Life Satisfaction, Anxiety and Camouflage in Adults with and without a Diagnosis of ASD

Background:

A growing number of people are being diagnosed with autism spectrum disorder (ASD) in adulthood. Relatively little is currently known about quality of life in people who are diagnosed with ASD in adulthood.

Objectives:

The aim of this work was to investigate subjective life satisfaction, anxiety, and trait-masking (camouflage) in people who have received a diagnosis of ASD in adulthood, and in individuals who self-identify with the autism phenotype but who do not have a clinical diagnosis.

Methods:

Eighty-nine people took part: twenty-nine had a diagnosis of ASD and sixty participants did not. The undiagnosed group represented a wide range of individuals including some people who strongly identified with the autism phenotype. Eighteen of the sixty participants in the undiagnosed group scored above the RAADS-R cut-off for ASD (hereafter referred to as undiagnosed high-trait group). Participants completed the Ritvo Autism Asperger Diagnostic Scale (RAADS-R), the Beck Anxiety Inventory – trait version and the Satisfaction with Life Scale (Diener et al. 1985). In addition to total scores, a “camouflage” variable was calculated by creating a composite score from the three questions in the RAADS-R that probe the extent to which respondents hide their autistic traits in order to ‘fit-in’. Four factor scores, reflecting social-relatedness, circumscribed interests, sensory / motor issues and social anxiety, were created based on previous factor analysis of the RAADS-R.

Results:

Participants who obtained RAADS-R scores below the cut-off for ASD had lower anxiety and higher life satisfaction than both the autistic adults and the undiagnosed high-trait group (p<.01). Autistic adults had increased anxiety and higher RAADS-R scores than the undiagnosed high-trait group (p<.05). Levels of life satisfaction did not differ between these two groups (p>.05). In both the autistic adults and the undiagnosed group (N = 60), RAADS-R scores positively correlated with anxiety, and negatively correlated with life satisfaction (all ρ > +/- .402). In the undiagnosed group, all four of the RAADS-R factor scores correlated with life satisfaction, whereas in the autistic group (N = 29) only the social-relatedness factor correlated with life satisfaction (ρ = -.458). In the undiagnosed group (N = 60), camouflage was significantly related to both anxiety and life satisfaction (ρ = -.292 and .277 respectively). This was not the case in the diagnosed group (all ρ > -.1).

Conclusions:

Reduced life satisfaction and increased anxiety are associated with the autism phenotype. In particular, the extent to which someone feels able to socially connect may impact life satisfaction in autistic adults. Camouflage of autistic traits is associated with increased anxiety and reduced life satisfaction in undiagnosed participants, but not in those with an ASD diagnosis. Anecdotal reports from some autistic participants indicated that one of the positive consequences of receiving an ASD diagnosis included greater acceptance which reduced the pressure and expectation to camouflage symptoms. This research suggests that diagnosis of ASD in adulthood can have a positive effect on life satisfaction and that improving social-relatedness could be one way to improve life satisfaction in autistic adults.