Major Life Events and Their Role in Psychopathology Among Transitioning Youth with Autism Spectrum Disorder

Background: Rates of comorbid psychiatric disorders are extraordinarily high among individuals with autism spectrum disorder (ASD).  Extant studies have focused on the behavioral characteristics associated with psychopathology, but tend to ignore the contextual factors that influence the emergence of these disorders.  The present analysis examines the role of a contextual factor strongly related to the emergence of psychopathology in typically developing populations: major and potentially traumatic (MPT) life events. 

Objectives: 1) To describe the frequency of MPT life events among youth with ASD transitioning to adulthood, as well as their rates of co-occurring psychiatric disorders; 2) To examine whether MPT life events predict psychopathology.

Methods: Participants were 41 families of youth with ASD in their last year of high school. Autism spectrum diagnoses were confirmed using the Autism Diagnostic Interview-Revised and Autism Diagnostic Observation Schedule. Youth averaged 18.7 years of age (range=17-22).  The majority were male (80.7%) and white non-Hispanic (90.2%).  Just under one-third (29.3%) had an intellectual disability (with full-scale IQ ranging from 40-137; M=83.25, SD=25.89).  Parent respondents included 37 mothers and 4 fathers. The sample was generally well-resourced, although 25% had annual incomes < $40,000.

Results: Just over 40% of youth had a current co-occurring psychiatric disorder.  Nearly one-quarter (24.4%) had a mood disorder and over one-quarter (26.8%) had an anxiety disorder.  Youth averaged 4.02 (SD=2.08) life events, with a range from 1 to 11. The most common events were death of someone close (56.1%), life-threatening illness/injury within the household (46.3%), parental job loss (36.6%), parental divorce/separation (34.1%), and severe bullying (29.3%). Approximately 60% of youth experienced one or more events that “severely affected” them.

The number of MPT life events was related to the presence of a current anxiety disorder, with each additional event increasing the odds of an anxiety disorder by 63%, Wald χ2=5.53, p<.05, OR=1.63.  Youth who were severely affected by an MPT life event were 3 times more likely to have any comorbid disorder, χ2(1)=5.58, p<.05,  5.7 times more likely to develop a mood disorder, χ2(1)=4.68, p<.05, and 6.3 times more likely to develop an anxiety disorder, χ2(1)=5.66, p<.05. Youth rarely developed a psychiatric disorder in the absence of severe life events. 

Conclusions: Just as in typically developing individuals, MPT life events are related to the emergence of psychopathology among youth with ASD.  Given high rates of co-occurring psychopathology in this population, which have been linked to diminished quality of life and significant public costs, further research should consider the role of trauma when focusing on behavioral health and development in ASD.

Key Reference: Turner, R.J., & Lloyd, D.A. (2004). Stress burden and the lifetime incidence of psychiatric disorder in young adults.  Archives of General Psychiatry, 61, 481-488.