in the non-ASD group, suggesting the use of these two strategies do not reduce mood in individuals with ASD. ER and mental health interventions should capture ER strategy use and aim to decrease maladaptive strategy use and increase adaptive strategy use

Emotion regulation in autism spectrum disorder: where we are and where we need to go

Emotion dysregulation is a common issue experienced by individuals with autism spectrum disorder (ASD) and has been associated with a wide range of negative mental and physical health outcomes. This commentary highlights the role emotion dysregulation plays in ASD by first considering the literature on emotion regulation (ER) in the general population and then summarizing the ER research in ASD. Based on the evaluation of previous research findings, we conclude that individuals with ASD have more ER difficulties and consistently self-report or demonstrate a less adaptive pattern of ER strategy use. In addition, the higher prevalence of internalizing and externalizing issues seen in ASD are associated with the greater habitual use of some ER strategies and less habitual use of others. Conceptual and methodological limitations are discussed, including the use of coping measures and single-method approaches, and ASD gender distribution. We propose a set of new directions for investigating ER in ASD, incorporating knowledge from other literatures on the role of flexibility in healthy adaptation, overlaps between flexibility and executive function deficits, the adaptive value of up-regulation of positive emotions, and the importance of emotional selfawareness. Increasing our capacity for identifying the mechanisms underlying co-morbid affective disorders can ultimately inform the design of effective interventions to maximize the wellbeing of individuals with ASD