Emotional Health of Adults with High Functioning Autism

Background:

It is widely accepted that stress, anxiety, and depression are elevated in individuals with autism spectrum disorder (ASD).  For example, Hofvander et al. (2009) reported that among a referred sample of adults, 53% met criteria for a mood disorder and 50% for an anxiety disorder.  As suggested by Lainhart and Folstein (1994), under-diagnosis may occur due to the overlap between the characteristics of anxiety and mood disorders and those of ASD, as well as the possibility that symptoms may be masked by impaired verbal and non-verbal communication (Stewart et al., 2006).  Individuals with high functioning autism (HFA) may be at particular risk for anxiety and depression due to awareness of their social difficulties and differences (Ghaziuddin et al., 2002).  However, individuals with HFA may be able to self-report stressors and symptoms, enabling early identification and intervention.

Objectives:

The aims of our study were to: determine whether symptoms of mood, anxiety and stress, as well as sources of stress and extent of negative thinking are measurable through self-report by individuals with HFA using available instruments; and to ascertain the incidence, characteristics and relationships between these variables in this population.     

Methods:

A sample of 95 individuals (69 males; 26 females) with HFA (mean age = 32.6; SD=13.9) completed the following instruments via self report, using either electronic or paper versions:   The Stress Survey Schedule for individuals with autism (adapted for self-report by adults) (SSS; Groden et al., 2001); the Depression Anxiety Stress Scales (DASS; Lovibond & Lovibond, 1995); and the Automatic Thoughts Questionnaire (ATQ; Hollon & Kendall, 1980).

Results:

On the DASS, symptoms of anxiety were reported by 54.7% of the sample, with 28.4% of these in the ‘severe’ or ‘extremely severe’ range; symptoms of depression were reported in 59.6% (28.8% severe or extreme); and symptoms of stress were reported in 61.3% (26.9% severe or extreme).  Co-morbidity was common and females were significantly more impaired than males.  Most people experienced a range of stressful events as measured by the adapted SSS, with 34.1% rated in the moderate to severe range. Negative automatic thoughts were also common, with the majority of participants reporting that these occurred ‘moderately often’ or ‘all the time’. Significant correlations were obtained between scores on the DASS subscales and both the SSS and the ATQ.

Conclusions:

It is important that individuals with HFA are screened for stress and for symptoms of anxiety and depression and it appears that they are able to self report using existing instruments.  There is a need for more research into the apparent relationships between symptoms, as well as predictors of risk in this population. Findings about specific stressors and negative thoughts may inform the development of targeted intervention programs.