Trait Mindfulness in Treatment-Seeking Adolescents with Autism Spectrum Disorder and Comorbid Anxiety

Background: Adolescents diagnosed with autism spectrum disorder (ASD) may face significant challenges in meeting social environment demands, potentially leading to distress (Russell, 2011). The co-occurrence of anxiety symptoms are common in adolescents with ASD; approximately 40% of youth with ASD have at least one comorbid anxiety diagnoses (van Steesel, 2011). Comorbidity in individuals with ASD shows relations to reduced quality of life (Chang & Wineman, 2014); thus, treatment to address comorbid diagnoses is crucial. Mindfulness-based stress reduction (MBSR) programs have shown promise as effective treatment for anxiety among both typically developing (TD) children (Zoogman, Goldberg, & Miller, 2015) and individuals with ASD (Conner & White, 2018; Sizoo & Kuiper, 2017). However, little is known about the clinical profiles of adolescents with ASD who present for MSBR treatment. Investigating these profiles may provide insight into factors impacting effective treatment for adolescents with ASD.

Objectives: Our aim was to develop an understanding of the relation between core symptoms of ASD and trait mindfulness in adolescents with comorbid anxiety presenting for MBSR treatment. We hypothesized that lower trait mindfulness would be related to higher pre-treatment perceived stress scores and more severe autism symptoms.

Methods: A total of 27 patients participated in a group therapy that implemented the Mindfulness Based Stress Reduction for Teens curriculum (MBSR-T; Biegel, Chang, Garrett, & Edwards, 2014) for 10-12 sessions. Nine adolescents (M_age = 15.33 SD_age = 2.34) were included in this preliminary analysis. Prior to beginning the intervention, the Perceived Stress Scale (PSS; Cohen, 1994) was collected to determine perception of stress, the Social Responsiveness Scale -Second Edition (SRS-2; Constantino & Gruber, 2012) was completed by parents to measure ASD symptoms, and the Mindful Attention Awareness Scale-Adolescent version (MAAS-A; Brown, West, Loverich, & Biegel, 2011) was collected to determine trait mindfulness.

Results: An average PSS total score of 23.88 (n = 9; SD = 5.23) was in the moderate range at the beginning of intervention. The average pre-treatment MAAS-A score was 3.76 (n = 9; SD = 1.22), indicating moderate levels of trait mindfulness with a wide range across the clinical sample. The MAAS-A and PSS were negatively correlated (r = -0.86, p = .003). The SRS-2 Restricted and Repetitive Behaviors (RRBs) subscale had a negative association with the MAAS-A (r = -0.79, p = .010). A trend was observed between the Awareness subscale of the SRS-2 and the MAAS-A (r = -0.66, p = .053). No other SRS-2 treatment subscales were significantly correlated with the MAAS-A.

Conclusions: Results support prior research that reduced trait mindfulness is associated with greater perceived stress among adolescents with ASD. Average trait mindfulness for adolescents with ASD appears similar to TD peers (Brown, Loverich, & Biegel, 2011). Our study also provides preliminary evidence that lower trait mindfulness is associated with more RRBs in adolescents and less social awareness. Future research should examine whether RRBs and deficits in social awareness are impacted by mindfulness training or if these core autism symptoms function to moderate the therapeutic efficacy of MBSR.