The Relationship Between Autistic Traits and Social Anxiety, Worry, Obsessive–Compulsive, and Depressive Symptoms: Specific and Non-specific Mediators in a Student Sample

Longitudinal Relationships Between Depressive Attributional Style and Internalizing Symptoms in an Autism-Enriched Sample of Incoming College Students

Background

Anxiety and depression are among the most common psychiatric conditions reported in first-year college students. Autistic adults are estimated to face double the rate of anxiety and depression compared with non-autistic peers, influencing quality of life, social success, and academic performance. One potential avenue to understand and address internalizing symptoms in autistic adults beginning their college careers is depressive attributional style, a biased causal explanatory style in which negative life events are attributed to internal, stable, and global causes. The current study evaluates the relationship between depressive attributional style and symptoms of anxiety and depression across the first semester of college, as moderated by autistic traits. We also explore baseline depressive attributional style across additional marginalized aspects of identity based on race/ethnicity, gender, and sexual orientation, and examine potential interaction effects of autistic traits on these relationships.

Methods

Undergraduate students were recruited from four northeastern universities. Our sample (n = 144) includes 47 participants who self-identified or reported a formal autism diagnosis, and 97 non-autistic participants. Participants completed baseline and endpoint questionnaires, as well as a 2-minute biweekly survey, tracking changes in sadness, anhedonia, and anxiety throughout their first semester.

Results

Longitudinal analyses demonstrate that elevated depressive attributional style at baseline predicted biweekly anxiety, sadness, and anhedonia symptoms across the semester. This pattern extended across (was not moderated by) levels of autistic traits, however, participants who reported higher autistic traits endorsed a significantly greater depressive attributional style at baseline, and greater anxiety, sadness, and anhedonia throughout the semester. The relationship between autistic traits and depressive attributional style was strongest for participants with a nonheterosexual orientation.

Conclusion

This study underscores the autistic community-identified need for mental health research, with attention to intersecting identities, and suggests depressive attributional style for further investigation as a potential treatment target.

Abstract

In the first year of college, many students face challenges with anxiety and depression. Autistic students report even higher mental health concerns than non-autistic students. One way to understand why this happens is by looking at how college students explain negative events in their lives. Autistic students may have a more depressive attributional style, in which they see themselves as a cause of negative events and believe that bad things will persist. This outlook is known to contribute to anxiety and depression.

Abstract

We wanted to see how a depressive attributional style might relate to anxiety and depression over the first semester of college, and whether this is affected by autistic traits and stress. We also looked at how autistic traits influence the relationship between depressive attributional style and the marginalized aspects of identity based on race/ethnicity, gender, and sexual orientation.

Abstract

We gave surveys to college students about their attributional style and experiences with depression and anxiety. Participants completed several surveys both before and after their first semester at college. They also completed a brief survey two times per week during the semester.

Abstract

We found that a depressive attributional style at baseline (presemester) was related to depression and anxiety symptoms across the semester. Participants with higher levels of autistic traits reported a more depressive attributional style and greater depression and anxiety during the semester. Individuals with higher autistic traits who identify as LGBTQIA+ were more likely than heterosexual individuals with high autistic traits to have a more depressive attributional style.

Abstract

This study helps us understand that a depressive attributional style might be related to anxiety and depression in both autistic and non-autistic students. In addition, a depressive attributional style may be more common in autistic individuals. These findings could mean that helping people develop a more adaptive thinking about negative events could help prevent or treat anxiety and depression in college students.

Abstract

Because we wanted our study to be accessible for autistic students without a formal diagnosis, we were unable to look at how the social identity of being autistic related to anxiety and depression throughout the semester.

Abstract

These findings give us first evidence that a depressive attributional style appears to be related to anxiety and depression in autistic students. This suggests that interventions designed to address the depressive attributional style in non-autistic individuals could potentially benefit autistic individuals as well, which may support access to mental health treatment for the autistic community.

Loneliness and susceptibility to social pain mediate the association between autistic traits and psychotic experiences in young non-clinical adults

Understanding of the mechanisms involved in the occurrence of psychotic experiences (PEs) in highly autistic individuals is crucial for identifying appropriate prevention and intervention strategies. This study aimed to investigate the mediating role of susceptibility to social pain and loneliness in the relationship between autistic traits (ATs) and PEs in adults from the general population of 12 Arab countries. This cross-sectional study is part of a large-scale multi-country research project. A total of 7646 young adults (age range 18-35 years, mean age of 22.55 ± 4.00 years and 75.5% females) from twelve Arab countries (i.e., Algeria, Bahrain, Egypt, Iraq, Jordan, Kingdom of Saudi Arabia, Kuwait, Lebanon, Morocco, Oman, Palestine, and Tunisia) were included. Mediation analyses showed that, after adjusting over confounding variables, both loneliness (indirect effect: Beta = 0.18; Boot SE = 0.02; Boot CI 0.14; 0.21) and social pain (indirect effect: Beta = 0.03; Boot SE = 0.01; Boot CI 0.001; 0.05) partially mediated the association between ATs and PEs. Higher ATs were significantly associated with more loneliness and susceptibility to social pain, and directly associated with more severe PEs. Finally, higher loneliness and susceptibility to social pain were significantly associated with greater PEs scores. Findings indicated that individuals with higher ATs tend to experience greater loneliness and feel more pain from rejection, which can in turn be associated with higher levels of PEs. Interventions targeting susceptibility to social pain and loneliness as a means of mitigating PEs among highly autistic adults should be considered.

Autistic Traits of People Who Engage in Pup Play: Occurrence, Characteristics and Social Connections

Pup play is a kink or BDSM activity and subculture that provides opportunities for social and sexual play and exploration. While growing scholarly attention has focused on the diverse dynamics of pup play cultures, and reasons for participation within them, no research has considered how pup play may be attractive for neurodivergent people. This study sample consisted of 413 pup play practitioners from an international internet survey to examine the occurrence of autistic traits and explore characteristics and social connections of people with autistic traits who engage in pup play. Autistic traits were assessed using the Autism-Spectrum Quotient-Short Form (AQ-S), with 1 in 2 participants reporting a score that is indicative of an autism diagnosis, substantially higher than the prevalence of autism in the general population (1 in 44). Using linear and multinomial regression analyses, we found that people with high autistic traits preferred non-flexible roles in pup play, had lower identity resilience, and more restricted sociosexuality. People with high autistic traits were also less likely to belong to pup play social communities or to closer-knit family/pack units despite wishing to and were also less likely to have a strong identification with pup play communities than people with low AQ-S scores. While these findings need to be treated as preliminary based on methodological and sample limitations, this research demonstrates the importance of considering intersections between autistic traits and sexual subcultures and provides evidence that sexuality research would be enhanced by a more inclusive approach to considering neurodivergence more broadly.

Brief Report: Local-Global Processing and Co-occurrence of Anxiety, Autistic and Obsessive-Compulsive Traits in a Non-clinical Sample

PURPOSE

Increased local-to-global interference has been found in those with ASD, AD and OCD, and as such, may represent a transdiagnostic marker. As a first step to investigating this, we aimed to assess the overlap in traits of these disorders in a non-clinical sample, and whether local-global processing relates to the traits of the three conditions.

METHODS

Participants (n = 149) completed questionnaires including the Autism Quotient (AQ), the Obsessive-Compulsive Inventory (OCI-R) and the Zung Self-rating Anxiety Scale (SAS) and an online version of the Navon task. Behavioural metrics of interference and precedence were extracted from the task and correlated with trait scores.

RESULTS

We found moderate to strong correlations between the total scores for ASD, anxiety and OCD. Most local-global processing indices did not relate to traits.

CONCLUSION

The study found evidence for an overlap in autism, anxiety and obsessive-compulsive traits in a non-clinical sample. However, local-global processing, as measured by the Navon task, did not appear to underpin symptomatology in the sample and could not be considered a transdiagnostic marker. Future research should investigate the value of alternate metrics.

Comparisons between obsessive-compulsive disorder and trichotillomania in terms of autistic traits and repetitive behaviors in adolescents

BACKGROUND

Our study aims to reveal the relationship between autistic traits and repetitive behaviors in adolescents diagnosed with obsessive-compulsive disorder and trichotillomania and to compare them to healthy controls.

METHOD

A total of 100 adolescents, 33 of whom were diagnosed with obsessive-compulsive disorder, 32 of whom were diagnosed with trichotillomania and 35 healthy controls, aged 11-18 years, who applied to a Child and Adolescent Psychiatry Outpatient Clinic between February 2023 and July 2023, were included in the study. Participants were evaluated with the Autism Spectrum Quotient (AQ)-Adolescent, Repetitive Behavior Scale-Revised (RBS-R), Children's Yale-Brown Obsessive Compulsive Scale (CY-BOCS), and Clinical Global Impression Scale-Severity (CGI-S). SPSS 25.0 program was used in the analysis. p < 0.05 was accepted as the significance level.

RESULTS

It was found that adolescents diagnosed with obsessive-compulsive disorder and trichotillomania had higher autistic trait levels compared to healthy controls, while there was no significant difference between the obsessive-compulsive disorder and trichotillomania groups. While stereotypic, routine, sameness, and restricted repetitive behaviors were more common in the obsessive-compulsive disorder and trichotillomania groups as opposed to healthy controls, it was found that compulsive behavior was more common in the obsessive-compulsive disorder group, and self-injurious behavior was more common in the trichotillomania group compared to healthy controls.

CONCLUSION

The findings of our study indicate that adolescents diagnosed with trichotillomania, similar to those with obsessive-compulsive disorder, have a higher level of autistic traits and repetitive behaviors. The authors believe it is crucial to focus on the social skill difficulties these adolescents may be experiencing.

Academic learning challenges and links to vocational outcomes in young autistic adults

LAY ABSTRACT

Finding a job can be hard for autistic adults. No studies have been completed that look into whether having difficulties learning and troubles finding a job are related in this population. The current study did so by evaluating the Learning Needs Screening Tool, a measure of learning challenges used in vocational rehabilitation settings, or places meant to help people find work. A total of 401 autistic adults completed this study online. Specifically, the study evaluated (a) the characteristics of the Learning Needs Screening Tool, including the relationships between questions that ask about similar learning challenges, and (b) the ability of the measure to relate to real-world outcomes that are associated with learning difficulties, namely prior special education receipt and difficulties finding a job. Evaluation of the questions asked on the Learning Needs Screening Tool revealed that they were highly related and that learning difficulties fell into different categories. Fifty-six percent of the people in the study showed learning challenges on the measure. People who were identified as having learning difficulties on the Learning Needs Screening Tool had higher rates of receiving special education services in the past and lower rates of current employment. These results suggest that the Learning Needs Screening Tool may help to identify autistic job seekers who have learning difficulties and may have more challenges finding a job.

The relationship between autistic traits and problematic smartphone use in adolescents: The serial mediating role of anxiety and executive dysfunction

BACKGROUND

Based on the Interaction of Person-Affect-Cognition-Execution (I-PACE) model, this study aimed to explore the relationship between autistic traits and problematic smartphone use (PSU) among Chinese adolescents and to examine the serial mediation effect of anxiety and executive dysfunction in the association between autistic traits and PSU.

METHODS

The Autism-Spectrum Quotient, Smartphone Addiction Scale, the trait version of the State-Trait Anxiety Inventory, and Dysexecutive Questionnaire were administered to a sample comprising 412 senior high school students (average age = 17.05 years, SD = 0.65). Structural equation models were utilized to explore the simple and serial mediating role of anxiety and executive dysfunction played in the association between autistic traits and PSU.

RESULTS

This study found that social rather than non-social autistic traits were positively associated with anxiety, executive dysfunction, and PSU. Furthermore, after controlling for gender, anxiety and executive dysfunction acted as sequential mediators in the connection between social autistic trait and PSU. However, non-social autistic trait did not predict anxiety, executive dysfunction, or PSU.

CONCLUSION

This study supports the I-PACE model and deepens understanding of PSU formation. Furthermore, the findings underscore the importance of addressing social challenges faced by adolescents with high autistic traits, providing a viable potential intervention pathway to promote healthy smartphone use in this population.

The Association Between Autistic Traits and Depression in College Students: The Mediating Roles of Interpersonal Emotion Regulation and Social Self-Efficacy

Purpose

Higher rates of depression are associated with autistic traits; however, the precise association between autistic traits and depression has yet to be fully elucidated. Good interpersonal emotional regulation and social self-efficacy are crucial for mental health; therefore, in this study, we investigated the relationships between autistic traits, interpersonal emotional regulation, social self-efficacy, and depression.

Patients and Methods

In total, 1024 participants (613 females and 411 males) aged 16 to 23 years old (M = 19.03, SD = 0.95) completed questionnaires that were designed to evaluate their autistic traits, interpersonal emotion regulation, social self-efficacy and depression. Data were analyzed by Spearman correlation and mediation effects analyses.

Results

Autistic traits were significantly and positively correlated with depression (r = 0.39, p < 0.001), and autistic traits were shown to positively predict depression (B = 0.28, p < 0.001). Interpersonal emotion regulation and social self-efficacy were found to play a serial mediating role between autistic traits and depression (indirect effect = 0.020, p = 0.006).

Conclusion

This study is a supplement to the mechanism of the relationship between autistic traits and depression. Interpersonal emotion regulation and social self-efficacy are important predictors of possible depression in individuals with high autistic traits. These findings suggest combining interpersonal emotional regulation training and exploring the clinical value of interpersonal emotional regulation interventions in individuals with high autistic traits and autism spectrum disorder, aiming to build social confidence, reduce negative moods, restore social functioning, and other aspects.

Autistic Sensory Traits and Psychological Distress: Mediating Role of Worry and Intolerance of Uncertainty

BACKGROUND/OBJECTIVES

Autistic adults exhibit core and comorbid features that can have an impact on their daily functioning and lead to considerable psychological distress. Significant and consistent associations have been identified between autism characteristics-restricted repetitive behaviors and sensory features-and high levels of stress and anxiety. For a better understanding of the issue, it is necessary to consider the cognitive aspects that can help explain variations in stress and anxiety levels among adults with autism. We therefore aimed to model the contributions of worry and intolerance of uncertainty on the relationship between autism characteristics (sensory sensitivities and repetitive behaviors) and psychological distress (stress and anxiety).

METHODS

The sample comprised 144 autistic individuals with a mean age of 35.15 (SD = 11.44). They participated in the study by completing an online questionnaire to assess the study variables. Most of the participants reported being diagnosed with Asperger syndrome (63.6%) or Level 1 autism spectrum disorder (27.1%).

RESULTS

The model fit index values tested through path analysis indicated a good fit (χ2 = 5.65; p = 0.13 ns; CFI = 0.993; NFI = 0.985; RMSEA = 0.079; SRMR = 0.025) and identified worry and intolerance of uncertainty as significant mediating variables within a comprehensive explanatory model.

CONCLUSIONS

These findings highlight the importance of worry and intolerance of uncertainty as specific targets in interventions aimed at improving stress and anxiety problems in autistic adults.

The Broad Autism Phenotype-International Test (BAP-IT): A two-domain-based test for the assessment of the broad autism phenotype

LAY ABSTRACT

The broad autism phenotype refers to a group of behaviors related to autism spectrum disorder, but that appear to a lesser extent. Its assessment has been performed through outdated broad autism phenotype/autism spectrum disorder definitions and tests. To address this problem, this study presents the development of a new test, the Broad Autism Phenotype-International Test, a 20-item measure consisting of two dimensions, SOCIAL-BAP and RIRE-BAP, targeting the two-domain operationalization of autism spectrum disorder in Spain and the United Kingdom. Unlike the Broad Autism Phenotype Questionnaire, this test received empirical support as a quick and effective broad autism phenotype measure that can facilitate both broad autism phenotype/autism spectrum disorder research and interventions. This is the first step to studying the BAP in several Spanish and English-speaking countries.

Sensory symptoms associated with autistic traits and anxiety levels in children aged 6-11 years

BACKGROUND

Autism spectrum conditions (ASC) and quantitative autistic traits (QATs) are associated with sensory symptoms, which may contribute to anxiety and adversely affect social and cognitive development. Although sensory symptoms can occur across all senses, the relative roles of specific sensory modalities as contributors to the autistic phenotype and to anxiety are not well understood. The objective of this study was to examine which sensory symptoms were most predictive of high anxiety.

METHODS

We recruited 257 female primary caregivers of children aged 6 to 11 years (49% girls) to a questionnaire study comprising parent-report measures for classical QATs (social, communicative, and rigid), autism-related sensorimotor symptoms (visual, auditory, tactile, olfactory, gustatory, vestibular, proprioceptive, and motor), and anxiety symptoms. First, Bayesian stochastic search variable selection (SSVS) was used to identify the most probable sensorimotor predictors of specific QATs as well as diagnosed ASC. Then, the selected predictors were used in another SSVS, using anxiety symptoms as a dependent variable, to identify which of the autism-relevant sensorimotor symptoms were most robustly predictive of anxiety. Finally, the effect sizes of anxiety-related sensory symptoms were estimated with linear regressions.

RESULTS

We found that auditory symptoms and motor difficulties were most predictive of ASC diagnosis. Developmental motor difficulties were also strongly related to all individual QATs, whereas auditory symptoms were more selectively predictive of rigid traits. Tactile symptoms robustly predicted social interaction QATs, and proprioceptive symptoms predicted communicative QATs. Anxiety outcomes were most strongly predicted by difficulties with auditory and olfactory processing.

CONCLUSIONS

The results support the clinical importance of being alert to complaints about sounds and hearing in neurodevelopmental populations, and that auditory processing difficulties may be evaluated as an early marker of poor mental health in children with and without diagnosed autism. Olfactory processing differences appeared to be an anxiety marker less strongly associated with ASC or QATs, while motor difficulties were highly autism-relevant but not equally strongly associated with anxiety outcomes. We suggest that future studies may focus on the mechanisms and consequences of neurodevelopmental central auditory processing dysfunction and its potential relationship to anxiety disorders.

Examining the Relations Between Social Competence, Autistic Traits, Anxiety and Depression in Autistic and Non-Autistic Children

The current study examined whether social competence and autistic traits are related to anxiety and depression in autistic and non-autistic children. Parents of 340 children aged 6 to 12 years old, including 186 autistic and 154 non-autistic children completed the Autism Spectrum Quotient (AQ) to assess their child's autistic traits, the Multidimensional Social Competence Scale (MSCS) to assess their child's social competence, and the Behaviour Assessment Scale for Children 2 (BASC-2) to assess their child's internalizing symptoms of depression and anxiety, and children were administered the Wechsler Abbreviated Scale of Intelligence, Second Edition (WASI-II) to assess their intellectual abilities. Hierarchical multiple regression analyses were conducted to investigate the relations between social competence, autistic traits, anxiety, and depression. Social competence was related to anxiety and depression symptoms in autistic children, but only depression symptoms in non-autistic children, above and beyond the effects of autistic traits, IQ and age. Autistic children were also reported to experience more severe anxiety and depression symptoms, and more autistic traits were related to higher levels of anxiety and depression in both groups. These findings suggest that social competence and internalizing symptoms are intricately connected in autistic children and need to be jointly considered in both assessment and intervention. The social implications are discussed with an emphasis on acceptance of diverse social styles as a viable avenue to reduce children's internalizing symptoms.

A follow-up study of peer relationships in autistic and non-autistic youths: Mediating effects from autistic, emotional and behavioral symptoms

BACKGROUND

Little is known about how clinical features prospectively influence peer relationships in autistic populations.

AIMS

This study investigated the clinical symptoms mediating the link between autism spectrum disorder (ASD) diagnosis and peer relationships at follow-up, i.e. the second time evaluation of this study.

METHODS

The sample consisted of 366 autistic youths and 134 non-autistic comparisons. The autistic traits and emotional/behavioral problems were measured at baseline by Social Responsiveness Scale (SRS) and Child Behavior Checklist (CBCL). The interactions and problems with peers were assessed by the Social Adjustment Inventory for Children and Adolescents (SAICA) at follow-up.

RESULTS

Each subscore of SRS and CBCL showed significant mediation effects. Multiple mediation analyses showed atypical social communication, social awareness problems, and delinquent behaviors mediated the link from ASD to less active peer interactions after controlling for sex, age, and IQ. Moreover, atypical social communication, social-emotional problems, and attention difficulties predicted problems with peers. After considering these mediation effects, the diagnosis of ASD still demonstrated a significantly direct effect on peer relationships at follow-up.

CONCLUSIONS AND IMPLICATIONS

Our findings support that social-related autistic features, attention problems, and delinquent behaviors mediated a link between ASD and peer relationships. These mediators are potential measures for improving interactions and decreasing difficulties with peers in the autistic population.

Intact painful sensation but enhanced non-painful sensation in individuals with autistic traits

Somatosensory abnormalities are commonly recognized as diagnostic criteria in autism spectrum disorder (ASD), and may also exist in individuals with autistic traits. The present research included two studies to explore the painful and non-painful sensation and their cognitive-neurological mechanisms of individuals with autistic traits. Study 1 included 358 participants to assess the relationship between autistic traits and pain/non-pain sensitivities using questionnaires: the Autism Spectrum Quotient (AQ), the Pain Sensitivity Questionnaire, and the Highly Sensitive Person Scale, respectively. Study 1 found that autistic traits were positively correlated with non-pain sensitivity, but not associated with pain sensitivity. Study 2 recruited 1,167 participants whose autistic traits were assessed using the AQ. Subsequently, thirty-three participants who scored within the top 10% and bottom 10% on the AQ were selected into High-AQ and Low-AQ groups, respectively, to explore the cognitive-neural responses of individuals with autistic traits to both painful and non-painful stimuli with event-related potential (ERP) technology. Results of Study 2 showed that the High-AQ group showed higher intensity ratings, more negative emotional reactions, and larger N1 amplitudes than the Low-AQ group to the non-painful stimuli, but no difference of response to the painful stimuli was found between High-AQ and Low-AQ groups. These findings suggest that individuals with autistic traits may experience enhanced non-painful sensation but intact painful sensation.

Exploring the mediating effect of camouflaging and the moderating effect of autistic identity on the relationship between autistic traits and mental wellbeing

Mental health difficulties are prevalent among autistic adults. Camouflaging (behaving differently to fit in) may be a mechanism by which autistic traits and mental health difficulties relate to each other, but little research has considered the role of different facets of camouflaging. Additionally, autistic identity might buffer against camouflaging and mental health difficulties. This research aims to explore the mediating effects of camouflaging behaviours on the relationship between autistic traits and both positive and negative mental wellbeing, as well as how autistic identity might moderate the relationship between autistic traits and camouflaging, and also mental health. Data were available for 627 autistic adults, recruited through volunteer databases and social media. Participants completed measures of autistic traits, anxiety, depression, positive wellbeing, camouflaging behaviours (compensating for difficulties, masking, and assimilating/putting on an act) and autistic identity. Mediation and moderated mediation models were tested, applying 95% bootstrapped CIs (10,000 resamples) and including age, gender and diagnosis as covariates. There were no significant direct effects between autistic traits and mental wellbeing. Assimilation was a significant mediator of all mental wellbeing measures, and compensation was a significant mediator of positive wellbeing only. Autistic identity was not a significant moderator. Assimilation and compensation should be considered when offering psychological interventions to support mental wellbeing of autistic people. Additional research into external drivers of camouflaging (e.g. stigma) and mechanisms by which camouflaging impacts mental wellbeing, such as autonomy, authenticity, skill mastery and community, may identify other areas of support. Concurrently, societal change is necessary to reduce the need to camouflage.

The Associations Between Camouflaging, Autistic Traits, and Mental Health in Nonautistic Adults

Background

Camouflaging is frequently reported in autistic people and entails the disguising of autistic traits in social situations. Camouflaging is associated with poor mental health in autistic people. This study examined the manifestation of camouflaging in a nonautistic sample, examining the relationship between autistic traits, self-reported camouflaging, gender, and mental health.

Method

In total 110 nonautistic adults completed standardized self-report questionnaires that measured autistic traits, mental health symptoms, and camouflaging behaviors. Hierarchical multiple linear regression models were used to analyze data and examine the unique contributions of autistic traits and camouflaging to mental health.

Results

Self-reported autistic traits were associated with increased symptoms of poor mental health. However, autistic traits were not associated with mental health symptoms when controlling for self-reported camouflaging, and self-reported camouflaging predicted increased mental health symptoms over and above the effects of autistic traits. Women had poorer mental health than men in our sample, and in women there was a stronger relationship between camouflaging and mental health than in men.

Conclusions

Camouflaging may contribute to poor mental health outcomes in the general population, just as it does for autistic people, to the extent that camouflaging more clearly relates to mental health profile than self-reported autism traits. This suggests camouflaging is an important construct for understanding mental health in general, and for exploring the complex relationship between autism and autistic traits.

The role of the broader autism phenotype in anxiety and depression in college-aged adults

The current study examines the relationship between the presence of autistic traits and anxiety and mood disorders in young adults from different racial groups. A representative sample from a predominately white university (2,791 non-Hispanic White (NHW) and 185 Black students) completed the broad autism phenotype questionnaire (BAPQ), a measure of depression (Patient Health Questionnaire, PHQ-9), and anxiety (Generalized Anxiety Disorder, GAD-7). Statistical Package for Social Sciences (SPSS) was used to perform two multiple regression analyses to determine the association between race, BAPQ score and anxiety and depression symptoms. The current study found a stronger association between autistic traits had depression and anxiety symptoms in Black participants than did NHW participants. These findings underscore the association between autistic traits and anxiety and depression in Black communities, and the need for further studies on this topic area. Additionally, it highlights the importance of improving access to mental health care for this population.

Autistic traits are associated with enhanced working memory capacity for abstract visual stimuli

We tested whether the association between autistic traits and enhanced performance in visual-perceptual tasks extends to visual working memory capacity. We predicted that any positive effect of autistic traits on visual working memory performance would be greatest during domain-specific tasks, in which visual resources must be relied upon. We used a visual 'matrix' task, involving recall of black-and-white chequered patterns which increased in size, to establish participants' capacity (span). We assessed 144 young adults' (M = 22.0 years, SD = 2.5) performance on abstract, 'low semantic' versus 'high semantic' task versions. The latter offered multimodal coding due to the availability of long-term memory resources that could supplement visual working memory. Participants also completed measures of autistic traits and trait anxiety. Autistic traits, especially Attention to Detail, Attention Switching, and Communication, positively predicted visual working memory capacity, specifically in the low semantic task, which relies on visual working memory resources. Autistic traits are therefore associated with enhanced processing and recall of visual information. The benefit is removed, however, when multimodal coding may be incorporated, emphasising the visual nature of the benefit. Strengths in focused attention to detail therefore appear to benefit domain-specific visual working memory task performance.

Gyrus rectus asymmetry predicts trait alexithymia, cognitive empathy, and social function in neurotypical adults

Reduced empathy and elevated alexithymia are observed in autism spectrum disorder (ASD), which has been linked to altered asymmetry in brain morphology. Here, we investigated whether trait autism, empathy, and alexithymia in the general population is associated with brain morphological asymmetry. We determined left-right asymmetry indexes for cortical thickness and cortical surface area (CSA) and applied these features to a support-vector regression model that predicted trait autism, empathy, and alexithymia. Results showed that less leftward asymmetry of CSA in the gyrus rectus (a subregion of the orbitofrontal cortex) predicted more difficulties in social functioning, as well as reduced cognitive empathy and elevated trait alexithymia. Meta-analytic decoding of the left gyrus rectus annotated functional items related to social cognition. Furthermore, the link between gyrus rectus asymmetry and social difficulties was accounted by trait alexithymia and cognitive empathy. These results suggest that gyrus rectus asymmetry could be a shared neural correlate among trait alexithymia, cognitive empathy, and social functioning in neurotypical adults. Left-right asymmetry of gyrus rectus influenced social functioning by affecting the cognitive processes of emotions in the self and others. Interventions that increase leftward asymmetry of the gyrus rectus might improve social functioning for individuals with ASD.

Sex-specific mechanisms for eating disorder risk in men and women with autistic traits: the role of alexithymia

BACKGROUND

A poorly understood relationship exists between eating disorders (ED) and autism spectrum conditions (ASC: henceforth 'autism'). ED are more prevalent in autistic people and people with high autistic traits, and autistic features are prognostic of longer illness. Aiming to understand what increases the risk of ED in relation to autism and autistic traits, previous research has implicated alexithymia as a causal mechanism in this relationship. These studies could not, however, disentangle whether alexithymia explains the relationship between ED pathology and autistic traits directly or through its impact on anxious/depressive symptoms, which in turn result in higher ED symptomatology. Moreover, despite evidence for sex differences in the aetiology of ED, little research has examined the impact of sex on these relationships.

METHODS

Focusing on the association between autistic traits and ED psychopathology, we examined independent mediating effects of alexithymia and anxious/depressive symptoms, as well as sequential mediation effects where alexithymia affects ED psychopathology via its impact on anxious/depressive symptoms. Participants were 198 men and 265 women with formally diagnosed and suspected ED, who completed an online survey of standardised scales.

RESULTS

In men, higher autistic traits were associated with ED psychopathology sequentially via greater alexithymia and through that, greater depressive/anxious symptoms. In women, alexithymia mediated the relationship between autistic traits and ED psychopathology both directly and sequentially through its impact on anxious/depressive symptoms. Interestingly, depressive/anxious symptoms also mediated that relationship independently from alexithymia.

CONCLUSIONS

While cross-sectional, these findings suggest that the relationship between autistic traits and ED symptomatology is mediated by other variables. In support of its proposed role in the aetiology of ED, alexithymia was directly associated with ED symptoms in women. It also affected ED symptoms indirectly, in all participants, via its effect on depressive/anxious symptoms. Interventions focusing on alexithymia may facilitate recovery not only via their effect on ED, but via their effect on other forms of state psychopathology which contribute to the maintenance and development of ED. Sex differences, however, reflect that alternative therapeutic targets for men and women may be beneficial.

Psychometric properties of the Persian version of the Autism-Spectrum Quotient (AQ-19) with Iranian university students

Studies suggest that autistic traits are widespread among the general population and, in this regard, the short form of the Autism-Spectrum Quotient (AQ), the AQ-28, was developed to measure autistic traits. The present study examines the factor structure, internal consistency, and convergent validity of the Persian version of the AQ-28 with 691 Iranian university students (M_age = 28.67, SD = 8.57, 57.3% women) who were recruited online and completed the AQ-28 and Symptom Checklist (SCL-25) measures. Confirmatory factor analysis results yielded a four-factor model, which was internally consistent and demonstrated hypothesized correlations with the external correlates of interest (e.g., anxiety, depression, and phobia). Results support the Persian version of the AQ with 19 items (AQ-19) as a measure with sound psychometrics to be used in studies with Iranian university students.

Autistic traits heighten sensitivity to rejection-induced social pain

Autistic traits-subclinical forms of characteristics associated with autism spectrum disorders-are associated with poor social interactions and high risks for mental health disorders. We hypothesized that altered sensitivity to social rejection is an important contributor to psychological distress observed among individuals with high autistic traits. Experiment 1 adopted a social-judgment task and compared behavioral and neural activity in response to social rejection between participants exhibiting either high or low autistic traits (HAT and LAT, respectively). Rejection-induced hurt feelings, P3 amplitudes, and θ-oscillation magnitudes were greater in the HAT group than in the LAT group. Mediation analysis indicated that autistic traits heighten rejection-induced social pain through increasing frontal-midline θ-oscillations. Responses to nonsocial feedback in the age-judgment task were comparable, confirming that the between-group differences were specific to social negative feedback. Experiment 2 assessed the association between autistic traits, rejection sensitivity, and psychological distress among randomly recruited participants. Results showed that autistic traits affected depressive/anxious symptomatology partially through heightened rejection sensitivity. Therefore, autistic traits heighten sensitivity to rejection-induced social pain that leads to psychological distress. This finding will help facilitate the development of strategies for coping with social pain and improving mental health for individuals with high autistic traits.

Differentiation of autism spectrum disorder and mood or anxiety disorder

LAY ABSTRACT

Symptoms of mood and anxiety disorders overlap with symptoms of autism spectrum disorder, making the diagnostic process challenging. This study found that a combination of communicational deficits and unusual and/or inappropriate social overtures facilitates differentiation between autism spectrum disorder and mood and anxiety disorders. Furthermore, the results confirm the essential need of a behavioral observation with the Autism Diagnostic Observation Schedule in combination with a full Autism Diagnostic Interview-Revised to support diagnostic decisions.

Screening for autism spectrum disorder in deaf adults with intellectual disability: Feasibility and accuracy of two autism screening instruments

BACKGROUND

There is a lack of autism screening instruments for deaf or hard of hearing (DHH) adults with intellectual disability.

AIMS

This study examined the diagnostic validity of the Pervasive Developmental Disorder in Mental Retardation Scale and the Diagnostic Behavioral Assessment for autism spectrum disorder - Revised in this rare population.

METHODS AND PARTICIPANTS

56 DHH adults with intellectual disability living in three specialized therapeutic communities were examined, 9 of whom met criteria for autism.

OUTCOMES AND RESULTS

With minimal adaptions regarding item interpretation, both tools showed good diagnostic and high convergent validity. Items probing for difficulties in reciprocal social interaction and restricted interests were discriminant between individuals with and without autism.

CONCLUSION

These data suggest that both autism screening tools are feasible and psychometrically sound when used with appropriate adaptations for DHH adults with intellectual disability.

Autistic Traits and Empathy for Others' Pain Among the General Population: Test of the Mediating Effects of First-Hand Pain Sensitivity

Autism spectrum disorders (ASD) are characterized by reduced pain empathy-a process that is grounded in first-hand pain perception. Because autistic traits are continuously distributed in the general population, we hypothesized that first-hand pain sensitivity would mediate the link between autistic traits and pain empathy. After controlling for alexithymia, higher autistic traits were associated with lower cognitive and emotional empathy in response to others' pain, as well as lower sensitivity to cold and heat pain (higher cold pain tolerance and lower laser heat pain-intensity ratings). Importantly, pain sensitivity fully mediated the link between autistic traits and pain empathy. These findings highlight the role of atypical first-hand pain sensitivity in the lack of pain empathy observed in people with high autistic traits or ASD.

The role of alexithymia and autistic traits in predicting quality of life in an online sample

BACKGROUND

Autistic people tend to report poorer Quality of Life (QOL) than comparison groups, though some studies do report more optimistic findings. Higher autistic traits are also related to poorer QOL. However, the role of alexithymia in this relationship has not been explored.

METHOD

A total of 163 participants (N = 53 autistic and N = 111 comparison) consented to take part; however, 30 participants were excluded due to missing data (who did not differ from those who were retained on age, gender, education, employment, or living status), leaving a final sample of 133 (N = 42 Autistic and 91 Comparison participants). Demographic information (including age, gender) was collected, alongside self-report measures of autistic traits, mental health, alexithymia, and QOL. We estimated regression models based on pre-registered analysis, and we conducted exploratory network analyses.

RESULTS

Alexithymic traits did not predict QOL when controlling for covariates. Depression significantly predicted Physical, Psychological, and Social QOL. When examining the impact of just alexithymic traits and autistic traits, both were significantly associated with Physical and Psychological QOL. For participants with a low depression score, the correlation between alexithymia and QOL was strong; suggesting that depression occludes the association between alexithymia and QOL. Network analyses suggested that depression and anxiety exert direct effects on Physical and Psychological QOL, whereas alexithymia scores may influence Physical QOL via autistic traits.

CONCLUSION

In sum, depression is a pervasive negative predictor of multiple QOL domains. The role of alexithymia in predicting QOL dimensionally and categorically was not ruled out, given our exploratory analyses, we suggest that interventions which target alexithymia may positively impact QOL for those who score low on depressive symptoms.

Distributional Properties and Criterion Validity of a Shortened Version of the Social Responsiveness Scale: Results from the ECHO Program and Implications for Social Communication Research

Prior work proposed a shortened version of the Social Responsiveness Scale (SRS), a commonly used quantitative measure of social communication traits. We used data from 3031 participants (including 190 ASD cases) from the Environmental Influences on Child Health Outcomes (ECHO) Program to compare distributional properties and criterion validity of 16-item "short" to 65-item "full" SRS scores. Results demonstrated highly overlapping distributions of short and full scores. Both scores separated case from non-case individuals by approximately two standard deviations. ASD prediction was nearly identical for short and full scores (area under the curve values of 0.87, 0.86 respectively). Findings support comparability of shortened and full scores, suggesting opportunities to increase efficiency. Future work should confirm additional psychometric properties of short scores.

The relationship between autistic characteristics, social engagement and executive function in a typical sample

Purpose

This study aims to represent a first attempt to examine in a non-clinical population the interplay between social engagement, executive function (EF) and theory of mind (ToM) within a social motivation theory framework.

Design/methodology/approach

A total of 170 participants (135 female; mean age = 19.01 and standard deviation = 1.27) completed measures of ToM (Faux Pas task), autistic traits (Autism Spectrum Quotient), social engagement (reward dependence subscale of the Temperament and Character Inventory), sociability and EF (both subscales of the Adult Temperament Questionnaire).

Findings

Path analyses found that EF, sociability and social engagement were negatively associated with autistic traits both directly and indirectly. Results indicate that EF may impact sociability and social engagement and their interaction may relate to the degree of autistic traits shown in a typical sample. However, ToM (as measured by the Faux Pas test) was not related to any of the other variables.

Originality/value

Sociability, social engagement and effortful control deficits may be linked to higher levels of autistic traits. These factors appear to form a hierarchy of factors underpinning autism spectrum disorder, with EF contributing to all aspects, followed by sociability and social engagement at a higher level. Future research examining in clinical populations the utility of a more integrated model of social motivation that incorporates EF appears warranted.

Clarifying Self-Report Measures of Social Anxiety and Obsessive-Compulsive Disorder to Improve Reporting for Autistic Adults

Background

Phenotypic similarities exist between autism-related experiences and anxiety (especially social anxiety and obsessive-compulsive disorder [OCD]), making it difficult for autistic people to self-report their experiences using existing measures developed for nonautistic adults. We examined whether clarifications aiming to tease out autism-related experiences from social anxiety or OCD in self-report questionnaires would influence autistic and nonautistic participants' ratings.

Methods

Two autistic consultants and two experienced clinicians were consulted to develop item clarifications aiming to disentangle autistic from anxiety experiences for two questionnaires: the Social Anxiety Questionnaire (SAQ) and the Padua Inventory (PI) for OCD. Autistic adults (n = 50) and nonautistic university students with higher (n = 81) and lower autistic traits (ATs; n = 104) completed the original questionnaire followed by the clarified questionnaire items online.

Results

For social anxiety, there were few significant differences between the original and clarified item and total SAQ scores. For OCD, participants reported significantly lower scores for the OCD-clarified PI items than for the original items and the autism-clarified items. Larger original-clarified PI mean item differences were noted in items describing repetitive behaviors, "obsessional" thoughts, and contamination fears. Similar patterns of differences were found in autistic and nonautistic participants with higher and lower ATs, but differences were often larger in the autistic group.

Conclusion

The SAQ in its original form appears to be an appropriate measure for autistic people to self-report social anxiety. However, autistic people appeared to complete the original PI items to reflect, to some extent, their autism-related experiences, rather than the originally intended OCD symptoms. Thus, the original OCD self-report ratings were inflated using the PI. Professionals should therefore clarify the intended meanings of different items of the PI to ensure more accurate and relevant ratings of OCD symptoms in autistic people.

Lay summary

Why was this study done?: Autistic people and people with higher autistic traits (ATs) often experience higher rates of anxiety. Anxiety measures developed for the general population may not be appropriate or accurate for measuring anxiety in autistic people. We investigated whether clarifying items in existing self-report questionnaires to tease out anxiety from autistic experiences would influence the way autistic adults self-report their social anxiety and obsessive-compulsive disorder (OCD) symptoms, and if so in what ways. We also wanted to know whether providing these item clarifications would affect the ratings of nonautistic individuals with varying rates of ATs to the same extent.What did the researchers do?: We initially consulted two autistic adults and two clinicians with experience working with autistic adults and co-occurring mental health difficulties. We selected two measures: the Social Anxiety Questionnaire (SAQ) for social anxiety symptoms and the Padua Inventory for OCD symptoms. The consultants identified social anxiety and OCD items that could be interpreted or experienced differently by autistic people and proposed ways to clarify them to make their meaning clearer.Next, 50 autistic people and 185 nonautistic university students participated in our online study. The nonautistic participants were grouped into those with higher or lower ATs. Participants completed the original social anxiety and OCD questionnaires first, followed by the clarified versions of the two questionnaires.What were the results of the study?: For social anxiety, we only found small differences in ratings when participants used measures with or without clarifications. This was true in both autistic and nonautistic participants. For OCD symptoms, autistic people's OCD ratings were significantly lower for many items after we provided clarifications, especially for items describing repetitive behaviors, "obsessional" thoughts, and contamination fears. This finding suggests that in the original questionnaire, autistic people may have also been rating their autism-related experiences, not just the OCD experiences or symptoms the questionnaire was trying to measure. We found similar differences between the original and clarified item ratings in nonautistic participants with higher and lower ATs. However, the differences were more common and pronounced with the autistic participants.What do these findings add to what was already known?: These findings suggest that original self-report measures of anxiety may need to be clarified so that autistic adults can better capture and rate their anxiety, rather than their autism-related experiences.What are potential weaknesses in the study?: We used only two anxiety questionnaires, so these findings may or may not be applicable to other OCD or social anxiety questionnaires available. Also, the clarifications we provided may not be representative of all autistic people's experiences, and it is possible that there are other and better ways to clarify the items. We also conducted many item comparisons in this study, so there is a possibility that some findings were due to chance.How will these findings help autistic adults now or in the future?: Our findings can help improve clinical interviews and use of anxiety questionnaires by making them more accurate. They can also help clinicians appreciate the importance of asking clarifying questions to ensure they better capture autistic adults' anxiety experiences.

Co-occurrence of autistic and psychotic traits: implications for depression, self-harm and suicidality

BACKGROUND

There is increasing interest in the clinical and aetiological overlap between autism spectrum disorders and schizophrenia spectrum disorders, reported to co-occur at both diagnostic and trait levels. Individually, sub-clinical autistic and psychotic traits are associated with poor clinical outcomes, including increased depressive symptomatology, self-harming behaviour and suicidality. However, the implications when both traits co-occur remain poorly understood. The study aimed to (1) examine the relationship between autistic and psychotic traits and (2) determine if their co-occurrence increases depressive symptomatology, self-harm and suicidality.

METHODS

Cross-sectional data from a self-selecting (online and poster advertising) sample of the adult UK population (n = 653) were collected using an online survey. Validated self-report measures were used to assess sub-clinical autistic and psychotic traits, depressive symptomatology, self-harming behaviour and suicidality. Correlation and regression analyses were performed.

RESULTS

A positive correlation between sub-clinical autistic and positive psychotic traits was confirmed (r_s = 0.509, p < 0.001). Overall, autistic traits and psychotic traits were, independently, significant predictors of depression, self-harm and suicidality. Intriguingly, however, depression was associated with a negative interaction between the autistic domain attention to detail and psychotic traits.

CONCLUSIONS

This study supports previous findings that sub-clinical autistic and psychotic traits are largely independently associated with depression, self-harm and suicidality, and is novel in finding that their combined presence has no additional effect on depression, self-harm or suicidality. These findings highlight the importance of considering both autistic and psychotic traits and their symptom domains in research and when developing population-based depression prevention and intervention strategies.

Coping style predicts sense of security and mediates the relationship between autistic traits and social anxiety: Moderation by a polymorphism of the FKBP5 gene

The mechanism underlying the relationship between autistic traits and social anxiety still remains unknown. It is therefore necessary to investigate potential psychological and biological mechanisms. A total of 2695 college students were samples for this research during 2017-2018. The assessed variables included demographic characteristics and measures of autistic traits, sense of security, coping styles, and social anxiety. Blood samples were collected from which DNA was extracted. Regression analysis indicated that autistic traits and negative coping were positively associated with social anxiety; furthermore, positive coping, interpersonal security, and sense of control were negatively associated with social anxiety. Further analyses demonstrated that the relationship between autistic traits and social anxiety was mediated by coping styles (both positive coping and negative coping) and sense of security (both interpersonal security and sense of control), and coping style predicted the sense of security. The FK506 binding protein 5 (FKBP5) gene rs3800373 moderated the association between autistic traits and social anxiety. The present study is the first to demonstrate that both coping style and sense of security play an intermediate role between autistic traits and social anxiety in a sample of Chinese college students; moreover, the FKBP5 gene moderates this association between autistic traits and social anxiety.

Anxiety and Depression from Adolescence to Old Age in Autism Spectrum Disorder

This study examined age trends in anxious and depressive symptoms, from older adolescence to old age, and explored the association between anxious and depressive symptoms with gender, ASD severity, and socio-economic factors. Two hundred and fifty-five individuals with ASD (151 males, M_age = 33.52 years, SD_age = 14.98) took part. More than one-third of participants reported clinically significant anxiety (38.4%) or depression (38%). A slight trend for an increase in the severity of both anxiety and depression from adolescence to middle adulthood, and then a slight decline in older adulthood was found. Female gender and higher ASD severity predicted more anxiety and depression symptoms. Our findings emphasise the need to provide timely assessment and treatment of anxiety and depression in ASD.

Alexithymia may explain the relationship between autistic traits and eating disorder psychopathology

BACKGROUND

Autistic people are disproportionately vulnerable to anorexia nervosa and other eating disorders (ED), and within the general population, autistic traits correlate with ED psychopathology. A putative mechanism which may underpin this heightened risk is alexithymia, a difficulty identifying and describing emotional states which is observed in both autism and ED. In two experiments with independent non-clinical samples, we explored whether alexithymia might mediate the heightened risk of eating psychopathology in individuals high in autistic traits.

METHODS

Our first experiment used the PROCESS macro for SPSS to examine relationships between alexithymia (measured by the Toronto Alexithymia Scale (TAS-20)), autistic traits (autism quotient (AQ)), and eating psychopathology (Eating Attitudes Test (EAT-26)) in 121 participants. Our second experiment (n = 300) replicated and furthered this analysis by examining moderating effects of sex and controlling for anxiety and depression as covariates. We also included an additional performance-based measure of alexithymia, the Levels of Emotional Awareness Scale (LEAS).

RESULTS

Study 1 suggested that TAS-20 scores mediated the relationship between heightened autistic traits and eating psychopathology. Replication and further scrutiny of this finding, in study 2, revealed that this mediation effect was partial and specific to the female participants in this sample. The mediation effect appeared to be carried by the difficulty identifying feelings subscale of the TAS-20, even when depression and anxiety were controlled for. LEAS scores, however, were not significantly related to autistic traits or eating psychopathology.

LIMITATIONS

Cross-sectional data prevents any conclusions around the direction and causality of relationships between alexithymia, autistic traits, and eating psychopathology (alongside depression and anxiety), necessitating longitudinal research. Our non-clinical sample was predominantly Caucasian undergraduate students, so it remains to be seen if these results would extrapolate to clinical and/or autistic samples. Divergence between the TAS-20 and LEAS raises crucial questions regarding the construct validity of these measures.

CONCLUSIONS

Our findings with respect to autistic traits suggest that alexithymia could partially explain the prevalence of ED in autistic people and may as such be an important consideration in the pathogenesis and treatment of ED in autistic and non-autistic people alike. Further research with clinical samples is critical to explore these ideas. Differences between men and women, furthermore, emphasize the importance of looking for sex-specific as well as generic risk factors in autistic and non-autistic men and women.

Sleep Quality in Autism from Adolescence to Old Age

Background

Sleep problems are common in autism from early childhood. Although research suggests that poor sleep continues at least into early middle age, the pattern of sleep problems has rarely been characterized beyond childhood. The aim of this study was to examine sleep quality from adolescence to old age in autistic individuals as compared with age-matched non-autistic comparison groups from the general population.

Methods

Participants ranged from 15 to 80 years; there were 297 participants in the autistic group (mean [M]_age = 34.36 years, standard deviation [SD] = 15.24), and the comparison group had 233 participants (M_age  = 33.01 years, SD = 15.53). Sleep quality, sleep onset latency (SoL), total night sleep, and sleep efficiency as measured by Pittsburgh Sleep Quality Index were compared between groups and across age groups (15-19, 20-39, 40-59, 60+ years). Five predictors of sleep quality (autistic traits, mental health condition, medication, employment, and sex) were also examined.

Results

Overall, problematic sleep was more common for the autistic participants (63.7%) than the comparison group (46.4%), and autistic participants had poorer sleep quality and longer SoL (all p < 0.001). In early adulthood and middle age, autistic adults had significantly poorer sleep quality and longer SoL than similar age comparison group adults; autistic and comparison group adolescents and the elderly did not differ. In the autistic group, predictors accounted for 21% of sleep quality variance. Sex (p < 0.001) was the strongest predictor, with all predictors except employment contributing unique variance. In the comparison group, predictors accounted for 25% of the variance in sleep quality. The strongest predictor was mental health condition (p < 0.001), with all predictors except sex contributing unique variance.

Conclusions

Autistic adolescents and adults, particularly females, remain vulnerable to sleep problems, with early and middle adulthood being at times of particular risk. Targeted sleep interventions are required.

Lay summary

Why was this study done?: Difficulty sleeping is a common occurrence among autistic individuals, but we know very little about sleep in autistic adults.What was the purpose of the study?: To compare self-reported sleep quality in autistic and non-autistic people aged 15 to 80 years.What did the researchers do?: Online surveys were completed by 297 autistic individuals (average age 34.36 years) and 233 non-autistic individuals (average age 33.01 years). Participants were asked questions about their sleep quality, the time it takes them to fall asleep (sleep latency), and the number of hours of sleep they usually get each night (total sleep). Using information about how long they slept and their responses to questions about their bedtime and wake time we calculated the percentage of time they spent in bed asleep (sleep efficiency [SE]). We compared these sleep measures between the autistic and non-autistic participants. We also split the participants into four age groups (15-19, 20-39, 40-59, and 60+ years) to look at any differences at specific age points. Finally, we looked to see whether autistic symptoms, having a mental health problem, being on medication, being unemployed, and/or sex (male/female) predicted sleep quality.What were the results of the study?: Poor sleep quality was more common for the autistic participants (63.7%) than non-autistic participants (46.4%). On average, autistic participants also had poorer sleep quality scores and it took them longer to fall asleep than non-autistic participants. Autistic participants in early adulthood (20-39) and middle age (40-59) had poorer sleep quality and took longer to fall asleep than non-autistic adults of the same age. There were no differences between autistic and non-autistic adolescents (15-19) or older adults (60+). For autistic participants, the best predictor of poor sleep quality was being female; other predictors of poor sleep quality were having a mental health problem, more autistic symptoms, and being on medication. Among non-autistic participants, the best predictor of poor sleep quality was having a mental health problem; other predictors were more autistic symptoms, being on medication, and being unemployed.What do these findings add to what is already known?: Similar to the findings in autistic children, autistic adults are more likely to have poor sleep quality compared with non-autistic adults. Autistic females are particularly at risk for poor sleep, and autistic adults aged 20 to 59 years are more at risk for poor sleep quality.What are potential weaknesses in the study?: Sleep was measured by using a self-report questionnaire, which is not as reliable as using a sleep diary or other objective measures of sleep (e.g., actigraphy). In addition, this study only looked at data collected at one point in time, and as such it is not possible to examine changes over time in sleep quality among autistic adults.How will these findings help autistic adults now or in the future?: The findings in this study identified that sleep difficulties persist across the lifespan for autistic adults. Therefore, there is a critical need for future research to focus on understanding the cause of poor sleep quality in autism and develop sleep interventions for autistic adults.

Autism and depression are connected: A report of two complimentary network studies

Autism and depression often co-occur. Through network analysis, we seek to gain a better understanding of this co-occurrence by investigating whether (1) autism and depression share overlapping groups of symptoms and/or (2) are connected through a bridge of mastery or worry symptoms. This is addressed in two complimentary studies: (1) Study 1 focusing on depressed (N = 258) and non-depressed adults (N = 117), aged 60-90 years; (2) Study 2 focusing on autistic (N = 173) and non-autistic adults (N = 70), aged 31-89 years. Self-report questionnaire data were collected on autistic traits (AQ-28), depression symptoms (Study 1: Inventory of Depressive Symptomatology Self Report; Study 2: Symptom Checklist 90-Revised depression subscale), worry (Worry Scale-R) and mastery (the Pearlin Mastery Scale). For both studies, data were analysed by creating glasso networks and subsequent centrality analyses to identify the most influential variables in the respective networks. Both depressed and autistic adults are highly similar in the perceived amount of worries and lack of control. While caution is needed when interpreting the pattern of findings given the bootstrapping results, findings from both studies indicate that overlapping symptoms do not fully explain the co-occurrence of autism and depression and the perception of having control over your life, that is, mastery seems a relevant factor in connecting autism and depression.

Revisiting the overlap between autistic and schizotypal traits in the non-clinical population using meta-analysis and network analysis

The present study aimed to explore the relationship between autistic and schizotypal traits in the non-clinical population. We first conducted a meta-analysis to quantify the correlation between self-reported autistic traits and the three dimensions of schizotypal traits (positive, negative and disorganization). The strongest correlation was found between autistic traits and negative schizotypal traits (r = 0.536, 95% CI [0.481, 0.586]), followed by the disorganization (r = 0.355, 95% CI [0.304, 0.404]) and positive (r = 0.256, 95% CI [0.208, 0.302]) dimensions. To visualize the partial correlations between dimensional behavioural traits, we constructed a network model based on a large sample of college students (N = 2469). Negative schizotypal traits were strongly correlated with autistic social/communicative deficits, whereas positive schizotypal traits were inversely correlated with autistic-like traits, lending support to the psychosis-autism diametrical model. Disentangling the overlapping and diametrical structure of autism and schizophrenia may help to elucidate the aetiology of these two neurodevelopmental disorders.

Enter the Wild: Autistic Traits and Their Relationship to Mentalizing and Social Interaction in Everyday Life

Theories derived from lab-based research emphasize the importance of mentalizing for social interaction and propose a link between mentalizing, autistic traits, and social behavior. We tested these assumptions in everyday life. Via smartphone-based experience sampling and logging of smartphone usage behavior we quantified mentalizing and social interaction in our participants' natural environment. Mentalizing occurred less frequently than reasoning about actions and participants preferred to mentalize when alone. Autistic traits were negatively correlated with communication via smartphone. Yet, they were not associated with social media usage, a more indirect way of getting in touch with others. Our findings critically inform recent theories on social cognition, social behavior, and the role of autistic traits in these phenomena.

Validation of the Repetitive Behavior Scale-Revised in Spanish-Speakers Participants with Autism Spectrum Disorder

Restricted and repetitive behavior (RRB) is one of the two key diagnostic features of autism spectrum disorder (ASD). DSM-5 highlights the importance of severity-based diagnostic modifiers assigned on the basis of intensity of needed supports. Therefore, there is a need for available measures that assess the severity of RRB. The repetitive behavior scale-revised (RBS-R) is probably the most used informant-based rating scale for the assessment of RRB and interests observed in ASD. The present study examined the psychometric properties of the Spanish version of the RBS-R in a sample of 233 participants with ASD, aged 3 to 63 years. Results revealed a six-factor model, good internal consistency, and concurrent-divergent validity. These findings suggest the utility of the Spanish version of RBS-R.

Teacher responses to anxiety-related behaviours in students on the autism spectrum

BACKGROUND

At least 50% of students on the autism spectrum experience clinical or subclinical levels of anxiety but there is scant research on how teachers respond to anxiety in children on the spectrum.

AIMS

To compare teacher responses to anxiety-related behaviour in students who do and do not have a diagnosis on the spectrum using the Teacher Responses to Anxiety in Children (TRAC).

METHODS AND PROCEDURES

Teachers (N = 64), predominantly from mainstream primary schools, completed an online survey comprised of a demographic questionnaire and two versions of the TRAC, one for students without autism and one for students with autism.

OUTCOMES AND RESULTS

Teachers report differences in the way they would likely respond to anxiety-related behaviours observed in students with and without autism. Teachers reported being more likely to use anxiety-promoting responses for students with autism who are showing behaviours indicative of general and separation anxiety, but not when they are showing behaviours indicative of social anxiety. Whilst there was no significant difference in the overall likelihood of use of autonomy-promoting responses between groups, there were differences in the likelihood of using specific autonomy-promoting responses dependent upon diagnosis and type of anxiety.

CONCLUSIONS AND IMPLICATIONS

Teachers report they are likely to respond differently to anxiety-related behaviours of students on the autism spectrum but the impact of this on the behaviour of these students is yet to be determined. Professional development is a priority to increase teacher knowledge about anxiety-related behaviours in students with autism and the ways in which teachers' responses may promote or reduce anxiety and autonomy.

Are PTSD and autistic traits related? An examination among typically developing Israeli adults

BACKGROUND AND OBJECTIVES

Previous research indicates that individuals with Autism Spectrum Disorder (ASD) face an increased risk of experiencing traumatic events. Autistic Traits (AT), characteristic of ASD, are continuously distributed across the general population. Our main objective was to examine the association between AT and PTSD (Post Traumatic Stress Disorder), a topic rarely assessed before.

METHODS

One hundred and three college students from 3 academic areas, previously found to be associated with different degrees of AT, completed self-report questionnaires tapping PTSD (the PCL-5; PTSD Checklist for DSM-5), AT (AQ; the Autism Spectrum Quotient), and traumatic life events.

RESULTS

AT were positively associated with all PTSD symptom clusters, except for avoidance. The association between imagination difficulties and PTSD was moderated by gender. Among participants meeting the PTSD cutoff, those with the highest AT levels reported a PTSD symptomatic profile with an increased dominance of hyper-arousal symptoms.

CONCLUSIONS

The AT-PTSD association reported here may be attributed to several factors, including increased victimization associated with AT, as well as shared vulnerability factors for both conditions, including impairments in social cognition. Further research is needed in order to understand the associations between these two conditions, considering gender differences, and possible shared underlying mechanisms.

Psychometric properties of the chinese version of autism spectrum quotient-children's version: A sex-specific analysis

A Simplified Chinese translation of the Autism Spectrum Quotient-Children's Version (AQ-C) is needed for research in mainland China. Autism Spectrum Disorder (ASD) is a condition that differs in presentation and prevalence by sex. Thus, evaluating the psychometric validity of the AQ-C in males and females is an important step in its validation. The present study aims to develop a Chinese translation of the parent-report AQ-C, and test its psychometric properties among Mandarin Chinese speaking boys and girls. A total of 1,020 non-clinical children and 134 children with ASD were assessed. Factor analyses were performed for the whole sample, as well as for girls and boys separately. A 30-item, 5-factor model (the Chinese AQ-C) showed adequate goodness of fit (root mean square error of approximation [RMSEA] = 0.037; comparative fit index [CFI] = 0.907; Tucker-Lewis index [TLI] = 0.901) for the whole sample. According to parents' reports, non-clinical boys had significantly higher scores than non-clinical girls on the Chinese AQ-C. Sex-specific factor structures were identified resulting in a 4-factor model with 32 items for girls (the Chinese AQ-Girls), and a 4-factor model with 34 items for boys (the Chinese AQ-Boys). The cut-off scores of the Chinese AQ-C, AQ-Girls, and AQ-Boys were 44.5, 42.5, and 46.5, respectively. These three Chinese versions of the AQ-C all showed satisfactory internal consistency (α = 0.786-0.840) and concurrent validity with the Social Responsiveness Scale (r = 0.789-0.814) for the total scale. Differences have been found in the sex-specific factor structures of the AQ-C which would be more reliable to use for future research when measuring autistic traits in the general population. Autism Res 2019, 12: 303-315 © 2018 International Society for Autism Research, Wiley Periodicals, Inc. LAY SUMMARY: This study developed Chinese versions of the Autism Spectrum Quotient-Children's Version (AQ-C) in Chinese boys and girls together and separately. The AQ-C showed good psychometric properties in boys and girls together and separately. There were differences in sex-specific factor structures of the AQ-C. These results suggest that the sex-specific Chinese versions of the AQ-C provide reliable and valid measurement of autistic traits.

ASD Traits Among Youth with Obsessive-Compulsive Disorder

Research has shown high rates of comorbid psychiatric disorders among samples of youth with obsessive-compulsive disorder (OCD) (Farrell et al., Psychiatry Res 199(2):115-123, 2012; Lewin et al., Psychiatry Res 178(2):317-322, 2010; POTS Team, J Am Med Assoc 292(16):1969-1976, 2004). Autism and autistic traits co-occur at high rates within clinical samples of youth with OCD (Ivarsson and Melin in J Anxiety Disord 22(6):969-978, 2008; Stewart et al. in Child Psychiatry Hum Dev 1-9, 2016). This study extends the literature by examining the relationship between ASD traits, family accommodation, and functional impairment in a sample of youth with OCD across a wide age range (n = 80; aged 7-17 years). Results indicated that autistic traits, as measured by the social responsiveness scale (SRS), were elevated in 32.5% of youth (based on a T-score of 66T and above) relative to typically developing youth, as well as youth with non-autism-related psychiatric disorders (Constantino and Gruber in Social responsiveness scale, Western Psychogical Services, Torrance, 2012). Furthermore, 27.5% of youth scored within a moderate range (66T-75T) and 5% of youth scored within a severe range (76T or higher) on the SRS, typical of children with ASD (Constantino and Gruber in Social responsiveness scale, Western Psychogical Services, Torrance, 2012). Additionally, ASD traits were associated with greater functional impairment above OCD severity. Furthermore, family accommodation mediated the relationship between ASD traits and functional impairment. Implications of these findings are discussed in the context of clinical assessment and direction for further research.

The mediating effects of childhood neglect on the association between schizotypal and autistic personality traits and depression in a non-clinical sample

BACKGROUND

Autistic personality traits (APT) and schizotypal personality traits (SPT) are associated with depression. However, mediating factors within these relationships have not yet been explored. Thus, the focus of the current study was to examine the effects of childhood neglect on the relationship between APT/SPT and depression.

METHODS

This cross-sectional study was conducted on first-year students (N = 2469) at Hunan University of Chinese Medicine and Hengyang Normal College (Changsha, China). Participants completed surveys on APT, SPT, childhood neglect, abuse and depression.

RESULTS

Through correlational analyses, APT and SPT traits were positively correlated with childhood neglect and depression (p < 0.05). In a hierarchical regression analysis, among types of childhood maltreatment, emotional neglect (β = 0.112, p < 0.001) and physical neglect (β = 0.105, p < 0.001) were the strongest predictors of depression. Childhood neglect did not account for the relationships between APT/SPT and depression. Further analysis found that childhood neglect mediated the relationship between SPT and depression but not APT and depression.

CONCLUSIONS

Among types of childhood maltreatment, neglect was the strongest predicting factor for depression. Neglect did not account for the relationship between APT/SPT and depression but was a strong mediating factor between SPT and depression.

Risks and Protective Factors for Stress Self-Management in Parents of Children With Autism Spectrum Disorder: An Integrated Review of the Literature

PROBLEM

Stress in parents of children with autism spectrum disorder (ASD) has been reported to be very high. However, little is known about what risk and protective factors influence parental stress self-management in this population. Accordingly, this manuscript is a synthesis of the risk and protective factors that impact self-management of stress in these parents. The concepts in the individual and family self-management theory context domain were used as a framework to guide data collection and analysis.

ELIGIBILITY CRITERIA

Searches were conducted using CINAHL, MedLine and PsychInfo. Studies were included if they addressed context factors in parents of children with ASD and were written in English.

SAMPLE

Ninety-eight studies met review criteria.

RESULTS

This review highlighted risk factors to parental stress self-management within the context of condition-specific factors, physical and social environment, and individual and family. The most concerning of these findings is that parents struggle accessing a diagnosis and services for their child and are frustrated with health care providers' knowledge of ASD and lack of communication.

CONCLUSIONS

The risks parents experience as they care for their child with ASD far outweigh the protective factors for self-management of parental stress.

IMPLICATIONS

Nurses who are aware of these issues can make important changes to their practice and have a significant impact on parental stress self-management and the care of children with ASD.

Psychometric properties of the Autism-Spectrum Quotient in both clinical and non-clinical samples: Chinese version for mainland China

BACKGROUND

The Autism-Spectrum Quotient (AQ) is widely used to quantify autistic traits, which have been evaluated in the parents of individuals with autism spectrum disorders (ASD) and in the general population. This paper's objective was to investigate the AQ's psychometric properties of the Chinese version for mainland China and to establish whether the pattern of sex differences in the quantity of autistic traits exists. We also examined the usefulness of the AQ in differentiating between individuals with ASD, schizophrenia (SCH), obsessive-compulsive disorder (OCD) and healthy controls (HC).

METHODS

In this study, the psychometric properties of the AQ were assessed in 1037 parents of children with ASD and in 1040 parents of typically developing children (TDC). Additionally, 32 participants with ASD, 37 patients with SCH, 38 OCD patients and 38 healthy controls (matched for age, gender and IQ) were assessed with the AQ.

RESULTS

The internal consistency and test-retest reliability of the AQ and AQ subscales were within an acceptable range. Parents of ASD children scored higher than TDC parents on total AQ and AQ subscales, and TDC parents scored more than parents of ASD children on 2 items of 50. Fathers scored higher than did mothers on total AQ and four subscales, with the sole exception being the subscale attention to detail. The total AQ score of the ASD group was higher than that of the SCH, OCD and HC groups, and the total AQ score of the HC group was significantly lower than that of the SCH and OCD groups, with no differences being observed between the SCH and OCD groups.

CONCLUSIONS

The Mandarin AQ demonstrated promising psychometric properties and was a reliable instrument for quantifying autistic traits in both clinical and non-clinical samples in mainland China.

Autism Characteristics in Older Adults with Depressive Disorders

OBJECTIVE

To study the prevalence of autism spectrum disorder (ASD) characteristics in older adults with and without depressive disorders and the social network and past negative life events in those with a high number of ASD characteristics and those without a large number of these characteristics.

METHODS

This large, multisite, naturalistic, prospective cohort study used data from the Netherlands Study of Depression in Older persons (aged 60-90 years) with (N = 259) and without (N = 114) a depressive disorder according to DSM-IV criteria. ASD characteristics were measured with the abbreviated Autism Spectrum Quotient with a cutoff score of 70. Additional measures were the Composite International Diagnostic Interview, the Inventory of Depressive Symptomatology, the Becks Anxiety Inventory, the Close Person Inventory, and the life events questionnaire.

RESULTS

Of the older adults with a depressive disorder, 31% showed elevated ASD characteristics, which is much higher than the observed 6% in the comparison group. High ASD characteristics were associated with elevated depression and anxiety symptoms and more comorbid anxiety disorders. Those with a high number of ASD characteristics did not differ in the size of their social network or the number of negative life events as compared with those with less ASD characteristics.

CONCLUSION

ASD might be overlooked in older adults, especially within geriatric psychiatry. When diagnosing and treating depression and anxiety in older patients, one should be attentive to ASD.