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Pathways to Psychopathology Among Autistic Adults

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A Correction to this article was published on 04 September 2023

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Abstract

Purpose of Review

Autistic adults frequently require treatment of mental health problems. Increased rates of suicidality and diminished quality of life among autistic people may be partially attributable to psychiatric symptoms. Some risk factors for mental health problems in autistic people are likely the same as risk factors present in neurotypical individuals, but unique factors that are specific to neurodivergent individuals, and some even more specific to autistic people, may exist. Understanding pathways from autism to mental health problems could inform intervention efforts at the individual and societal levels.

Recent Findings

We review a growing body of research identifying risk processes across the affective, cognitive, and social domains. Consistent with the principle of equifinality, different processes appear to independently and jointly lead to heightened risk for the onset of mental health problems.

Summary

Autistic adults frequently utilize mental healthcare services, and experience heightened risk for chronic impairment as a result of mental health problems. Understanding causal and developmental risk processes in autism should inform personalized treatment. We synthesize extant research on these processes and offer suggestions for addressing them therapeutically and societally.

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References

  1. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders: DSM-5-TR. 2022.

  2. Lewis LF. Exploring the Experience of Self-Diagnosis of Autism Spectrum Disorder in Adults. Arch Psychiatr Nurs. 2016;30(5):575–80. https://doi.org/10.1016/j.apnu.2016.03.009.

    Article  PubMed  Google Scholar 

  3. Gotham K, Brunwasser SM, Lord C. Depressive and anxiety symptom trajectories from school age through young adulthood in samples with autism spectrum disorder and developmental delay. J Am Acad Child Adolesc Psychiatry. 2015;54(5):369-376.e3. https://doi.org/10.1016/j.jaac.2015.02.005.

    Article  PubMed  PubMed Central  Google Scholar 

  4. Hollocks MJ, Lerh JW, Magiati I, Meiser-Stedman R, Brugha TS. Anxiety and depression in adults with autism spectrum disorder: A systematic review and meta-analysis. Psychol Med. 2019;49(4). https://doi.org/10.1017/S0033291718002283.

  5. Benevides TW, et al. Listening to the autistic voice: Mental health priorities to guide research and practice in autism from a stakeholder-driven project. Autism. 2020;24(4):822–33. https://doi.org/10.1177/1362361320908410.

    Article  PubMed  PubMed Central  Google Scholar 

  6. Cadman T et al. NEW RESEARCH Caregiver Burden as People With Autism Spectrum Disorder and Attention-Deficit/Hyperactivity Disorder Transition into Adolescence and Adulthood in the United Kingdom. [Online]. Available: www.jaacap.org

  7. Joshi G, et al. Psychiatric comorbidity and functioning in a clinically referred population of adults with autism spectrum disorders: A comparative study. J Autism Dev Disord. 2013;43(6):1314–25. https://doi.org/10.1007/s10803-012-1679-5.

    Article  PubMed  Google Scholar 

  8. Smith IC, White SW. Socio-emotional determinants of depressive symptoms in adolescents and adults with autism spectrum disorder: A systematic review. Autism. 2020;24(4):995–1010. https://doi.org/10.1177/1362361320908101.

    Article  PubMed  Google Scholar 

  9. Lugo-Marín J et al. Prevalence of psychiatric disorders in adults with autism spectrum disorder: A systematic review and meta-analysis. Res Autis Spect Dis. 2019;59. Elsevier Ltd, pp. 22–33. https://doi.org/10.1016/j.rasd.2018.12.004.

  10. Russell AJ, Mataix-Cols D, Anson M, Murphy DG. Obsessions and Compulsions in Asperger Syndrome and High-Functioning Autism. Brit J Psychiat J Ment Sci. 2005;186:525–528.

  11. Hofvander B. et al. Psychiatric and psychosocial problems in adults with normal-intelligence autism spectrum disorders. BMC Psychiat. 2009;9. https://doi.org/10.1186/1471-244X-9-35.

  12. Tantam D. Lifelong Eccentricity and Social Isolation. I. Psychiatric, Social, and Forensic Aspects. Br J Psychiatry. 1988;153:777–82.

    Article  CAS  PubMed  Google Scholar 

  13. Vohra R, Madhavan S, Sambamoorthi U. Emergency Department Use Among Adults with Autism Spectrum Disorders (ASD). J Autism Dev Disord. 2016;46(4):1441–54. https://doi.org/10.1007/s10803-015-2692-2.

    Article  PubMed  PubMed Central  Google Scholar 

  14. Vohra R, Madhavan S, Sambamoorthi U. Comorbidity prevalence, healthcare utilization, and expenditures of Medicaid enrolled adults with autism spectrum disorders. Autism. 2017;21(8):995–1009. https://doi.org/10.1177/1362361316665222.

    Article  PubMed  Google Scholar 

  15. Kõlves K, Fitzgerald C, Nordentoft M, Wood SJ, Erlangsen A. Assessment of Suicidal Behaviors Among Individuals With Autism Spectrum Disorder in Denmark. JAMA Netw Open. 2021;4(1):e2033565. https://doi.org/10.1001/jamanetworkopen.2020.33565.

  16. Anderson-Chavarria M. The autism predicament: models of autism and their impact on autistic identity. Disabil Soc. 2022;37(8):1321–41. https://doi.org/10.1080/09687599.2021.1877117.

    Article  Google Scholar 

  17. Courchesne V, et al. Interests and Strengths in Autism, Useful but Misunderstood: A Pragmatic Case-Study. Front Psychol. 2020;11. https://doi.org/10.3389/fpsyg.2020.569339.

  18. White SW, Schall C, Santos JD, Maddox BB, Hillier A, Klinger L, Pugliese C. Promoting Quality of Life: Suggestions for Mental Health Care Providers Working with Young Autistic Adults. Aut Adult. 2023.

  19. “NIMH » A New Approach to Clinical Trials.” [Online]. Available: https://www.nimh.nih.gov/about/directors/thomas-insel/blog/2014/a-new...

  20. Yarkoni T, Poldrack RA, Nichols TE, Van Essen DC, Wager TD. Scale Automated Synthesis of Human Functional Neuroimaging Data. Nat Methods. 2011;8:665–670.

  21. White SW. Introduction to the Special Issue: Experimental Therapeutics in Clinical Child and Adolescent Psychology: Identifying Mechanisms and Moving the Needle. J Clin Child Adoles Psychol. 2022;51(3):261–263. https://doi.org/10.1080/15374416.2022.2051521.

  22. Nuske HJ, Vivanti G, Dissanayake C. Are emotion impairments unique to, universal, or specific in autism spectrum disorder? A comprehensive review. Cogn Emot. 2013;27(6):1042–61. https://doi.org/10.1080/02699931.2012.762900.

    Article  PubMed  Google Scholar 

  23. Sivathasan S, Fernandes TP, Burack JA, Quintin EM. Emotion processing and autism spectrum disorder: A review of the relative contributions of alexithymia and verbal IQ. Research in Autism Spectrum Disorders 2020;77. Elsevier Ltd. https://doi.org/10.1016/j.rasd.2020.101608.

  24. Berthoz S, Hill EL. The validity of using self-reports to assess emotion regulation abilities in adults with autism spectrum disorder. Eur Psychiatry. 2005;20(3):291–8. https://doi.org/10.1016/j.eurpsy.2004.06.013.

    Article  PubMed  Google Scholar 

  25. Kinnaird E, Stewart C, Tchanturia K. Investigating alexithymia in autism: A systematic review and meta-analysis. Euro Psychiat. 2019;55. Elsevier Masson SAS, pp. 80–89. https://doi.org/10.1016/j.eurpsy.2018.09.004.

  26. Albantakis L, et al. Alexithymic and autistic traits: Relevance for comorbid depression and social phobia in adults with and without autism spectrum disorder. Autism. 2020;24(8):2046–56. https://doi.org/10.1177/1362361320936024.

    Article  PubMed  PubMed Central  Google Scholar 

  27. Costa AP, Loor C, Steffgen G. Suicidality in Adults with Autism Spectrum Disorder: The Role of Depressive Symptomatology, Alexithymia, and Antidepressants. J Autism Dev Disord. 2020;50(10):3585–97. https://doi.org/10.1007/s10803-020-04433-3.

    Article  PubMed  Google Scholar 

  28. South M, Rodgers J. Sensory, emotional and cognitive contributions to anxiety in autism spectrum disorders. Front Human Neurosci. 2017;11. Frontiers Media S. A. https://doi.org/10.3389/fnhum.2017.00020.

  29. Maisel ME, Stephenson KG, South M, Rodgers J, Freeston MH, Gaigg SB. Modeling the cognitive mechanisms Linking autism symptoms and Anxiety in adults. J Abnorm Psychol. 2016;125(5):692–703. https://doi.org/10.1037/abn0000168.

    Article  PubMed  Google Scholar 

  30. Thompson RA. Emotion Regulation: A Theme in Search of Definition. Biol Behav Considerat. 1994.

  31. Khor AS, Melvin GA, Reid SC, Gray KM. Coping, daily hassles and behavior and emotional problems in adolescents with high-functioning autism/Asperger’s disorder. J Autism Dev Disord. 2014;44(3):593–608. https://doi.org/10.1007/s10803-013-1912-x.

    Article  PubMed  Google Scholar 

  32. Jahromi LB, Meek SE, Ober-Reynolds S. Emotion regulation in the context of frustration in children with high functioning autism and their typical peers. J Child Psychol Psychiatry. 2012;53(12):1250–8. https://doi.org/10.1111/j.1469-7610.2012.02560.x.

    Article  PubMed  Google Scholar 

  33. Mazefsky CA, Borue X, Day TN, Minshew NJ. Emotion Regulation Patterns in Adolescents With High-Functioning Autism Spectrum Disorder: Comparison to Typically Developing Adolescents and Association With Psychiatric Symptoms. Autism Res. 2014;7(3):344–54. https://doi.org/10.1002/aur.1366.

    Article  PubMed  PubMed Central  Google Scholar 

  34. Charlton AS, Smith IC, Mazefsky CA, White SW. The Role of Emotion Regulation on Co-occurring Psychopathology in Emerging Adults with ASD. J Autism Dev Disord. 2019. https://doi.org/10.1007/s10803-019-03983-5.

    Article  Google Scholar 

  35. Conner CM, White SW, Scahill L, Mazefsky CA. The role of emotion regulation and core autism symptoms in the experience of anxiety in autism. Autism. 2020;24(4):931–40. https://doi.org/10.1177/1362361320904217.

    Article  PubMed  PubMed Central  Google Scholar 

  36. Brewe AM, Mazefsky CA. White SW. Autism Spectrum Disorder. in Encyclopedia of Autism Spectrum Disorders, F. Volkmar, Ed., New York, NY: Springer, 2020.

  37. Girault JB, Piven J. The Neurodevelopment of Autism from Infancy Through Toddlerhood. Neuroimaging Clin N Am. 2020;30(1):97–114.

  38. Piven J, Elison JT, Zylka MJ. Toward a conceptual framework for early brain and behavior development in Autism. Mole Psychiat. 2017;22(10)1385–1394. Nature Publishing Group. https://doi.org/10.1038/mp.2017.131.

  39. Weinstein M, et al. Abnormal white matter integrity in young children with autism. Hum Brain Mapp. 2011;32(4):534–43. https://doi.org/10.1002/hbm.21042.

    Article  PubMed  Google Scholar 

  40. Fingher N, et al. Toddlers later diagnosed with autism exhibit multiple structural abnormalities in temporal corpus callosum fibers. Cortex. 2017;97:291–305. https://doi.org/10.1016/j.cortex.2016.12.024.

    Article  PubMed  PubMed Central  Google Scholar 

  41. Richey JA, et al. Neural Mechanisms of Emotion Regulation in Autism Spectrum Disorder. J Autism Dev Disord. 2015;45(11):3409–23. https://doi.org/10.1007/s10803-015-2359-z.

    Article  PubMed  PubMed Central  Google Scholar 

  42. Kana RK, Patriquin MA, Black BS, Channell MM, Wicker B. Altered Medial Frontal and Superior Temporal Response to Implicit Processing of Emotions in Autism. Autism Res. 2016;9(1):55–66. https://doi.org/10.1002/aur.1496.

    Article  PubMed  Google Scholar 

  43. Tottenham N, Hare TA, Casey BJ. Behavioral assessment of emotion discrimination, emotion regulation, and cognitive control in childhood, adolescence, and adulthood. Front Psychol. 2011;2;1–9. https://doi.org/10.3389/fpsyg.2011.00039.

  44. Kliemann D, Dziobek I, Hatri A, Baudewig J, Heekeren HR. The role of the amygdala in atypical gaze on emotional faces in autism spectrum disorders. J Neurosci. 2012;32(28):9469–76. https://doi.org/10.1523/JNEUROSCI.5294-11.2012.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  45. Kleinhans NM, et al. Association between amygdala response to emotional faces and social anxiety in autism spectrum disorders. Neuropsychologia. 2010;48(12):3665–70. https://doi.org/10.1016/j.neuropsychologia.2010.07.022.

    Article  PubMed  PubMed Central  Google Scholar 

  46. Shalev I, et al. Reexamining empathy in autism: Empathic disequilibrium as a novel predictor of autism diagnosis and autistic traits. Autism Res. 2022;15(10):1917–28. https://doi.org/10.1002/aur.2794.

    Article  PubMed  PubMed Central  Google Scholar 

  47. Samson AC, Hardan AY, Podell RW, Phillips JM, Gross JJ. Emotion regulation in children and adolescents with autism spectrum disorder. Autism Res. 2015;8(1):9–18. https://doi.org/10.1002/aur.1387.

    Article  PubMed  Google Scholar 

  48. Cai RY, Richdale AL, Uljarević M, Dissanayake C, Samson AC. Emotion regulation in autism spectrum disorder: Where we are and where we need to go. Aut Res. 2018;11(7):962–978. John Wiley and Sons Inc. https://doi.org/10.1002/aur.1968.

  49. Mandell D, Siegle GJ, Shutt L, Feldmiller J, Thase ME. Neural substrates of trait ruminations in depression. J Abnorm Psychol. 2014;123(1):35–48.

  50. Mazefsky CA, Collier A, Golt J, Siegle GJ. Neural features of sustained emotional information processing in autism spectrum disorder. Autism. 2020;24(4):941–53. https://doi.org/10.1177/1362361320903137.

    Article  PubMed  PubMed Central  Google Scholar 

  51. Ibrahim K, et al. Reduced Amygdala-Prefrontal Functional Connectivity in Children With Autism Spectrum Disorder and Co-occurring Disruptive Behavior. Biol Psychiatry Cogn Neurosci Neuroimaging. 2019;4(12):1031–41. https://doi.org/10.1016/j.bpsc.2019.01.009.

    Article  PubMed  PubMed Central  Google Scholar 

  52. Prater KE, Hosanagar A, Klumpp H, Angstadt M, Phan KL. Aberrant amygdala-frontal cortex connectivity during perception of fearful faces and at rest in generalized social anxiety disorder. Depress Anxiety. 2013;30(3):234–41. https://doi.org/10.1002/da.22014.

    Article  PubMed  Google Scholar 

  53. Golan O, Haruvi-Lamdan N, Laor N, Horesh D. The comorbidity between autism spectrum disorder and post-traumatic stress disorder is mediated by brooding rumination. Autism. 2022;26(2):538–44. https://doi.org/10.1177/13623613211035240.

    Article  PubMed  Google Scholar 

  54. Crane L, Goddard L, Pring L. Autobiographical memory in adults with autism spectrum disorder: The role of depressed mood, rumination, working memory and theory of mind. Autism. 2013;17(2):205–19. https://doi.org/10.1177/1362361311418690.

    Article  PubMed  Google Scholar 

  55. Siegle GJ, Granholm E, Ingram RE, Matt GE. Pupillary and Reaction Time Measures of Sustained Processing of Negative Information in Depression. 2001.

  56. Gotham KO, et al. Pupil response to social-emotional material is associated with rumination and depressive symptoms in adults with autism spectrum disorder. PLoS One. 2018;13(8). https://doi.org/10.1371/journal.pone.0200340.

  57. Cooper K, Russell A, Calley S, Chen H, Kramer J, Verplanken B. Cognitive processes in autism: Repetitive thinking in autistic versus non-autistic adults. Autism. 2022;26(4):849–58. https://doi.org/10.1177/13623613211034380.

    Article  PubMed  Google Scholar 

  58. Buckle KL, Leadbitter K, Poliakoff E, Gowen E. No Way Out Except From External Intervention’: First-Hand Accounts of Autistic Inertia. Front Psychol. 2021;12. https://doi.org/10.3389/fpsyg.2021.631596.

  59. Clements CC, Zoltowski AR, Yankowitz LD, Yerys BE, Schultz RT, Herrington JD. Evaluation of the social motivation hypothesis of autism a systematic review and meta-analysis, in JAMA Psychiatry. Am Med Assoc. 2018;797–808. https://doi.org/10.1001/jamapsychiatry.2018.1100.

  60. Keifer CM, Day TC, Hauschild KM, Lerner MD. Social and Nonsocial Reward Anticipation in Typical Development and Autism Spectrum Disorders: Current Status and Future Directions. 1920. https://doi.org/10.1007/s11920-021-01247-7/Published.

  61. Wise RA. Dopamine, Learning and Motivation. Nat Rev Neurosci. 2004;5(6):483–94.

    Article  CAS  PubMed  Google Scholar 

  62. Schwarz K, et al. Transdiagnostic Prediction of Affective, Cognitive, and Social Function Through Brain Reward Anticipation in Schizophrenia, Bipolar Disorder, Major Depression, and Autism Spectrum Diagnoses. Schizophr Bull. 2020;46(3):592–602. https://doi.org/10.1093/schbul/sbz075.

    Article  PubMed  Google Scholar 

  63. Vidal-Ribas P, et al. Bidirectional Associations Between Stress and Reward Processing in Children and Adolescents: A Longitudinal Neuroimaging Study. Biol Psychiatry Cogn Neurosci Neuroimaging. 2019;4(10):893–901. https://doi.org/10.1016/j.bpsc.2019.05.012.

    Article  PubMed  PubMed Central  Google Scholar 

  64. Barch DM. The relationships among cognition, motivation, and emotion in schizophrenia: How much and how little we know, in Schizophrenia Bulletin. 2005;875–881. https://doi.org/10.1093/schbul/sbi040.

  65. Redgrave P, Gurney K. The short-latency dopamine signal: A role in discovering novel actions? Nat Rev Neurosci. 2006;7:967–75.

    Article  CAS  PubMed  Google Scholar 

  66. Murty VP, Shah H, Montez D, Foran W, Calabro F, Luna B. Age-related trajectories of functional coupling between the VTA and nucleus accumbens depend on motivational state. J Neurosci. 2018;38(34):7420–7. https://doi.org/10.1523/JNEUROSCI.3508-17.2018.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  67. Hallquist MN, Geier CF, Luna B. Incentives facilitate developmental improvement in inhibitory control by modulating control-related networks. Neuroimage. 2018;172:369–80. https://doi.org/10.1016/j.neuroimage.2018.01.045.

    Article  PubMed  Google Scholar 

  68. Conner CM, White SW. Brief Report: Feasibility and Preliminary Efficacy of Individual Mindfulness Therapy for Adults with Autism Spectrum Disorder. J Autism Dev Disord. 2018;48(1). https://doi.org/10.1007/s10803-017-3312-0.

  69. Schopler E, MesibovGB. Learning and Cognition in Autism. New York, NY: . Springer Science & Business Media. 2013.

  70. Tregay J. Book Review: Sensory Perceptual Issues in Autism and Asperger Syndrome: Different Sensory Experiences - Different Perceptual Worlds. Autism. 2006;10(1):117–8. https://doi.org/10.1177/1362361306062016.

    Article  Google Scholar 

  71. Howell JW, Heck DH. Cognition, Motor Control and Other Aspects of Autism: A Pragmatic Review, in The Molecular Basis of Autism, S. H. Fatemi, Ed., New York, NY: Springer. 2015;393–406.

  72. Gillberg C, Billstedt E. Autism and Asperger syndrome: Coexistence with other clinical disorders. Acta Psychiatr Scand. 2000;102(5):321–30. https://doi.org/10.1034/j.1600-0447.2000.102005321.x.

    Article  CAS  PubMed  Google Scholar 

  73. Bradley EA, Summers JA, Wood HL, Bryson SE. Comparing Rates of Psychiatric and Behavior Disorders in Adolescents and Young Adults with Severe Intellectual Disability with and without Autism. 2004.

  74. Tsakanikos E, Bouras N, Sturmey P, Holt G. Psychiatric co-morbidity and gender differences in intellectual disability. J Intellect Disabil Res. 2006;50(8):582–7. https://doi.org/10.1111/j.1365-2788.2006.00832.x.

    Article  CAS  PubMed  Google Scholar 

  75. Johnston K, Murray K, Spain D, Walker I, Russell A. Executive Function: Cognition and Behaviour in Adults with Autism Spectrum Disorders (ASD). J Autism Dev Disord. 2019;49(10):4181–92. https://doi.org/10.1007/s10803-019-04133-7.

    Article  PubMed  PubMed Central  Google Scholar 

  76. St. John T, Woods S, Bode T, Ritter C, Estes A. A review of executive functioning challenges and strengths in autistic adults. Clin Neuropsychol. 2022;36(5):1116–1147. Routledge. https://doi.org/10.1080/13854046.2021.1971767.

  77. Uddin LQ. Brain Mechanisms Supporting Flexible Cognition and Behavior in Adolescents With Autism Spectrum Disorder. Biol Psychiat. 2021;89(2):172–183. Elsevier Inc. https://doi.org/10.1016/j.biopsych.2020.05.010.

  78. Monsell S. Task switching. Trends in Cognitive Sciences. 2003;7(3):134–140. Elsevier Ltd. https://doi.org/10.1016/S1364-6613(03)00028-7.

  79. Conner CM, Elias R, Smith IC, White SW. Emotion regulation and executive function: Associations with depression and anxiety in autism. Res Autism Spectr Disord. 2023;101. https://doi.org/10.1016/j.rasd.2023.102103.

  80. Gotham K, Bishop SL, Brunwasser S, Lord C. Rumination and perceived impairment associated with depressive symptoms in a verbal adolescent-adult ASD sample. Autism Res. 2014;7(3):381–91. https://doi.org/10.1002/aur.1377.

    Article  PubMed  PubMed Central  Google Scholar 

  81. Eysenck MW, Derakshan N, Santos R, Calvo MG. Anxiety and cognitive performance: attentional control theory. Emotion. 2007;7(2):336.

  82. Tafet GE, Nemeroff CB. The links between stress and depression: Psychoneuroendocrinological, genetic, and environmental interactions. J Neuropsychiatry Clin Neurosci. 2016;28(2):77–88. https://doi.org/10.1176/appi.neuropsych.15030053.

    Article  PubMed  Google Scholar 

  83. Ochsner KN, Silvers JA, Buhle JT. Functional imaging studies of emotion regulation: a synthetic review and evolving model of the cognitive control of emotion. Ann N Y Acad Sci. 2012;1251:E1–24. https://doi.org/10.1111/j.1749-6632.2012.06751.x.

    Article  PubMed  PubMed Central  Google Scholar 

  84. McRae K, Zarolia P. Cognition and Emotion in Emotion Dysregulation, in The Oxford Handbook of Emotion Dysregulation, T. P. Beauchaine and S. E. Crowell, Eds., New York, NY: Oxford University Press, 2020;39–52.

  85. Jazaieri H, Uusberg H, Uusberg A, Gross JJ. Cognitive Processes and Risk for Emotion Dysregulation, in Oxford Handbook of Emotion Dysregulation, T. P. Beauchaine and S. E. Crowell, Eds., New York, NY: Oxford University Press. 2020;127–140.

  86. Zelazo PD. Executive function and psychopathology: A neurodevelopmental perspective. Annu Rev Clin Psychol. 2020;16:431–54.

    Article  PubMed  Google Scholar 

  87. Romer AL, Pizzagalli DA. Is executive dysfunction a risk marker or consequence of psychopathology? A test of executive function as a prospective predictor and outcome of general psychopathology in the adolescent brain cognitive development study®. Dev Cogn Neurosci. 2021;51. https://doi.org/10.1016/j.dcn.2021.100994.

  88. Vella L, Ring HA, Aitken MRF, Watson PC, Presland A, Clare ICH. Understanding self-reported difficulties in decision-making by people with autism spectrum disorders. Autism. 2018;22(5):549–59. https://doi.org/10.1177/1362361316687988.

    Article  PubMed  Google Scholar 

  89. Yechiam E, Busemeyer JR, Stout JC, Bechara A. Using Cognitive Models to Map Relations Between Neuropsychological Disorders and Human Decision-Making Deficits. 2005.

  90. Luke L, Clare ICH, Ring H, Redley M, Watson P. Decision-making difficulties experienced by adults with autism spectrum conditions. Autism. 2012;16(6):612–21. https://doi.org/10.1177/1362361311415876.

    Article  PubMed  Google Scholar 

  91. Carleton RN. Into the unknown: A review and synthesis of contemporary models involving uncertainty. J Anxiet Dis. 2016;39:30–43. Elsevier Ltd. https://doi.org/10.1016/j.janxdis.2016.02.007.

  92. Buhr K, Dugas MJ. The role of fear of anxiety and intolerance of uncertainty in worry: An experimental manipulation. Behav Res Ther. 2009;47(3):215–23. https://doi.org/10.1016/j.brat.2008.12.004.

    Article  PubMed  Google Scholar 

  93. Vasa RA, Keefer A, Reaven J, South M, White SW. Priorities for Advancing Research on Youth with Autism Spectrum Disorder and Co-occurring Anxiety. J Autism Dev Disord, vol. 48, no. 3, 2018, doi: https://doi.org/10.1007/s10803-017-3320-0.

  94. Conner CM, Kim PS, White SW, Mazefsky CA. The role of emotion dysregulation and intolerance of uncertainty in autism: Transdiagnostic factors influencing co-occurring conditions. Res Dev Disabil. 2022;130. https://doi.org/10.1016/j.ridd.2022.104332.

  95. Normansell-Mossa KM, Top DN, Russell N, Freeston M, Rodgers J, South M. Sensory Sensitivity and Intolerance of Uncertainty Influence Anxiety in Autistic Adults. Front Psychol. 2021;12. https://doi.org/10.3389/fpsyg.2021.731753.

  96. Pugliese CE, White SW. Brief report: Problem solving therapy in college students with autism spectrum disorders: Feasibility and preliminary efficacy. J Autism Dev Disord. 2014;44(3). https://doi.org/10.1007/s10803-013-1914-8.

  97. Kenworthy L, et al. Randomized controlled effectiveness trial of executive function intervention for children on the autism spectrum. J Child Psychol Psychiatry. 2014;55(4):374–83. https://doi.org/10.1111/jcpp.12161.

    Article  PubMed  Google Scholar 

  98. Wallace GL, et al. Real-World Executive Functions in Adults with Autism Spectrum Disorder: Profiles of Impairment and Associations with Adaptive Functioning and Co-morbid Anxiety and Depression. J Autism Dev Disord. 2016;46(3):1071–83. https://doi.org/10.1007/s10803-015-2655-7.

    Article  PubMed  PubMed Central  Google Scholar 

  99. Seifert N, Seddig D, Eckhard J. Does social isolation affect physical and mental health? A test of the social causation hypothesis using dynamic panel models with fixed effects. Aging Ment Health. 2022;26(7):1353–67. https://doi.org/10.1080/13607863.2021.1961125.

    Article  PubMed  Google Scholar 

  100. Han E, Scior K, Avramides K, Crane L. A systematic review on autistic people’s experiences of stigma and coping strategies. Aut Res. 2022;15(1):12–26. John Wiley and Sons Inc. https://doi.org/10.1002/aur.2652.

  101. Han GT, Tomarken AJ, Gotham KO. Social and nonsocial reward moderate the relation between autism symptoms and loneliness in adults with ASD, depression, and controls. Autism Res. 2019;12(6):884–96. https://doi.org/10.1002/aur.2088.

    Article  PubMed  PubMed Central  Google Scholar 

  102. Weightman MJ, Air TM, Baune BT. A review of the role of social cognition in major depressive disorder. Frontiers in Psychiatry. 2014;5. Frontiers Media S.A. https://doi.org/10.3389/fpsyt.2014.00179.

  103. Ladegaard N, Larsen ER, Videbech P, Lysaker PH. Higher-order social cognition in first-episode major depression. Psychiatry Res. 2014;216(1):37–43. https://doi.org/10.1016/j.psychres.2013.12.010.

    Article  PubMed  Google Scholar 

  104. Hollocks MJ, et al. The Association Between Social Cognition and Executive Functioning and Symptoms of Anxiety and Depression in Adolescents With Autism Spectrum Disorders. Autism Res. 2014;7(2):216–28. https://doi.org/10.1002/aur.1361.

    Article  PubMed  Google Scholar 

  105. Ohtani T, et al. Reduced brain activation in response to social cognition tasks in autism spectrum disorder with and without depression. Neuropsychiatr Dis Treat. 2021;17:3015–24. https://doi.org/10.2147/NDT.S327608.

    Article  PubMed  PubMed Central  Google Scholar 

  106. Van Roekel E, Scholte RHJ, Didden R. Bullying among adolescents with autism spectrum disorders: Prevalence and perception. J Autism Dev Disord. 2010;40(1):63–73. https://doi.org/10.1007/s10803-009-0832-2.

    Article  PubMed  Google Scholar 

  107. Maïano C, Normand CL, Salvas MC, Moullec G, Aimé A. Prevalence of School Bullying Among Youth with Autism Spectrum Disorders: A Systematic Review and Meta-Analysis. Aut Res. 2016;9(6):601–615. John Wiley and Sons Inc. 2016. https://doi.org/10.1002/aur.1568.

  108. Sebastian C, Blakemore SJ, Charman T. Reactions to ostracism in adolescents with autism spectrum conditions. J Autism Dev Disord. 2009;39(8):1122–30. https://doi.org/10.1007/s10803-009-0725-4.

    Article  PubMed  Google Scholar 

  109. McDonnell CG, Boan AD, Bradley CC, Seay KD, Charles JM, Carpenter LA. Child maltreatment in autism spectrum disorder and intellectual disability: results from a population-based sample. J Child Psychol Psychiatry. 2019;60(5):576–84. https://doi.org/10.1111/jcpp.12993.

    Article  PubMed  Google Scholar 

  110. Mandell DS, Walrath CM, Manteuffel B, Sgro G, Pinto-Martin JA. The prevalence and correlates of abuse among children with autism served in comprehensive community-based mental health settings. Child Abuse Negl. 2005;29(12):1359–72. https://doi.org/10.1016/j.chiabu.2005.06.006.

    Article  PubMed  Google Scholar 

  111. Dike JE, DeLucia EA, Semones O, Andrzejewski T, McDonnell CG. A Systematic Review of Sexual Violence Among Autistic Individuals. Rev J Autism Dev Disord. 2022.

  112. Taylor JL, Gotham KO. Cumulative life events, traumatic experiences, and psychiatric symptomatology in transition-aged youth with autism spectrum disorder. J Neurodev Disord. 2016;8(1). https://doi.org/10.1186/s11689-016-9160-y.

  113. Bottini S. Social reward processing in individuals with autism spectrum disorder: A systematic review of the social motivation hypothesis. Res Aut Spect Dis. 2018;45:9–26. Elsevier Ltd. https://doi.org/10.1016/j.rasd.2017.10.001.

  114. Dawson G et al. Neurocognitive and electrophysiological evidence of altered face processing in parents of children with autism: Implications for a model of abnormal development of social brain circuitry in autism. Dev Psychopathol. 2005;17(03). https://doi.org/10.1017/s0954579405050327.

  115. Hadjikhani N, et al. Activation of the fusiform gyrus when individuals with autism spectrum disorder view faces. Neuroimage. 2004;22(3):1141–50. https://doi.org/10.1016/j.neuroimage.2004.03.025.

    Article  PubMed  Google Scholar 

  116. Pierce K, Redcay E. Fusiform Function in Children with an Autism Spectrum Disorder Is a Matter of ‘Who.’ Biol Psychiatry. 2008;64(7):552–60. https://doi.org/10.1016/j.biopsych.2008.05.013.

    Article  PubMed  PubMed Central  Google Scholar 

  117. Jaswal VK, Akhtar M. Being versus appearing socially uninterested: Challenging assumptions about social motivation in autism. Behav Brain Sci. 2018;42:e82. https://doi.org/10.1017/s0140525X18001826.

    Article  PubMed  Google Scholar 

  118. Higgins JM, Arnold SRC, Weise J, Pellicano E, Trollor JN. Defining autistic burnout through experts by lived experience: Grounded Delphi method investigating #AutisticBurnout. Autism. 2021;25(8):2356–69. https://doi.org/10.1177/13623613211019858.

    Article  PubMed  Google Scholar 

  119. Arnold SRC, Higgins JM, Weise J, Desai A, Pellicano E, Trollor JN. Confirming the nature of autistic burnout. Autism. 2023. https://doi.org/10.1177/13623613221147410.

    Article  PubMed  Google Scholar 

  120. Mantzalas J, Richdale AL, Dissanayake C. A conceptual model of risk and protective factors for autistic burnout. Autism Research, 2022;15(6):976–987. John Wiley and Sons Inc. https://doi.org/10.1002/aur.2722.

  121. Raymaker DM, et al. ‘Having All of Your Internal Resources Exhausted Beyond Measure and Being Left with No Clean-Up Crew’: Defining Autistic Burnout. Autism in Adulthood. 2020;2(2):132–43. https://doi.org/10.1089/aut.2019.0079.

    Article  PubMed  Google Scholar 

  122. Weissman MM, Markowitz JC, Klerman G. Comprehensive Guide to Interpersonal Psychotherapy. Basic Books. 2000.

  123. Hull L, et al. Is social camouflaging associated with anxiety and depression in autistic adults? Mol Autism. 2021;12(1). https://doi.org/10.1186/s13229-021-00421-1.

  124. Morris EK, Smith NG, Altus DG. B.F. Skinner’s contributions to applied behavior analysis. Behav Anal. 2005;258:99–131.

    Article  Google Scholar 

  125. Smith T, Eikeseth S. O. Ivar Lovaas: Pioneer of applied behavior analysis and intervention for children with autism. J Autism Dev Disord. 2011;41(3):375–8. https://doi.org/10.1007/s10803-010-1162-0.

    Article  PubMed  Google Scholar 

  126. Sandoval-Norton AH, Shkedy G. How much compliance is too much compliance: Is long-term ABA therapy abuse? Cog Psychol. 2019;6(1). Cogent OA. https://doi.org/10.1080/23311908.2019.1641258.

  127. Kupferstein H. Evidence of increased PTSD symptoms in autistics exposed to applied behaviouranalysis. Advances in Autism. 2018;4(3):122–9.

    Google Scholar 

  128. Kirkham P. ‘The line between intervention and abuse’ – autism and applied behaviour analysis. Hist Human Sci. 2017;30(2):107–26. https://doi.org/10.1177/0952695117702571.

    Article  Google Scholar 

  129. Gorycki KA, Ruppel PR, Zane T. Is long-term ABA therapy abusive: A response to Sandoval-Norton and Shkedy. Cogent Psychol. 2020;7(1). https://doi.org/10.1080/23311908.2020.1823615.

  130. Leaf JB, Ross RK, Cihon JH, Weiss MJ. Evaluating Kupferstein’s claims of the relationship of behavioral intervention to PTSS for individuals with autism. Advances in Autism. 2018;4(3):122–9. https://doi.org/10.1108/AIA-02-2018-0007.

    Article  Google Scholar 

  131. Chown N, Hughes E, Leatherland J, Davison S. Response to Leaf et al’s critique of Kupferstein’s finding of a possible link between applied behavior analysis and post-traumatic stress disorder. Adv Autism. 2019;5(4):318. https://doi.org/10.1108/AIA-01-2019-0002.

    Article  Google Scholar 

  132. Hussain M, Jones JM. Discrimination, diversity, and sense of belonging: Experiences of students of color. J Divers High Educ. 2021;14(1):63–71.

  133. Cooper K, Smith LGE, Russell A. Social identity, self-esteem, and mental health in autism. Eur J Soc Psychol. 2017;47(7):844–54. https://doi.org/10.1002/ejsp.2297.

    Article  Google Scholar 

  134. Cage E, Di Monaco J, Newell V. Experiences of Autism Acceptance and Mental Health in Autistic Adults. J Autism Dev Disord. 2018;48(2):473–84. https://doi.org/10.1007/s10803-017-3342-7.

    Article  PubMed  Google Scholar 

  135. Wilson RB, Thompson AR, Rowse G, Smith R, Dugdale AS, Freeth M. Autistic women’s experiences of self-compassion after receiving their diagnosis in adulthood. Autism. 2022. https://doi.org/10.1177/13623613221136752.

    Article  PubMed  PubMed Central  Google Scholar 

  136. Ferenc K, Płatos M, Byrka K, Król ME. Looking through rainbow-rimmed glasses: Taking neurodiversity perspective is related to subjective well-being of autistic adults. Autism. 2022. https://doi.org/10.1177/13623613221135818.

    Article  PubMed  Google Scholar 

  137. Maddox BB, Dickson KS, Stadnick NA, Mandell DS, Brookman-Frazee L. Mental Health Services for Autistic Individuals Across the Lifespan: Recent Advances and Current Gaps. Curr Psychiat Rep. 2021;23(10). Springer. https://doi.org/10.1007/s11920-021-01278-0.

  138. Adams D, Young K. A Systematic Review of the Perceived Barriers and Facilitators to Accessing Psychological Treatment for Mental Health Problems in Individuals on the Autism Spectrum. Rev J Autism Dev Disord. 2021;8(4):436–53. https://doi.org/10.1007/s40489-020-00226-7.

    Article  Google Scholar 

  139. Lipinski S, Boegl K, Blanke ES, Suenkel U, Dziobek I. A blind spot in mental healthcare? Psychotherapists lack education and expertise for the support of adults on the autism spectrum. Autism. 2022;26(6):1509–21. https://doi.org/10.1177/13623613211057973.

    Article  PubMed  Google Scholar 

  140. Darazsdi Z, Bialka CS. ‘Oh, you couldn’t be autistic’: Examining anti-autistic bias and self-esteem in the therapeutic alliance. Autism. 2023. https://doi.org/10.1177/13623613231154622.

    Article  PubMed  Google Scholar 

  141. Cai RY, Brown L. Cultivating self-compassion to improve mental health in autistic adults. Autism in Adulthood. 2021;3(3):230–237.

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Dr. White reports grants from the National Institutes of Health, the Department of Defense, the Patient Centered Outcomes Research Institute, and the Organization for Autism Research, during the conduct of this study. She is also a paid consultant to Mazzy Health LLC, inc., outside the submitted work. Dr. Siegle reports grants from the National Institutes of Health and receives royalty payments on a patent regarding vibroacoustic intervention technology, licensed to Apollo Neurosciences, which is being evaluated for applications to autism. Dr. Kana reports grants from National Institutes of Health. Dr. Rothman reports grants from National Institutes of Health, the Department of Defense, the Patient Centered Outcomes Research Institute, and the Organization for Autism Research.

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White, S.W., Siegle, G.J., Kana, R. et al. Pathways to Psychopathology Among Autistic Adults. Curr Psychiatry Rep 25, 315–325 (2023). https://doi.org/10.1007/s11920-023-01429-5

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