The Influence of Depression on Adaptive Behaviors and Quality of Life in ASD Compared to Typically Developing Adults

Background:

Co-occurring depression is prevalent among adults with ASD and is suggested to exacerbate deficits in adaptive behavior and quality of life (QoL) within this population. However, research is required to elucidate the individual and combined contributions of depression and ASD to domains of adaptive behavior and QoL.

Objectives:

1) To replicate findings indicating the association of comorbid depression with poorer adaptive behavior and QoL in adults with ASD.

2) To shed light on the unique influences of depression and ASD on adult outcomes by comparing adaptive behavior and QoL among typically developing adults with depression (TD-dep), adults with ASD with no current depression concerns (ASD-nd), and adults with ASD who score above clinical cut-off on a gold-standard survey of depression symptoms (ASD-dep).

Methods:

Participants included adults aged 18-34 with ASD (n=22) and TD adults with current depression (n=19). Diagnoses were confirmed with the ADOS-2 and the Structured Clinical Interview for DSM Disorders (SCID-5). All participants completed the SRS-2 for a dimensional measure of autism symptomology; the Adaptive Behavior Assessment System (ABAS-3) to assess adaptive behavior in Conceptual, Social, and Practical domains; the World Health Organization Quality of Life scale (WHOQOL-BREF); and the Beck Depression Inventory (BDI-II). Participants with ASD were divided into depression concern (n=10) and no-concern (n=12) groups based on the BDI-II clinical cut-off of 2. Groups were compared on variables of interest using ANOVA with Tukey’s post-hoc tests. The effects of depression were assessed dimensionally within ASD using linear regression analyses.

Results:

The ASD-nd subsample was significantly younger than the ASD-dep group. SRS-2 total scores were significantly higher in the ASD-dep group, however TD-dep scores did not differ from ASD-nd. VIQ was not significantly different among the three groups (see Table 1 for all statistics). Adaptive behavior Composite scores were significantly lower for the ASD-dep group (indicating weaker skills) than the TD-dep group. As a group, ASD-nd tended to have poorer adaptive skills than TD-dep but stronger skills than ASD-dep, however no significant differences were found. This trend was preserved across Conceptual, Practical, and Social domains of adaptive behavior. Overall QoL was significantly higher in ASD-nd participants than both other groups, with no difference in QoL between TD-dep and ASD-dep. This trend persisted for all WHOQOL-BREF domains except Social Relationships, in which ASD-dep scores indicated the poorest QoL of all groups, and ASD-nd and TD-dep did not differ significantly. In dimensional analyses within ASD only, higher BDI-II scores predicted lower adaptive behavior Composites, even controlling for VIQ (B=-.398, p=.038), and lower QoL even controlling for autism symptomology (SRS-2) (B=-.764, p=.001).

Conclusions:

Results support findings that comorbid depression further compromises impairments in adaptive behavior and QoL for adults with ASD. Additionally, depression in TD adults appears to be associated with poorer adaptive behavior and QoL similar to those impairments in non-depressed adults with ASD. These data also suggest that depression may have a greater singular impact on QoL than does ASD, although co-occurring depression and ASD still account for the lowest QoL ratings.