Department of Psychiatry and Behavioral Sciences, Vanderbilt University Medical Center, Nashville, Tennessee, USA.
Department of Pediatrics, University of Southern California, Los Angeles, California, USA.
Autism Res. 2024 Nov;17(11):2278-2291. doi: 10.1002/aur.3208. Epub 2024 Aug 6.
Anxiety and depression are prevalent among autistic adolescents and may be difficult to accurately diagnose and treat given various factors (e.g., diagnostic overshadowing, heterogeneity). Therefore, efforts to examine transdiagnostic factors (i.e., distress tolerance, behavioral activation) may afford more parsimonious means for assessment and treatment. To our knowledge, there has been little research on distress tolerance, behavioral activation, and depressive and anxiety symptoms in autistic adolescents to guide diagnostic practices and treatment planning. In the current study, we examined the interrelationships between these transdiagnostic factors and depressive and anxiety symptoms using ratings from 100 verbally fluent autistic adolescents without intellectual disability (M = 13.70, SD = 2.23, Range: 11:00-17:11 years) and 100 of their caregivers. Many adolescents reported male sex assigned at birth (61%), cisgender (87%), not Hispanic/Latinx (90%), and White (80%) identities. A series of correlational analyses were employed to examine associations between these constructs from youth and caregiver perspectives, and multiple linear regression analyses were conducted to explore the mediating roles of distress tolerance and behavioral activation. Preliminary results show that low distress tolerance and behavioral activation were associated with more severe internalizing symptoms per self- and caregiver-report. Some differences by rater emerged, which highlight the importance of multi-informant ratings in autism. Results from mediation analyses may show that behavioral activation may be more salient to assessments and treatment planning for depression than distress tolerance, while distress tolerance may be important for both anxiety and depression; however, findings are preliminary given the cross-sectional nature of the data. Findings suggest that these transdiagnostic concepts may be important to individualizing treatment approaches, including the timing of certain approaches, for anxiety and/or depression in autistic adolescents.
焦虑和抑郁在自闭症青少年中很普遍，由于各种因素（例如，诊断阴影、异质性），可能难以准确诊断和治疗。因此，努力检查跨诊断因素（即，痛苦耐受力、行为激活）可能为评估和治疗提供更简洁的方法。据我们所知，针对自闭症青少年的痛苦耐受力、行为激活以及抑郁和焦虑症状的研究很少，无法为诊断实践和治疗计划提供指导。在当前的研究中，我们使用 100 名语言流利的自闭症青少年（无智力障碍）（M = 13.70，SD = 2.23，范围：11：00-17：11 岁）及其 100 名照顾者的评分，检查了这些跨诊断因素与抑郁和焦虑症状之间的相互关系。许多青少年报告了出生时的男性性别分配（61%）、顺性别（87%）、非西班牙裔/拉丁裔（90%）和白人（80%）身份。我们采用了一系列相关分析来检验青少年和照顾者视角下这些结构之间的关联，还进行了多项线性回归分析，以探讨痛苦耐受力和行为激活的中介作用。初步结果表明，根据自我报告和照顾者报告，痛苦耐受力和行为激活较低与更严重的内化症状有关。评分者之间存在一些差异，这突出了在自闭症中使用多信息者评分的重要性。中介分析的结果可能表明，与痛苦耐受力相比，行为激活可能对评估和治疗抑郁更为重要，而痛苦耐受力对焦虑和抑郁都很重要；但是，鉴于数据的横断面性质，结果只是初步的。研究结果表明，这些跨诊断概念对于为自闭症青少年的焦虑和/或抑郁制定个体化治疗方法（包括某些方法的时间安排）可能很重要。
