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In Their Own Words: Associated Features in Intellectually Able Adult Males and Females with Autism Spectrum Disorder (ASD)
Adults with ASD can experience difficulties not limited to the primary criteria for diagnosis of ASD. We sought to examine associated features that verbally able adults report about themselves, and in particular, whether there are differences by gender in the type and severity of features reported. Qualitative information about associated features reported by outpatients with ASD was compiled to develop a questionnaire including 51 statements (Adolescent and Adult Autism Spectrum Checklist – AAASC). (See Table 1).
Objectives:
1) To determine which associated features were most highly rated in our sample, 2) To determine whether mean scores were associated with scores on other widely used self-report measures for assessment of adult ASD, 3) To compare findings on male and female respondents.
Methods:
The AAASC was rated by 107 individuals with ASD (37.5% female; 73.7% Euro American; 44.7% 18 – 30 y/o; 55.3% 31-71 y/o) seen at a clinic specializing in adult ASD diagnosis and intervention. Statements were rated on a 0 -5 scale where 5 was highest. For analysis the statements were grouped in four content areas: Preference for Sameness and Routine; Cognitive Style and Executive Functioning; Difficulties in Conversation; Social Awareness and Expectations.
Mean values for each content area were calculated, and five items with mean ratings lower than 2.0 were removed from further analysis. The remaining 46 items in their four groupings were examined first for their relative frequency, then for the association of their mean scores with scores on the Social Responsiveness Scale, 2nd Edition (SRS-2), Autism Quotient (AQ), Empathy Quotient (EQ), and Ritvo Autism Asperger Diagnostic Scale-Revised Version (RAADS-R). Mean scores were then examined using multivariate analysis of variance, with chronological age covaried, to examine differences by gender.
Results:
For the sample as a whole, items associated with Preference for Sameness and Routine were rated highest, followed by Cognitive Style and Executive Function, Difficulties in Conversation, and Social Awareness and Expectations, respectively (Table 1). Multiple regression revealed that total scores on the SRS-2, RAADS-R, and AQ were strongly related to some or all of the 4 groupings, and the EQ only to Preference for Sameness and Routine (Table 1). Results of the MANOVA were statistically significant (Wilks Lambda = .871; F (4, 95) = 3.53, p=.01) for differences by gender. Tests of between subjects effects found that females reported significantly higher levels of associated features in all categories than did males (Preference for Sameness and Routine, p=.024; Cognitive Style and Executive Functioning, p=.05; Difficulties in Conversation, p=.002; Social Awareness and Expectations, p=.001).
Conclusions:
The associated features reported by adults with ASD were highly congruent with existing self-report measures of ASD characteristics. It is of note that adults with ASD frequently endorsed problems that reflect cognitive differences, especially in executive function, an area not typically assessed on ASD measures. Interestingly, women reported significantly higher levels of problems than men across content areas. They may experience their problems as more severe, or they may be more willing to report on problems.