Research into autism and mental health has traditionally associated poor mental health and autism as inevitably linked. Other possible explanations for mental health problems among autistic populations have received little attention. As evidenced by the minority disability movement, autism is increasingly being considered part of the identities of autistic people. Autistic individuals thus constitute an identity-based minority and may be exposed to excess social stress as a result of disadvantaged and stigmatized social status. The authors test the utility of the minority stress model as an explanation for the experience of mental health problems within a sample of high-functioning autistic individuals (n = 111). Minority stressors including everyday discrimination, internalized stigma, and concealment significantly predicted poorer mental health, despite controlling for general stress exposure. These results indicate the potential utility of minority stress in explaining increased mental health problems ...

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Extending the Minority Stress Model to Understand Mental Health Problems Experienced by the Autistic Population

Co-morbid mental health conditions such as anxiety and depression are extremely common in autistic adults. Vulnerability to negative life experiences such as victimisation and unemployment may be partially responsible for the development of these conditions. Here we measure the frequency of negative life experiences in autistic adults and explore how these are associated with current anxiety and depression symptoms and life satisfaction. We developed the Vulnerability Experiences Quotient (VEQ) through stakeholder consultation. The VEQ includes 60 items across 10 domains. Autistic adults with a clinical diagnosis and non-autistic controls completed the VEQ, screening measures for anxiety and depression, and a life-satisfaction scale in an online survey. Likelihood of experiencing each VEQ event was compared between groups, using binary logistic regression. Mediation analysis was used to test whether total VEQ score mediated the relationship between autism and (1) depression (2) anxiety and (3) life satisfaction. Autistic adults (N = 426) reported higher rates of the majority of events in the VEQ than non-autistic adults (N = 268). They also reported more anxiety and depression symptoms and lower life satisfaction. Group differences in anxiety, depression and life satisfaction were partially mediated by VEQ total score. This study highlights several important understudied areas of vulnerability for autistic adults, including domestic abuse, contact with social services (as parents) and financial exploitation and hardship. Improved support, advice and advocacy services are needed to reduce the vulnerability of autistic adults to negative life experiences, which may in turn improve mental health and life satisfaction in this population. Autism Res 2019, 12: 1516-1528. © 2019 The Authors. Autism Research published by International Society for Autism Research published by Wiley Periodicals, Inc. LAY SUMMARY: This study investigated whether autistic adults are more vulnerable to certain negative life experiences, and whether these experiences are related to anxiety, depression and life satisfaction. We found that autistic adults are more vulnerable to many different negative life events, including employment difficulties, financial hardship and domestic abuse. Negative life experiences partially explained the higher rates of anxiety and depression symptoms and lower life satisfaction in autistic adults compared to non-autistic adults. Improved support services are required to reduce the vulnerability of autistic adults. Reducing vulnerability may improve mental health and increase life satisfaction in this population.

https://onlinelibrary.wiley.com/doi/pdf/10.1002/aur.2162

The Vulnerability Experiences Quotient (VEQ): A Study of Vulnerability, Mental Health and Life Satisfaction in Autistic Adults.

Since its initial description, the concept of autism has been firmly rooted within the conventional medical paradigm of child psychiatry. Increasingly, there have been calls from the autistic community and, more recently, nonautistic researchers, to rethink the way in which autism science is framed and conducted. Neurodiversity, where autism is seen as one form of variation within a diversity of minds, has been proposed as a potential alternative paradigm. In this review, we concentrate on three major challenges to the conventional medical paradigm - an overfocus on deficits, an emphasis on the individual as opposed to their broader context and a narrowness of perspective - each of which necessarily constrains what we can know about autism and how we are able to know it. We then outline the ways in which fundamental elements of the neurodiversity paradigm can potentially help researchers respond to the medical model's limitations. We conclude by considering the implications of a shift towards the neurodiversity paradigm for autism science.

Annual Research Review: Shifting from 'normal science' to neurodiversity in autism science.

Differences in sexual functioning of adolescents with and without autism spectrum disorder (ASD) are understudied In the current study, self-reported sexual behaviours, interests and attitudes of 50 adolescent boys, aged 15–18, with at least average intelligence and diagnosed with ASD, were compared with a matched general population control group of 90 boys Results demonstrated substantial similarity between the groups in terms of sexual behaviours The only significant difference was that boys with ASD reacted more tolerant towards homosexuality compared to the control group Results reveal that sexuality is a normative part of adolescent development in high-functioning boys with ASD Hence, attention should be given to this topic in education and mental health care

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Sexuality in Adolescent Boys with Autism Spectrum Disorder: Self-Reported Behaviours and Attitudes.

OBJECTIVE: Pediatric primary care providers (PCPs) caring for patients with autism spectrum disorder (ASD) often encounter irritability (vocal or motoric outbursts expressive of anger, frustration, or distress) and problem behavior (directed acts of aggression toward other people, self, or property). The Autism Intervention Research Network on Physical Health and Autism Speaks Autism Treatment Network charged a multidisciplinary workgroup with developing a practice pathway to assist PCPs in the evaluation and treatment of irritability and problem behavior (I/PB). METHODS: The workgroup reviewed the literature on the evaluation and treatment of contributory factors for I/PB in ASD. The workgroup then achieved consensus on the content and sequence of each step in the pathway. RESULTS: The practice pathway is designed to help the PCP generate individualized treatment plans based on contributing factors identified in each patient. These factors may include medical conditions, which the PCP is in a key position to address; functional communication challenges that can be addressed at school or at home; psychosocial stressors that may be ameliorated; inadvertent reinforcement of I/PB; and co-occurring psychiatric conditions that can be treated. The pathway provides guidance on psychotropic medication use, when indicated, within an individualized treatment plan. In addition to guidance on assessment, referral, and initial treatment, the pathway includes monitoring of treatment response and periodic reassessment. CONCLUSIONS: The pediatric PCP caring for the patient with ASD is in a unique position to help generate an individualized treatment plan that targets factors contributing to I/PB and to implement this plan in collaboration with parents, schools, and other providers.

http://pediatrics.aappublications.org/content/pediatrics/137/Supplement_2/S136.full.pdf

Irritability and Problem Behavior in Autism Spectrum Disorder: A Practice Pathway for Pediatric Primary Care

There is a significant gap in understanding the risk of sexual victimization in individuals with autism spectrum disorders (ASD) and the variables that contribute to risk. Age appropriate sexual interest, limited sexual knowledge and experiences, and social deficits, may place adults with ASD at increased risk. Ninety-five adults with ASD and 117 adults without ASD completed questionnaires regarding sexual knowledge sources, actual knowledge, perceived knowledge, and sexual victimization. Individuals with ASD obtained less of their sexual knowledge from social sources, more sexual knowledge from non-social sources, had less perceived and actual knowledge, and experienced more sexual victimization than controls. The increased risk of victimization by individuals with ASD was partially mediated by their actual knowledge. The link between knowledge and victimization has important clinical implications for interventions.

https://link.springer.com/content/pdf/10.1007%2Fs10803-014-2093-y.pdf

Stephanie M. Brown-Lavoie

Papers

Sexual Knowledge and Victimization in Adults with Autism Spectrum Disorders