The Relationship Between Stress and Social Functioning in Adults with Autism Spectrum Disorders

Background:  Adults with autism spectrum disorder (ASD) face substantial challenges accomplishing basic tasks associated with daily living, which are exacerbated by their broad and pervasive difficulties with social interactions. These challenges put people with ASD at increased risk for psychophysiological distress, which likely factors heavily into social functioning for adults with ASD, as suggested by a growing literature on stress in children that indicates that children with ASD have differential responses to stress than healthy children. We hypothesized that adults with ASD would experience more stress than healthy controls and that there would be an inverse relationship between stress and social functioning in patients with ASD.

Objectives:  Assess differences in stress between verbal adults with ASD and without intellectual disability (n=36) and healthy controls (n=39). Examine the relationship between stress and social functioning composite scores in verbal adults with ASD and without intellectual disability (n=36) and healthy controls (n=39).

Methods:  Baseline data were collected from 36 adults with ASD and 39 controls who were participants in a randomized-controlled trial of Cognitive Enhancement Therapy and Enriched Supportive Therapy. Composite stress (perceived stress and interviewer-observed stress on the Brief Psychiatric Rating Scale; higher scores indicate greater stress) and social functioning (global functioning using the Global Assessment Scale and social adjustment using the Social Adjustment Scale-II; higher scores indicate better functioning) scores were used to test the hypotheses. Average age was 23.4 for patients with ASD and 26.0 for controls (p=.047). Males accounted for 88.9% (n=32) of patients with ASD and 74.4% (n=29) of controls. Mean full-scale IQ was 109.3 for patients with ASD and 105.0 for controls. Racial and ethnic minorities accounted for 22.2% (n=8) of participants with ASD and 17.9% (n=7) of controls. Analyses examined both stress levels among patients with ASD and controls and the relationship between stress and global functioning for both patients with ASD and controls, controlling for age.

Results:  As expected, results indicated that adults with ASD both perceived themselves and were perceived as having greater stress (M=3.29) compared to controls (M=1.56), F(1,72)=228.909, p<.001, and that age significantly predicts stress in patients with ASD and controls, F(1,72)=6.822, p=.011. In adults with ASD, stress was significantly related to social functioning (β=-.241, t(33)=-4.631, p<.001, sr²=.352), after controlling for age, but this was not the case with controls (β=-.081, t(36)=.868, p=.391, sr²=.019). This indicates that adults with ASD with higher stress were more likely to have poorer social functioning, but that stress was not significantly related to social functioning in controls in the current sample.

Conclusions:  Findings indicate that adults with ASD experience greater perceived and interviewer-observed stress than controls and that stress is significantly related to social functioning in adults with ASD. These findings highlight the role of psychosocial distress in determining adult functioning and outcomes in this population. Results also suggest the need to develop and assess treatments that are designed to target stress and coping in adults with ASD.