The Relationship Between Stress and Global Functioning in Adults With Autism Spectrum Disorders

Background and Purpose: Adults with autism spectrum disorders (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, coupled with biobehavioral vulnerabilities inherent to ASD, put people with these conditions at increased risk for psychophysiological distress. Stress, and more specifically the way that one responds to stress, is essential to adjustment in adulthood, and likely factors heavily into both daily life and long-term outcomes for adults with ASD, as suggested by a growing literature on stress in children with ASD which indicates that children with ASD have differential responses to stress than healthy children. We hypothesized that adults with ASD would experience more perceived and interviewer-observed stress than healthy controls and that there would be an inverse relationship between stress and global functioning.

Methods: Baseline data were collected from 26 adults with ASD and 33 healthy controls who were participants in a randomized-controlled clinical trial of Cognitive Enhancement Therapy and Enriched Supportive Therapy. Measures of perceived stress and interviewer-observed stress on the Brief Psychiatric Rating Scale (BPRS) and global functioning (as measures by the Global Assessment Scale) were used to test the hypothesis. Average age was 24.12 for patients with ASD and 26.00 for controls. Males accounted for 88.5% (n=23) of patients with ASD and 72.7% (n=24) of controls. Analyses examined both stress levels among patients with ASD and healthy controls via a stress composite score (perceived stress/anxiety and interviewer-observed stress/tension on the BPRS) and the relationship between stress and global functioning for both patients with ASD and healthy controls.

Results: As expected, results indicated that adults with ASD both perceived themselves and were perceived as having greater stress (M=3.69) compared to healthy controls (M=1.64), F(1, 57)=68.47, p<.001, and that stress was highly significantly related to global functioning, β=-11.17, p<.001, such that participants with higher stress were more likely to have lower global functioning. In adults with ASD, stress was significantly related to global functioning at the p=.10 level, β=-3.49, p=.53, but this was not the case with healthy controls, β=-1.566, p=.364. This indicates that adults with ASD with higher stress were more likely to have lower global functioning, but that stress was not significantly related to global functioning in healthy controls in the current sample.

Conclusions and Implications: Findings indicate that adults with ASD experience greater perceived and interviewer-observed stress and that stress is significantly related to global functioning in adults with ASD. These findings underscore the effect of high psychosocial distress on poor adult functioning in this population and suggest that interventions designed to target psychosocial distress may be efficacious in improving adult functioning. Further research is needed that examines the relationship between expanded psychosocial, cardiovascular, and neuroendocrine measures of stress and social functioning and daily living skills, and it will be important for social work to secure an integral role in future research development efforts.