Abstract
Autistic youth are more likely to experience depression than their non-autistic peers, yet research on risk and protective factors to depression in this population is limited. Behavioral activation (i.e., prioritizing and engaging in meaningful activities), including social activities, is an important mechanism in the pathway to depression in non-autistic youth that is understudied in autism. Ratings of youth depressive symptoms and behavioral and social activation at one timepoint from 100 autistic youth without intellectual disability and 100 of their caregivers were analyzed. The study aims were to examine caregiver and youth ratings of youth internalizing symptoms and behavioral and social activation, inter-rater reliability on study variables, and associations between depressive symptoms and behavioral and social activation in autistic youth by rater. Results revealed significant differences in youth and caregiver ratings on all variables and inter-rater reliability ranged from poor to moderate. Across both raters, more severe anxiety symptoms and lower behavioral activation were associated with more severe depressive symptoms; social activation, specifically the number of friends youth have, was significant in caregiver ratings only. Findings can be leveraged to enhance risk stratification and intervention efforts for autistic youth experiencing depression.
This is a preview of subscription content, access via your institution.
References
Bal, V. H., Wilkinson, E., Glascock, V., Hastings, R. P., & Jahoda, A. (2022). Mechanisms of change in behavioral activation: Adapting depression treatment for autistic people. Cognitive and Behavioral Practice. https://doi.org/10.1016/j.cbpra.2022.03.006
Bitsika, V., & Sharpley, C. F. (2015). Differences in the prevalence, severity and symptom profiles of depression in boys and adolescents with an autism spectrum disorder versus normally developing controls. International Journal of Disability, Development and Education. https://doi.org/10.1080/1034912X.2014.998179
Bodden, D. H. M., Stikkelbroek, Y., & Dirksen, C. D. (2018). Societal burden of adolescent depression, an overview and cost-of-illness study. Journal of Affective Disorders. https://doi.org/10.1016/j.jad.2018.06.015
Botha, M., & Gillespie-Lynch, K. (2022). Come as you are: Examining autistic identity development and the neurodiversity movement through an intersectional lens. Human Development. https://doi.org/10.1159/000524123
Burnett-Zeigler, I., & Lyons, J. S. (2010). Caregiver factors predicting service utilization among youth participating in a school-based mental health intervention. Journal of Child and Family Studies. https://doi.org/10.1007/s10826-009-9331-5
Burrows, C. A., Usher, L. V., Becker-Haimes, E. M., McMahon, C. M., Mundy, P. C., Jensen-Doss, A., & Henderson, H. A. (2018). Profiles and correlates of parent–child agreement on social anxiety symptoms in youth with autism spectrum disorder. Journal of Autism and Developmental Disorders, 48(3), 2023–2037.
Chan, S., Markoulakis, R., & Levitt, A. (2023). Predictors of barriers to accessing youth mental health and/or addiction care. Journal of the Canadian Academy of Child & Adolescent Psychiatry, 32(1), 27–37.
Chorpita, B. F., Moffitt, C. E., & Gray, J. (2005). Psychometric properties of the revised child anxiety and depression scale in a clinical sample. Behaviour Research and Therapy. https://doi.org/10.1016/j.brat.2004.02.004
Cuijpers, P., van Straten, A., & Warmerdam, L. (2007). Behavioral activation treatments of depression: A meta-analysis. In Clinical Psychology Review. https://doi.org/10.1016/j.cpr.2006.11.001
Dobson, K. S. (1985). The relationship between anxiety and depression. Clinical Psychology Review. https://doi.org/10.1016/0272-7358(85)90010-8
Dumont, M., & Provost, M. A. (1999). Resilience in adolescents: Protective role of social support, coping strategies, self-esteem, and social activities on experience of stress and depression. Journal of Youth and Adolescence. https://doi.org/10.1023/A:1021637011732
Frankel, F., & Mintz, J. (2011). Maternal reports of play dates of clinic referred and community children. Journal of Child and Family Studies. https://doi.org/10.1007/s10826-010-9437-9
George, D., & Mallery, P. (2019). IBM SPSS statistics 26 step by step: A simple guide and reference. Routledge.
Hess, J. A., Matson, J. L., & Dixon, D. R. (2010). Psychiatric symptom endorsements in children and adolescents diagnosed with autism spectrum disorders: A comparison to typically developing children and adolescents. Journal of Developmental and Physical Disabilities. https://doi.org/10.1007/s10882-009-9185-1
Hirschfeld, R. M. A., Montgomery, S. A., Keller, M. B., Kasper, S., Schatzberg, A. F., Möller, H. J., Healy, D., Baldwin, D., Humble, M., Versiani, M., Montenegro, R., & Bourgeois, M. (2000). Social functioning in depression: A review. Journal of Clinical Psychiatry. https://doi.org/10.4088/JCP.v61n0405
Hopko, D. R., Lejuez, C. W., & Hopko, S. D. (2004). Behavioral activation as an intervention for coexistent depressive and anxiety symptoms. Clinical Case Studies. https://doi.org/10.1177/1534650103258969
Hunsley, J., & Mash, E. J. (2007). Evidence-based assessment. Annual Review of Clinical Psychology, 3(1), 29–51.
Hymas, R., Badcock, J. C., & Milne, E. (2022). Loneliness in autism and its association with anxiety and depression: A systematic review with meta-analyses. Review Journal of Autism and Developmental Disorders. https://doi.org/10.1007/s40489-022-00330-w
Jacobson, N. S., Martell, C. R., & Dimidjian, S. (2001). behavioral activation treatment for depression: returning to contextual roots. Clinical Psychology: Science and Practice. https://doi.org/10.1093/clipsy.8.3.255
Joshi, G., Petty, C., Wozniak, J., Henin, A., Fried, R., Galdo, M., Kotarski, M., Walls, S., & Biederman, J. (2010). The heavy burden of psychiatric comorbidity in youth with autism spectrum disorders: A large comparative study of a psychiatrically referred population. Journal of Autism and Developmental Disorders. https://doi.org/10.1007/s10803-010-0996-9
Kaat, A. J., & Lecavalier, L. (2015). reliability and validity of parent- and child-rated anxiety measures in autism spectrum disorder. Journal of Autism and Developmental Disorders. https://doi.org/10.1007/s10803-015-2481-y
Kalvin, C. B., Marsh, C. L., Ibrahim, K., Gladstone, T. R., Woodward, D., Grantz, H., & Sukhodolsky, D. G. (2020). Discrepancies between parent and child ratings of anxiety in children with autism spectrum disorder. Autism Research, 13(1), 93–103.
Kanter, J. W., Manos, R. C., Bowe, W. M., Baruch, D. E., Busch, A. M., & Rusch, L. C. (2010). What is behavioral activation? A review of the empirical literature. Clinical Psychology Review. https://doi.org/10.1016/j.cpr.2010.04.001
Kapp, S. K. (2018). Social support, well-being, and quality of life among individuals on the autism spectrum. Pediatrics. https://doi.org/10.1542/peds.2016-4300N
Kessler, R. C. (2012). The cost of depression NIH public access. Psychiatric Clinics of North America. https://doi.org/10.1016/j.psc.2011.11.005
Kinderman, P., Tai, S., Pontin, E., Schwannauer, M., Jarman, I., & Lisboa, P. (2015). Causal and mediating factors for anxiety, depression and well-being. British Journal of Psychiatry. https://doi.org/10.1192/bjp.bp.114.147553
Koo, T. K., & Li, M. Y. (2016). A guideline of selecting and reporting intraclass correlation coefficients for reliability research. Journal of Chiropractic Medicine. https://doi.org/10.1016/j.jcm.2016.02.012
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. https://doi.org/10.1007/s10803-011-1339-1
Lewinsohn, P. M. (1974). A behavioral approach to depression. The psychology of depression.
Libster, N., Knox, A., Engin, S., Geschwind, D., Parish-Morris, J., & Kasari, C. (2023). Sex differences in friendships and loneliness in autistic and non-autistic children across development. Molecular Autism, 14(1), 9–16.
Lord, C., Ruter, M., DiLavore, P., Risi, S., Gotham, K., & Bishop, S. (2012). Autism diagnostic observation schedule–2nd edition (ADOS-2) (p. 284). Western Psychological Corporation.
Manos, R. C., Kanter, J. W., & Busch, A. M. (2010). A critical review of assessment strategies to measure the behavioral activation model of depression. Clinical Psychology Review. https://doi.org/10.1016/j.cpr.2010.03.008
Manos, R. C., Kanter, J. W., & Luo, W. (2011). The behavioral activation for depression scale-short form: Development and validation. Behavior Therapy. https://doi.org/10.1016/j.beth.2011.04.004
Mantzalas, J., Richdale, A. L., & Dissanayake, C. (2022). A conceptual model of risk and protective factors for autistic burnout. Autism Research, 15(6), 976–987.
Martin, F., & Oliver, T. (2019). Behavioral activation for children and adolescents: a systematic review of progress and promise. European Child and Adolescent Psychiatry. https://doi.org/10.1007/s00787-018-1126-z
Mournet, A. M., Wilkinson, E., Bal, V. H., & Kleiman, E. M. (2022). A systematic review of predictors of suicidal thoughts and behaviors among autistic adults: Making the case for the role of social connection as a protective factor. Clinical Psychology Review. https://doi.org/10.1016/j.cpr.2022.102235
Orchard, F., Pass, L., Cocks, L., Chessell, C., & Reynolds, S. (2019). Examining parent and child agreement in the diagnosis of adolescent depression. Child and Adolescent Mental Health. https://doi.org/10.1111/camh.12348
Petrina, N., Carter, M., & Stephenson, J. (2014). The nature of friendship in children with autism spectrum disorders: A systematic review. Research in Autism Spectrum Disorders. https://doi.org/10.1016/j.rasd.2013.10.016
Pezzimenti, F., Han, G. T., Vasa, R. A., & Gotham, K. (2019). depression in youth with autism spectrum disorder. Child and Adolescent Psychiatric Clinics of North America. https://doi.org/10.1016/j.chc.2019.02.009
Raymaker, D. M., Teo, A. R., Steckler, N. A., Lentz, B., Scharer, M., Delos Santos, A., Kapp, S. K., Hunter, M., Joyce, A., & Nicolaidis, C. (2020). “Having all of your internal resources exhausted beyond measure and being left with no clean-up crew”: defining autistic burnout. Autism in Adulthood. https://doi.org/10.1089/aut.2019.0079
Schwartzman, J. M., & Corbett, B. A. (2020). Higher depressive symptoms in early adolescents with Autism Spectrum Disorder by self- and parent-report compared to typically-developing peers. Research in Autism Spectrum Disorders. https://doi.org/10.1016/j.rasd.2020.101613
Schwartzman, J. M., Williams, Z. J., Paterson, A. V., Jacobs, A. X., & Corbett, B. A. (2023). Community-guided measurement-based care for autistic youth and adults receiving psychotherapy: A conceptual overview and pilot implementation study of MBC-AUT. Autism. https://doi.org/10.1177/13623613221143587
Smith, I. C., & White, S. W. (2020). Socio-emotional determinants of depressive symptoms in adolescents and adults with autism spectrum disorder: A systematic review. In Autism. https://doi.org/10.1177/1362361320908101
Stavrakaki, C., & Vargo, B. (1986). The relationship of anxiety and depression: A review of the literature. British Journal of Psychiatry. https://doi.org/10.1192/bjp.149.1.7
Steger, M. F., & Kashdan, T. B. (2009). Depression and everyday social activity, belonging, and well-being. Journal of Counseling Psychology. https://doi.org/10.1037/a0015416
Sterling, L., Renno, P., Storch, E. A., Ehrenreich-May, J., Lewin, A. B., Arnold, E., Lin, E., & Wood, J. (2015). Validity of the revised children’s anxiety and depression scale for youth with autism spectrum disorders. Autism. https://doi.org/10.1177/1362361313510066
Vasa, R. A., & Mazurek, M. O. (2015). An update on anxiety in youth with autism spectrum disorders. Current Opinion in Psychiatry, 28(2), 83–101.
Funding
The study received core support from the National Center for Advancing Translational Sciences (CTSA UL1TR000445) to utilize the REDCap system. Jessica M. Schwartzman is supported by the National Institute for Mental Health grant K23-MH131852.
Author information
Authors and Affiliations
Contributions
JMS contributed to the study conception and design. Material preparation and data collection were performed by HRB, and data analysis performed by JMS. The first draft of the manuscript was written by JMS and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.
Corresponding author
Ethics declarations
Conflict of interest
The authors have no financial and/or non-financial conflict of interest to declare.
Ethical Approval
All procedures performed in this study were approved by the Vanderbilt University Institutional Review Board and with the 1964 Helsinki declaration and its later amendments.
Additional information
Publisher's Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Supplementary Information
Below is the link to the electronic supplementary material.
Rights and permissions
Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.
About this article
Cite this article
Schwartzman, J.M., Bonner, H.R. Behavioral and Social Activation in Autism and Associations with Youth Depressive Symptoms from Youth and Caregiver Perspectives. J Autism Dev Disord (2023). https://doi.org/10.1007/s10803-023-06039-x
Accepted:
Published:
DOI: https://doi.org/10.1007/s10803-023-06039-x