22747
Personality Profiles in Intellectually Able Adults with ASD
Persons with high-functioning autism spectrum disorders (ASD) may go undiagnosed into adulthood, when they then present for evaluation because of increasing difficulties in adjustment or mental health. In addition to the social deficits of ASD, many experience clinically significant anxiety, depression, executive functioning deficits and other problems. However, the co-occurrence of other disorders with ASD in intellectually able adults can lead to confusion when they are assessed, resulting in misdiagnosis of disorders they do not have (e.g., bipolar disorder diagnosed because of outbursts), or a failure to detect ASD. Careful and clinically informed assessment is necessary to clarify the clinical picture.
The Personality Assessment Inventory (PAI, Morey 1991, 2007) is a valid, reliable self-report instrument often used to help identify psychopathology in adults, including adults with ASD. However, to date there are no studies that examine patterns of PAI scores of intellectually able persons with ASD.
Objectives:
This study is designed to investigate PAI scale and subscale patterns from responses of adults who meet DSM-IV/DSM-5 criteria for ASD, and then compare them to PAI scores from a smaller sample of adults with other clinical diagnoses to determine profile similarities and differences. A primary objective of this study is to provide evidence of PAI score patterns linked to ASD which can then be used for clinical application.
Methods:
Data were collected from 112 archival PAI records from two sources: an outpatient clinic which specializes in diagnosing ASD in adults, and a county psychiatric hospital. There were 75 participants with DSM-IV/DSM-5 ASD (33% F), and 25 participants with Other Psychopathology (32% F). Distribution of ages was similar between groups. Data were analyzed from 11 clinical scales and associated subscales.
Results:
Adults with ASD had mean Borderline elevations on scales for Anxiety, Anxiety Related Disorders, Depression, and Schizophrenia. In the subscales, Cognitive and Affective Anxiety, and Cognitive and Affective Depression were Borderline elevated, and Schizophrenia Social Detachment was clinically elevated. MANOVA comparing the ASD and Other Psychopathology groups found significantly higher scores (greater psychopathology) for persons with ASD on the Anxiety scale and Cognitive and Affective Anxiety subscales and on the Schizophrenia Social Detachment subscale.
Conclusions:
Results suggest that on average, intellectually able adults with ASD have a distinct pattern of elevations on the PAI both when compared to norms for the PAI. The pattern identified suggests that significant anxiety and depression, especially the cognitive and affective symptoms of both, are likely to be reported by adults with ASD. The mean clinical elevation on the Schizophrenia scale in this group, when examined in light of the subscales, indicates that they are reporting withdrawal and detachment rather than psychosis. The comparison with the inpatient group, though preliminary, supports these findings. Further research comparing with other populations on the PAI as well as non-self-report instruments will be needed to confirm the validity of this pattern.