Effects of Internalizing Problems on Daily Living Skills Among High-Functioning Adults with Autism Spectrum Disorders in Japan

Background:  Adaptive functioning encompasses behaviors deemed critical to living independently, including daily living skills. Such adaptive behavior is often impaired to some degree in individuals with Autism Spectrum Disorders (ASDs) (Sparrow et al., 2005), with deficits appearing to be particularly pronounced in individuals with high-functioning ASDs in Japan. In addition to issues with adaptive behavior, though, individuals with ASDs are also likely to have mental health problems. Studies have shown that rates of depressive and anxiety disorders are higher in those with high-functioning ASDs. These internalizing problems may exacerbate deficits in daily living skills and most adaptive behaviors. And, few studies have investigated the relationship between daily living skills and severity of internalizing problems in adults with high-functioning ASDs. 

Objectives:  In our cross-sectional study, we examined the effects of internalizing problems on daily living skills in adults with high-functioning ASDs.

Methods:  

Participants were 116 adults (90 men and 26 women) who had been diagnosed with a high-functioning ASD. Mean age was 28.10±6.54 years, with a range from 20 to 52 years.

Measures: Daily Living Skills Participants’ daily living skills were evaluated using Daily Living Skill domain, the Vineland Adaptive Behavior Scale-II Japanese version (VABS-J; Tsujii et al., 2014; Sparrow et al., 2005). 

Internalizing Problems Due to impairment of self-monitoring in individuals with ASD, levels of internalizing problems were assessed using both self- and other-rated methods. For self-rating severity of internalizing symptoms, the Kessler Psychological Distress Scale (K10; Kessler et al., 2002) Japanese version (Furukawa et al., 2002) was used. For other-rating severity of internalizing problems, parents of participants answered questions regarding Internalizing Problems in Maladaptive Behavior Index, VABS-J. 

Results:  

With regard to scores of Daily Living Skills domain, we performed a hierarchical regression analysis with gender and age as independent variables in the first step, main effects of scores on the self- and the other-rated scales in the second step, and the two way interaction of K10×Internalizing Problems in VABS-J in the final step. Finding from this analysis indicated the interaction was significant (β =-.292, p<.05). Simple slope analysis showed that, for adults with high K10 scores, other-rated severity of internalizing problems was negatively associated with daily living skills (t =-2.19, p<.05), whereas among those with low K10 scores, no association was noted between other-rated severity of internalizing problems and daily living skills (t=0.49, n.s.). Further, with regard to Community subdomain scores, a significant effect of interaction was noted between K10 score and the other-rated score (β =--.360, p<.05). For adults with high K10 scores, other-rated severity of internalizing problems was negatively associated with Community scores (t =-2.42, p<.05), whereas among those with low K10 scores, no association was noted between other-rated severity of internalizing problems and Community scores (t=1.19, n.s.).

Conclusions:  

Results in the current study suggest that severity of internalizing problems negatively affects daily living skills in adults with ASD in Japan. Pharmacotherapy or psychological treatment (i.e. cognitive behavior therapy) may therefore improve degree of adaptive behavior in individuals with ASD.