Skip to main content

Perception of Life as Stressful, Not Biological Response to Stress, is Associated with Greater Social Disability in Adults with Autism Spectrum Disorder

Abstract

This study examined differences between adults with autism spectrum disorder (ASD; N = 40) and typical community volunteers (N = 25) on measures of stressful life events, perceived stress, and biological stress response (cardiovascular and cortisol reactivity) during a novel social stress task. Additional analyses examined the relationship between stress and social functioning as measured by the Social Adjustment Scale-II and the Waisman Activities of Daily Living scale. Results indicated that adults with ASD experienced significantly more stressful life events and perceived stress, and greater systolic blood pressure reactivity than typical community volunteers. Results also indicated that perceived stress and stressful life events were significantly associated with social disability. Interventions targeting stress management might improve social function in adults with ASD.

This is a preview of subscription content, access via your institution.

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5

References

  • Baron, M. G., Groden, J., Groden, G., & Lipsitt, L. P. (2006). Stress and coping in autism. New York: Oxford University Press.

    Book  Google Scholar 

  • Baron-Cohen, S., Ring, H. A., Bullmore, E. T., Wheelwright, S., Ashwin, C., & Williams, S. (2000). The amygdala theory of autism. Neuroscience & Biobehavioral Reviews, 24(3), 355–364.

    Article  Google Scholar 

  • Bejerot, S., Eriksson, J. M., & Mörtberg, E. (2014). Social anxiety in adult autism spectrum disorder. Psychiatry Research, 220(1), 705–707.

    Article  PubMed  Google Scholar 

  • Bellack, A. S., Morrison, R. L., Mueser, K. T., Wade, J. H., & Sayers, S. L. (1990). Role play for assessing the social competence of psychiatric patients. Psychological Assessment: A Journal of Consulting and Clinical Psychology, 2(3), 248.

    Article  Google Scholar 

  • Bishop-Fitzpatrick, L., Hong, J., Smith, L. E., Makuch, R., Greenberg, J. S., & Mailick, M. R. (2016). Characterizing objective quality of life and normative outcomes in adults with autism spectrum disorder: An exploratory latent class analysis. Journal of Autism & Developmental Disorders, 46(8), 2707–2719.

    Article  Google Scholar 

  • Bishop-Fitzpatrick, L., Mazefsky, C., Minshew, N. J., & Eack, S. M. (2015). The relationship between stress and social functioning in adults with autism spectrum disorder and without intellectual disability. Autism Research, 8(2), 164–173.

    Article  PubMed  Google Scholar 

  • Bishop-Fitzpatrick, L., Minshew, N. J., & Eack, S. M. (2013). A systematic review of psychosocial interventions for adults with autism spectrum disorders. Journal of Autism and Developmental Disorders, 43(3), 687–694.

    Article  PubMed  PubMed Central  Google Scholar 

  • CDC (2014). Prevalence of autism spectrum disorder among children aged 8 years—Autism and Developmental Disabilities Monitoring Network, 11 Sites, United States, 2010. Surveillance Summaries, MMWR 2012, 63(SS02), 1–21.

    Google Scholar 

  • Chalfant, A. M., Rapee, R., & Carroll, L. (2007). Treating anxiety disorders in children with high functioning autism spectrum disorders: A controlled trial. Journal of Autism and Developmental Disorders, 37(10), 1842–1857.

    Article  PubMed  Google Scholar 

  • Cohen, J. (1988). Statistical power analysis for the behavioral sciencies (2nd edn.). Hillsdale, NJ: Lawrence Erlbaum Associates.

    Google Scholar 

  • Cohen, S., Hamrick, N. M., Rodriguez, M. S., Feldman, P. J., Rabin, B. S., & Manuck, S. B. (2000). The stability of and intercorrelations among cardiovascular, immune, endocrine, and psychological reactivity. Annals of Behavioral Medicine, 22(3), 171–179.

    Article  PubMed  Google Scholar 

  • Cohen, S., & Janicki-Deverts, D. (2012). Who’s stressed? Distributions of psychological stress in the United States in probability samples from 1983, 2006, and 20091. Journal of Applied Social Psychology, 42(6), 1320–1334.

    Article  Google Scholar 

  • Cohen, S., Kamarck, T., & Mermelstein, R. (1983). A global measure of perceived stress. Journal of Health and Social Behavior, 24(4), 385–396.

    Article  PubMed  Google Scholar 

  • Cohen, S., & Williamson, G. M. (1988). Perceived stress in a probability sample of the United States. In S. Spacapan & S. Oskamp (Eds.), The Social Psychology of Health (pp. 31–67). Newbury Park: Sage Publications.) .).

    Google Scholar 

  • Davies, M. A., Bromet, E. J., Schulz, S. C., & Dunn, L. O. (1989). Community adjustment of chronic schizophrenic patients in urban and rural settings. Hospital & Community Psychiatry.

  • Dixon, W. J., & Tukey, J. W. (1968). Approximate behavior of the distribution of Winsorized t (Trimming/Winsorization 2). Technometrics, 10(1), 83–98.

    Google Scholar 

  • Eack, S. M., Greenwald, D. P., Hogarty, S. S., Bahorik, A. L., Litschge, M. Y., Mazefsky, C. A., et al. (2013). Cognitive Enhancement Therapy for adults with autism spectrum disorder: Results of an 18-month feasibility study. Journal of Autism & Developmental Disorders, 43(12), 2866–2877.

    Article  Google Scholar 

  • Faul, F., Erdfelder, E., Lang, A.-G., & Buchner, A. (2007). G*Power 3: A flexible statistical power analysis program for the social, behavioral, and biomedical sciences. Behavior Research Methods, 39(2), 175–191.

    Article  PubMed  Google Scholar 

  • First, M., Spitzer, R., Gibbon, M., & Williams, J. (2002). Structured clinical interview for the DSM-IV-TR axis I disorders, research version, patient edition. New York: Biometrics Research, New York State Psychiatric Institute.

    Google Scholar 

  • Fox, J., & Weisberg, S. (2011). An {R} companion to applied regression (2nd ed.). Thousand Oaks, CA: Sage. Retrieved from http://socserv.socsci.mcmaster.ca/jfox/Books/Companion.

  • Gantman, A., Kapp, S. K., Orenski, K., & Laugeson, E. A. (2012). Social skills training for young adults with high-functioning autism spectrum disorders: A randomized controlled pilot study. Journal of Autism and Developmental Disorders, 42(6), 1094–1103.

    Article  PubMed  Google Scholar 

  • Gerhardt, P., & Lainer, I. (2011). Addressing the needs of adolescents and adults with autism: A crisis on the horizon. Journal of Contemporary Psychotherapy, 41(1), 37–45.

    Article  Google Scholar 

  • Ghaziuddin, M., Ghaziuddin, N., & Greden, J. (2002). Depression in persons with autism: Implications for research and clinical care. Journal of Autism and Developmental Disorders, 32(4), 299–306.

  • Gillott, A., & Standen, P. J. (2007). Levels of anxiety and sources of stress in adults with autism. Journal of Intellectual Disabilities, 11(4), 359–370.

    Article  PubMed  Google Scholar 

  • Glazer, W. M., Aaronson, H. S., Prusoff, B. A., & Williams, D. H. (1980). Assessment of social adjustment in chronic ambulatory schizophrenics. The Journal of Nervous and Mental Disease, 168(8), 493–497.

    Article  PubMed  Google Scholar 

  • Goodwin, M. S., Groden, J., Velicer, W. F., & Diller, A. (2007). Brief report: Validating the Stress Survey Schedule for persons with autism and other developmental disabilities. Focus on Autism and Other Developmental Disabilities, 22(3), 183–189.

    Article  Google Scholar 

  • Goodwin, M. S., Groden, J., Velicer, W. F., Lipsitt, L. P., Baron, M. G., Hofmann, S. G., et al. (2006). Cardiovascular arousal in individuals with autism. Focus on Autism and Other Developmental Disabilities, 21(2), 100–123.

    Article  Google Scholar 

  • Gotham, K., Bishop, S. L., Brunwasser, S., & Lord, C. (2014). Rumination and perceived impairment associated with depressive symptoms in a verbal adolescent–adult ASD sample. Autism Research, 7(3), 381–391.

    Article  PubMed  PubMed Central  Google Scholar 

  • Groden, J., Diller, A., Bausman, M., Velicer, W., Norman, G., & Cautela, J. (2001). The development of a stress survey schedule for persons with autism and other developmental disabilities. Journal of Autism and Developmental Disorders, 31(2), 207–217.

    Article  PubMed  Google Scholar 

  • Groden, J., Goodwin, M. S., Baron, M. G., Groden, G., Velicer, W. F., Lipsitt, L. P., et al. (2005). Assessing cardiovascular responses to stressors in individuals with autism spectrum disorders. Focus on Autism and Other Developmental Disabilities, 20(4), 244–252.

    Article  Google Scholar 

  • Harrell, F. E. (2008). Hmisc: Harrell miscellaneous. R package version 3.16–10. http://CRAN.R-project.org/package=Hmisc.

  • Hirvikoski, T., & Blomqvist, M. (2015). High self-perceived stress and poor coping in intellectually able adults with autism spectrum disorder. Autism: The International Journal of Research and Practice, 19(6), 752–757.

    Article  Google Scholar 

  • Honaker, J., King, G., & Blackwell, M. (2011). Amelia II: A program for missing data. Journal of Statistical Software, 45(7), 1–47.

    Article  Google Scholar 

  • Hong, J., Bishop-Fitzpatrick, L., Smith, L. E., Greenberg, J. S., & Mailick, M. R. (2016). Factors associated with subjective quality of life of adults with autism spectrum disorder: Self-report versus maternal reports. Journal of Autism and Developmental Disorders, 46(4), 1368–1378.

    Article  PubMed  PubMed Central  Google Scholar 

  • Howlin, P., Goode, S., Hutton, J., & Rutter, M. (2004). Adult outcome for children with autism. Journal of Child Psychology and Psychiatry, 45(2), 212–229.

    Article  PubMed  Google Scholar 

  • Kirby, E. D., Williams, V. P., Hocking, M. C., Lane, J. D., & Williams, R. B. (2006). Psychosocial benefits of three formats of a standardized behavioral stress management program. Psychosomatic Medicine, 68(6), 816–823.

    Article  PubMed  Google Scholar 

  • Kirschbaum, C., & Hellhammer, D. H. (1994). Salivary cortisol in psychoneuroendocrine research: Recent developments and applications. Psychoneuroendocrinology, 19(4), 313–333.

    Article  PubMed  Google Scholar 

  • Klusek, J., Martin, G. E., & Losh, M. (2013). Physiological arousal in autism and fragile X syndrome: Group comparisons and links with pragmatic language. American Journal on Intellectual and Developmental Disabilities, 118(6), 475–495.

    Article  PubMed  PubMed Central  Google Scholar 

  • Koegel, L. K., Ashbaugh, K., Koegel, R. L., Detar, W. J., & Regester, A. (2013). Increasing socialization in adults with Asperger’s syndrome. Psychology in the Schools, 50(9), 899–909.

    Article  Google Scholar 

  • Koegel, L. K., Navab, A., Ashbaugh, K., & Koegel, R. L. (2015). Using reframing to reduce negative statements in social conversation for adults with autism spectrum disorder. Journal of Positive Behavior Interventions (in press)

  • Koegel, R. L., Russo, D. C., & Rincover, A. (1977). Assessing and training teachers in the generalized use of behavior modification with autistic children. Journal of Applied Behavior Analysis, 10(2), 197–205.

    Article  PubMed  PubMed Central  Google Scholar 

  • Krantz, D. S., & Manuck, S. B. (1984). Acute psychophysiologic reactivity and risk of cardiovascular disease: A review and methodologic critique. Psychological Bulletin, 96(3), 435–464.

    Article  PubMed  Google Scholar 

  • Laugeson, E. A., Frankel, F., Gantman, A., Dillon, A. R., & Mogil, C. (2012). Evidence-based social skills training for adolescents with autism spectrum disorders: The UCLA PEERS program. Journal of Autism and Developmental Disorders, 42(6), 1025–1036.

    Article  PubMed  Google Scholar 

  • Lenth, R. V. (2013). lsmeans: Least-squares means. R package version 1.06–05.

  • Lord, C., Risi, S., Lambrecht, L., Cook, E. H., Leventhal, B. L., DiLavore, P. C., et al. (2000). The autism diagnostic observation schedule-generic: A standard measure of social and communication deficits associated with the spectrum of autism. Journal of Autism and Developmental Disorders, 30(3), 205–223.

    Article  PubMed  Google Scholar 

  • Lord, C., Rutter, M., & Lecouteur, A. (1994). Autism diagnostic interview-revised: A revised version of a diagnostic interview for caregivers of individuals with possible pervasive developmental disorders. Journal of Autism and Developmental Disorders, 24(5), 659–685.

    Article  PubMed  Google Scholar 

  • Lovaas, O. I., Schreibman, L., & Koegel, R. L. (1974). A behavior modification approach to the treatment of autistic children. Journal of Autism and Childhood Schizophrenia, 4(2), 111–129.

    Article  PubMed  Google Scholar 

  • Lydon, S., Healy, O., Reed, P., Mulhern, T., Hughes, B. M., & Goodwin, M. S. (2014). A systematic review of physiological reactivity to stimuli in autism. Developmental Neurorehabilitation, 1–21.

  • Maenner, M. J., Smith, L. E., Hong, J., Makuch, R., Greenberg, J. S., & Mailick, M. R. (2013). Evaluation of an activities of daily living scale for adolescents and adults with developmental disabilities. Disability and Health Journal, 6(1), 8–17.

    Article  PubMed  Google Scholar 

  • Manuck, S. B. (1994). Cardiovascular reactivity in cardiovascular disease: “Once more unto the breach”. International Journal of Behavioral Medicine, 1(1), 4–31.

    Article  PubMed  Google Scholar 

  • Maras, K. L., & Bowler, D. M. (2012). Context reinstatement effects on eyewitness memory in autism spectrum disorder. British Journal of Psychology, 103(3), 330–342.

    Article  PubMed  Google Scholar 

  • Maras, K. L., Gaigg, S. B., & Bowler, D. M. (2012). Memory for emotionally arousing events over time in autism spectrum disorder. Emotion (Washington, DC), 12(5), 1118.

    Article  Google Scholar 

  • Mathersul, D., McDonald, S., & Rushby, J. A. (2013). Psychophysiological correlates of social judgement in high-functioning adults with autism spectrum disorder. International Journal of Psychophysiology, 87(1), 88–94.

    Article  PubMed  Google Scholar 

  • Mazefsky, C., Herrington, J., Siegel, M., Scarpa, A., Maddox, B. B., Scahill, L., et al. (2013). The role of emotion regulation in autism spectrum disorder. Journal of the American Academy of Child & Adolescent Psychiatry, 52(7), 679–688.

    Article  Google Scholar 

  • Nir, I., Meir, D., Zilber, N., Knobler, H., Hadjez, J., & Lerner, Y. (1995). Brief report: Circadian melatonin, thyroid-stimulating hormone, prolactin, and cortisol levels in serum of young adults with autism. Journal of Autism and Developmental Disorders, 25(6), 641–654.

    Article  PubMed  Google Scholar 

  • Pickering, T. G., Hall, J. E., Appel, L. J., Falkner, B. E., Graves, J., Hill, M. N., et al. (2005). Recommendations for blood pressure measurement in humans and experimental animals part 1: blood pressure measurement in humans: a statement for professionals from the Subcommittee of Professional and Public Education of the American Heart Association Council on High Blood Pressure Research. Hypertension, 45(1), 142–161.

    Article  PubMed  Google Scholar 

  • Pinheiro, J., Bates, D., DebRoy, S., Sarkar, D., & R Core TEAM (2015). nlme: Linear and nonlinear mixed effects models. R package version 3.1–120. Retrieved from http://CRAN.R-project.org/package=nlme.

  • R Core Team (Ed.). (2015). R: A language and environment for statistical computing. Vienna: R Foundation for Statistical Computing.

    Google Scholar 

  • Revelle, W. (2014). psych: Procedures for personality and psychological research. In Northwestern University, Evanston. R package version 1.5.4. Evanston, IL: Northwestern University.

    Google Scholar 

  • Richdale, A., & Prior, M. (1992). Urinary cortisol circadian rhythm in a group of high-functioning children with autism. Journal of Autism and Developmental Disorders, 22(3), 433–447.

    Article  PubMed  Google Scholar 

  • Richman, L. S., Bennett, G. G., Pek, J., Siegler, I., & Williams, R. B. (2007). Discrimination, dispositions, and cardiovascular responses to stress. Health Psychology, 26(6), 675.

    Article  PubMed  Google Scholar 

  • Robins, R. W., Fraley, R. C., & Krueger, R. F. (2009). Handbook of Research Methods in Personality Psychology. New York: Guilford Press.

    Google Scholar 

  • Schafer, J. L., & Graham, J. W. (2002). Missing data: our view of the state of the art. Psychological methods, 7(2), 147–177.

    Article  PubMed  Google Scholar 

  • Schooler, N., Weissman, M., & Hogarty, G. E. (1979). Social adjustment scale for schizophrenics. In W. A. Hargreaves, C. C. Attkisson, & J. Sorenson (Eds.), Resource material for community mental health program evaluators (pp. 290–303). DHHS Pub. No. (ADM).

  • Seltzer, M. M., Shattuck, P. T., Abbeduto, L., & Greenberg, J. S. (2004). Trajectory of development in adolescents and adults with autism. Mental Retardation and Developmental Disabilities Research Reviews, 10(4), 234–247.

    Article  PubMed  Google Scholar 

  • Shattuck, P. T., Roux, A. M., Hudson, L. E., Taylor, J. L., Maenner, M. J., & Trani, J. F. (2012). Services for adults with an autism spectrum disorder. Canadian Journal of Psychiatry, 57(5), 284–291.

    PubMed  PubMed Central  Google Scholar 

  • Singh, N. N., Lancioni, G. E., Manikam, R., Winton, A. S., Singh, A. N., Singh, J., & Singh, A. D. (2011). A mindfulness-based strategy for self-management of aggressive behavior in adolescents with autism. Research in Autism Spectrum Disorders, 5(3), 1153–1158.

    Article  Google Scholar 

  • Smith, L. E., Greenberg, J. S., & Mailick, M. R. (2012a). Adults with autism: Outcomes, family effects, and the multi-family group psychoeducation model. Current Psychiatry Reports, 14(6), 732–738.

  • Smith, L. E., Maenner, M. J., & Seltzer, M. M. (2012b). Developmental trajectories in adolescents and adults with autism: The case of daily living skills. Journal of the American Academy of Child & Adolescent Psychiatry, 51(6), 622–631.

  • Smith, M. J., Ginger, E. J., Wright, K., Wright, M. A., Taylor, J. L., Humm, L. B., et al. (2014). Virtual reality job interview training in adults with autism spectrum disorder. Journal of Autism and Developmental Disorders, 44(10), 2450–2463.

    Article  PubMed  PubMed Central  Google Scholar 

  • Spek, A. A., Van Ham, N. C., & Nyklíček, I. (2013). Mindfulness-based therapy in adults with an autism spectrum disorder: A randomized controlled trial. Research in Developmental Disabilities, 34(1), 246–253.

    Article  PubMed  Google Scholar 

  • Strain, P. S., & Odom, S. L. (1986). Peer social initiations: Effective intervention for social skills development of exceptional children. Exceptional Children, 52(6), 543–551.

    PubMed  Google Scholar 

  • Sze, K. M., & Wood, J. J. (2007). Cognitive behavioral treatment of comorbid anxiety disorders and social difficulties in children with high-functioning autism: A case report. Journal of Contemporary Psychotherapy, 37(3), 133–143.

    Article  Google Scholar 

  • Taylor, J. L., & Corbett, B. A. (2014). A review of rhythm and responsiveness of cortisol in individuals with autism spectrum disorders. Psychoneuroendocrinology, 49(0), 207–228.

    Article  PubMed  PubMed Central  Google Scholar 

  • Volkmar, F., Cook, E. H., Pomeroy, J., Realmuto, G., & Tanguay, P. (1999). Practice parameters for the assessment and treatment of children, adolescents, and adults with autism and other pervasive developmental disorders. Journal of the American Academy of Child & Adolescent Psychiatry, 38 (12), 32 S–54 S.

    Article  Google Scholar 

  • Wechsler, D. (1945). A standardized memory scale for clinical use. The Journal of Psychology: Interdisciplinary and Applied, 19(1), 87–95.

    Article  Google Scholar 

  • Wechsler, D. (2008). Wechsler Adult Intelligence Scale® (4th ed.) (WAIS®-IV). San Antonio, TX: Harcourt Assessment.

    Google Scholar 

  • Williams, V. P., Bishop-Fitzpatrick, L., Lane, J. D., Gwyther, L. P., Ballard, E. L., Vendittelli, A. P., et al. (2010). Video-based coping skills to reduce health risk and improve psychological and physical well-being in Alzheimer’s disease family caregivers. Psychosomatic medicine, 72(9), 897–904.

    Article  PubMed  PubMed Central  Google Scholar 

  • Wood, J. J., Drahota, A., Sze, K., Har, K., Chiu, A., & Langer, D. A. (2009). Cognitive behavioral therapy for anxiety in children with autism spectrum disorders: A randomized, controlled trial. Journal of Child Psychology and Psychiatry, 50(3), 224–234.

    Article  PubMed  PubMed Central  Google Scholar 

  • Wood, J. J., Drahota, A., Sze, K., Van Dyke, M., Decker, K., Fujii, C., Bahng, C., Renno, P., Hwang, W., & Spiker, M. (2009). Brief report: Effects of cognitive behavioral therapy on parent-reported autism symptoms in school-age children with high-functioning autism. Journal of Autism and Developmental Sisorders, 39(11), 1608–1612.

    Article  Google Scholar 

Download references

Acknowledgments

This study was supported by grants from the NIH (MH-85851, MH-95783, RR-24154, HD-55748, P30HD003352, T32HD007489); Autism Speaks (5703 and 8568); Department of Defense (AR100344); and Pennsylvania Department of Health. We are extremely grateful to the individuals with autism spectrum disorder who participated in this study; without their generous support and commitment, our research would not be possible.

Author Contributions

Dr. Bishop-Fitzpatrick formulated the aims, conceptualized the analytic method, conducted statistical analyses, wrote the initial draft of the manuscript, and revised the manuscript to address reviewer comments. Drs. Minshew and Mazefsky provided guidance on the design of the study and participated in the manuscript development and revisions. Dr. Eack provided guidance on the design of the study and the analytic methods and participated in the manuscript development and revisions.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Lauren Bishop-Fitzpatrick.

Ethics declarations

Conflict of interest

Dr. Bishop-Fitzpatrick, Dr. Minshew, Dr. Mazefsky, and Dr. Eack declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Bishop-Fitzpatrick, L., Minshew, N.J., Mazefsky, C.A. et al. Perception of Life as Stressful, Not Biological Response to Stress, is Associated with Greater Social Disability in Adults with Autism Spectrum Disorder. J Autism Dev Disord 47, 1–16 (2017). https://doi.org/10.1007/s10803-016-2910-6

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10803-016-2910-6

Keywords

  • Cortisol
  • Cardiovascular reactivity
  • ASD
  • Asperger’s
  • High-functioning autism
  • Stress
  • Intervention