Relationship between Co-Occurring Psychiatric Conditions and Adaptive and Cognitive Ability

Background:

Adults with ASD commonly experience co-occurring psychiatric conditions, low adaptive abilities, and varying levels of cognitive functioning. Limited research reports mixed findings on the relationship between adaptive abilities and psychiatric conditions in adults with ASD. Anxiety and depression are common among adults with ASD and may impact functional outcomes such as employment and independence. Understanding the relationship between adaptive ability and psychiatric comorbidity may shed light onto why adults with ASD experience suboptimal life outcomes in relation to their cognitive functioning.

Objectives:

To explore the relationship between level of adaptive and cognitive ability and the presence of depression and anxiety in adults with ASD.

Methods:

Participants for this study (N = 304, aged 18-64, M = 32.20, SD = 10.47, 88.2% male) were identified from a larger sample of adults with ASD who were ascertained in childhood or during transition into adulthood. Inclusion in the analysis required the presence of (1) assessments for adaptive behavior and intellectual ability and (2) record of psychiatric conditions. Co-morbid anxiety/depression were determined through the presence of either corresponding electronic medical record diagnostic code data and/or an in-person Mini PAS-ADD assessment of psychiatric co-morbidity. The Vineland Adaptive Behavior Scales (Survey, First and Second Edition) were used to assess adaptive behavior. An individual’s intellectual ability was identified using the most complete assessment of cognitive ability available in research records. The following categories of adaptive and intellectual ability were used: normal ≥ 70, mild = 50-69, and severe < 50. Logistic regression was used to predict anxiety and depression case status based on adaptive functioning/intellectual ability category with the normal category used as the reference variable.

Results:

Tables 1 and 2 report logistic regression results. Depression was less common among participants with severe and mild intellectual abilities (b = -1.47, p = 0.008; b = -1.09, p = 0.003) and severe impairment in daily living skills of adaptive ability (b = -1.11, p = 0.002). Anxiety had no association with severe and mild intellectual ability (b = 0.11, p = .82; b = .30, p = 0.39) but is predicted by adaptive functioning in the composite score, communication and social scales predicted anxiety (b = 0.83, p = 0.023; b = 0.70, p = 0.050; b = 0.90, p = 0.012).

Conclusions:

Depression was less commonly identified among individuals with severely limited daily living adaptive skills and mild to severe ID. This may reflect the challenge in identifying internalizing depressive symptoms in individuals with intellectual and adaptive impairment, necessitating exploration into the manner in which individuals with these impairments manifest their experience of depression. Limited composite adaptive and social abilities, predicted anxiety, though the cause and effect aspect of this relationship is unknown. Anxiety may be caused by increased challenges in daily functioning, or anxiety may interfere with learning adaptive skills when anxiety-provoking experiences are avoided. Alternatively, both may share a common underlying etiology. More research is warranted to clarify the nature of this association.