Subjective Wellbeing Of Autistic Adolescents And Young Adults: A Cross-Sectional Study

Autistic individuals often face unique challenges that can impact their overall well-being. These challenges may include difficulties in social communication and interaction, sensory sensitivities, and struggles with emotional regulation.

Many autistic people experience higher rates of anxiety, depression, and social isolation compared to their non-autistic peers.

Additionally, they may encounter barriers in education, employment, and building meaningful relationships.

The constant effort required to navigate a world not designed for their neurodiversity can lead to increased stress and fatigue.

These factors, combined with societal misunderstanding and lack of appropriate support, can significantly affect an autistic person’s subjective well-being and quality of life.

Ridgway, K., Macmillan, C., Demmer, D. H., Hooley, M., Hedley, D., Westrupp, E., & Stokes, M. A. (2024). Subjective wellbeing of autistic adolescents and young adults: A cross sectional study. Autism Research. https://doi.org/10.1002/aur.3139

Key Points

• Autistic adolescents and young adults show significantly lower subjective well-being (SWB) compared to their non-autistic peers.
• Autistic participants were nearly three times more likely to score below the expected positive SWB range.
• No significant differences were found in positive affect between autistic and non-autistic groups.
• Autistic participants showed higher negative affect at the youngest age, but similar patterns across age compared to non-autistic participants.
• Diagnosis was a stronger predictor of SWB than positive or negative affect.
• Autistic participants scored lower on four out of seven subscales of the Personal Wellbeing Index-School Children (PWI-SC): personal health, personal relationships, personal safety, and future security.
• The study suggests that the mechanisms underlying Homeostatic Protective mood during adolescence may not follow the typical pattern of high positive affect and low negative affect for autistic individuals.
• The research highlights the importance of screening for resource deficiency and applying appropriate interventions in preadolescence for autistic individuals.
• While informative, the study has limitations such as its cross-sectional design and sample size.
• Understanding subjective well-being in autistic populations is crucial for developing targeted interventions and support strategies to improve overall quality of life.

Rationale

Subjective well-being (SWB) is a critical aspect of mental health and overall quality of life. Previous research has shown that autistic individuals often experience lower SWB compared to their non-autistic peers (Begeer et al., 2017; Thorpe, 2018).

However, there is limited understanding of how SWB, positive affect, and negative affect interact and develop across adolescence and young adulthood in autistic populations.

This study aimed to address this gap by examining age-related patterns of SWB, positive affect, and negative affect in autistic and non-autistic adolescents and young adults.

The homeostatic theory of SWB proposes that a balance of high positive affect and low negative affect maintains SWB within a narrow range (Cummins, 2013).

However, it is unclear whether this theory applies similarly to autistic individuals, who may face unique challenges in social development and emotion regulation (Cai et al., 2018; Samson, Hardan, Podell, et al., 2015).

Understanding these patterns is crucial for developing targeted interventions and support strategies to improve the well-being of autistic individuals during critical developmental periods.

By comparing autistic and non-autistic adolescents and young adults, this study sought to identify potential differences in SWB patterns and their underlying mechanisms.

This knowledge can inform clinical practice and interventions aimed at enhancing the quality of life for autistic individuals throughout their lifespan.

Method

The study employed a cross-sectional design to analyze age-related differences in SWB, positive affect, and negative affect between autistic and non-autistic adolescents and young adults.

Procedure

Participants completed a suite of self-report pencil and paper measures over a one-hour period.

Data were collected by two trained researchers in the participant’s home or at the University campus using a standardized protocol.

Sample

The final sample included 102 adolescents and young adults aged between 10 and 22 years old:

• 53 autistic participants (Mage = 13.89, SD = 3.11; 36 male)
• 49 non-autistic participants (Mage = 14.06, SD = 3.19; 28 male) All autistic participants reported a clinical autism diagnosis without intellectual disability (i.e., >70 intelligence quotient).

Measures

1. Personal Wellbeing Index-School Children (PWI-SC) fourth edition: A self-report measure of SWB with seven items representing different life domains.
2. Positive and Negative Affective Scale (PANAS): A self-report measure of mood with two orthogonal scales of positive affect and negative affect.

Statistical measures

• T-tests to compare group differences in SWB, positive affect, and negative affect
• Multiple regression analysis to determine group differences in slope and intercepts over SWB, positive affect, and negative affect
• Proportions test to compare the proportion of participants scoring <70 in SWB between groups
• Multiple regression analysis exploring diagnosis on SWB after controlling for positive affect, negative affect, age, and sex

Results

Autistic participants showed significantly lower overall SWB compared to non-autistic participants (t(100) = 3.2, p < 0.01, d = 0.64).

Autistic participants had a significantly lower intercept for SWB than non-autistic participants. Autistic group’s SWB increased across age (b = 0.02) compared to a decrease in the non-autistic group (b = −0.19).

No significant between-group differences were found in positive affect at intercept or slope (t(100) = 0.22, p = 0.83, d = 0.04).

Autistic participants showed significantly higher negative affect at the intercept (t = 1.69, p = 0.04). No significant difference was found in negative affect across age between diagnostic groups.

Autistic participants were 2.99 times more likely to score < 70 points on the PWI-SC than non-autistic participants (Z = 2.37, p < 0.01).

Multiple regression analysis revealed:

• Diagnosis explained 9% of variance in SWB (F(2, 100) = 10.37, p = 0.002)
• Positive affect contributed an additional 4% of variance (F(2, 100) = 7.77, p = <0.001)
• Negative affect added 3% of variance (F(2, 100) = 6.63, p = <0.001)
• Overall, the model explained 16% of variance in SWB

Autistic participants scored significantly lower on five subscales of the PWI-SC:

• Personal health
• Personal relationships
• Personal safety
• Community connectedness
• Future security

All correlations between variables were lower in the autistic group compared to the non-autistic group.

Correlations between positive affect and negative affect were moderate and positive in both groups.

In the non-autistic group, PWI-SC scores were negatively correlated with negative affect and positively correlated with positive affect (small correlations).

In the autistic group, a small positive correlation was found between PWI-SC scores and both negative affect and positive affect.

Insight

The study reveals that autistic adolescents and young adults experience significantly lower subjective well-being compared to their non-autistic peers.

This finding extends previous research by demonstrating that the development of resources necessary for Homeostatic Protective mood and SWB may be delayed from childhood among autistic individuals.

Interestingly, the study found no significant differences in positive affect between autistic and non-autistic groups.

This unexpected similarity may reflect diagnostic differences in life experiences, such as autistic adolescents spending more time engaged in preferred interests that elicit positive affective responses.

The higher negative affect at the youngest age for autistic participants, combined with similar patterns across age between groups, suggests that the mechanisms underlying Homeostatic Protective mood during adolescence may not follow the typical pattern of high positive affect and low negative affect for autistic individuals.

This finding challenges existing theories and highlights the need for further research into the unique factors influencing SWB in autistic populations.

The study’s results indicate that being autistic and having poorly established external and internal buffers may reset SWB to a lower set point, potentially leaving autistic individuals more vulnerable to poorer long-term physical health and wellbeing, as well as to depression.

This emphasizes the importance of screening for resource deficiency and applying appropriate interventions in preadolescence for autistic individuals.

Future research should focus on longitudinal studies to better understand the cumulative effects of positive and negative affect on SWB over time in autistic populations.

Additionally, exploring alternative patterns of mechanisms that may underpin Homeostatic Protective mood and maintain SWB at a lower set point in autistic people could provide valuable insights for developing targeted interventions.

Strengths

The study had several methodological strengths, including:

1. Comparison of autistic and non-autistic groups across a wide age range (10-22 years).
2. Use of validated measures for assessing SWB and affect (PWI-SC and PANAS).
3. Consideration of multiple factors influencing SWB, including positive affect, negative affect, and diagnosis.
4. Examination of subscales within the PWI-SC to identify specific areas of difference between autistic and non-autistic participants.

Limitations

This study also had several methodological limitations, including:

1. Cross-sectional design: While providing insights into age-related patterns, this design cannot account for individual, contextual, or environmental differences that may affect SWB over time.
2. Sample size: Although adequate for preliminary examination, a larger sample size could have increased statistical power and potentially revealed additional significant differences between groups.
3. Reliability issues: The reliability coefficients for the PWI-SC and negative affect were weaker than seen in other studies, necessitating cautious interpretation of results.
4. Lack of gender data: The study only captured sex reported at birth, limiting insights into potential gender-related differences in SWB and affect.
5. Geographical limitations: The study does not specify the geographical location of participants, which may limit generalizability to other cultural contexts.

These limitations suggest that results should be interpreted with caution and highlight the need for further research with larger, more diverse samples and longitudinal designs to confirm and expand upon these findings.

Implications

The study’s findings have significant implications for clinical psychology practice and support for autistic individuals:

1. Early intervention: The results highlight preadolescence as a crucial time to screen for resource deficiency and apply appropriate interventions. Clinicians should consider implementing SWB screening for preadolescents and monitoring SWB throughout development.
2. Targeted support: Given the lower scores on specific PWI-SC subscales (personal health, personal relationships, personal safety, and future security), interventions should focus on strengthening these areas for autistic individuals.
3. Individualized approaches: The unexpected patterns of positive and negative affect suggest that standard approaches to improving SWB may not be as effective for autistic individuals. Clinicians should consider developing tailored strategies that account for the unique experiences and challenges faced by autistic adolescents and young adults.
4. Resource development: Efforts should be made to help autistic individuals develop strong external buffers to compensate for or boost lower internal buffers, thereby strengthening Homeostatic Protective mood and maintaining SWB within a positive set-point range.
5. Education and awareness: The findings can inform education programs for families, educators, and healthcare providers about the unique challenges autistic individuals face in maintaining positive SWB during adolescence and young adulthood.
6. Policy implications: The study’s results may support the development of policies that ensure appropriate support and resources are available to autistic individuals throughout their developmental years, with a particular focus on adolescence and young adulthood.

These implications underscore the importance of a holistic approach to supporting autistic individuals, considering not only their immediate challenges but also their long-term well-being and quality of life.

References

Primary reference

Ridgway, K., Macmillan, C., Demmer, D. H., Hooley, M., Hedley, D., Westrupp, E., & Stokes, M. A. (2024). Subjective wellbeing of autistic adolescents and young adults: A cross sectional study. Autism Research. https://doi.org/10.1002/aur.3139

Other references

Begeer, S., Ma, Y., Koot, H. M., Wierda, M., van Beijsterveldt, C. T., Boomsma, D. I., & Bartels, M. (2017). Brief Report: Influence of gender and age on parent reported subjective well-being in children with and without autism. Research in Autism Spectrum Disorders, 35, 86-91. https://doi.org/10.1016/j.rasd.2016.11.004

Cai, R. Y., Richdale, A. L., Uljarević, M., Dissanayake, C., & Samson, A. C. (2018). Emotion regulation in autism spectrum disorder: Where we are and where we need to go. Autism Research, 11(7), 962-978. https://doi.org/10.1002/aur.1968

Cummins, R. A. (2013). Subjective well-being, homeostatically protected mood and depression: A synthesis. The exploration of happiness: present and future perspectives, 77-95. https://doi.org/10.1007/978-94-007-5702-8_5

Samson, A. C., Hardan, A. Y., Podell, R. W., Phillips, J. M., & Gross, J. J. (2015). Emotion regulation in children and adolescents with autism spectrum disorder. Autism Research, 8(1), 9-18. https://doi.org/10.1002/aur.1387

Thorpe, P. T. (2018). Subjective well-being in adults with autism spectrum disorder. University of Sydney.

Keep Learning

Socratic questions for a college class discussion

1. How might the unique social experiences of autistic adolescents contribute to their different patterns of subjective well-being compared to non-autistic peers?
2. In what ways could the concept of “Homeostatic Protective mood” be adapted or reconsidered for autistic individuals based on the findings of this study?
3. How might early interventions targeting subjective well-being in autistic preadolescents impact their long-term mental health outcomes?
4. What ethical considerations should researchers and clinicians keep in mind when developing interventions to improve subjective well-being in autistic populations?
5. How might cultural factors influence the patterns of subjective well-being, positive affect, and negative affect in autistic individuals across different societies?
6. In what ways could the findings of this study inform inclusive education practices for autistic students?
7. How might the relationship between special interests and positive affect in autistic individuals be leveraged to improve overall subjective well-being?
8. What role might sensory sensitivities play in the subjective well-being of autistic individuals, and how could this be investigated in future research?
9. How could the concept of neurodiversity influence our interpretation and application of these research findings?
10. In what ways might the transition to adulthood impact subjective well-being differently for autistic individuals compared to their non-autistic peers, and how could support systems be adapted to address these differences?