Brief Report
Free access
Published Online: 30 August 2023

The Inter-Relationship of Emotion Regulation, Self-Compassion, and Mental Health in Autistic Adults

Publication: Autism in Adulthood
Volume 5, Issue Number 3

Abstract

Background: Emotion regulation is one of the key factors that influence mental health outcomes in autistic and nonautistic populations. Recent research has also identified self-compassion as a negative correlate of depression and positive correlate of psychological well-being in autistic adults. Empirical evidence from the general population supports the notion that being kind and compassionate toward oneself during stressful and difficult moments can help with one's ability to regulate negative emotions, which then has flow-on effects on mental health outcomes. However, the inter-relationship between self-compassion, emotion regulation, and mental health has not been examined in autistic samples. Therefore, the aim of this study was to determine if emotion regulation mediates the relationship between self-compassion and anxiety or depression in a sample of autistic adults.
Methods: Participants were 153 adults (meanage = 35.70, standard deviationage = 12.62) who had either self-reported a clinical diagnosis of autism spectrum disorder or self-identified as autistic. They completed an online survey capturing self-compassion, emotion regulation, anxiety, and depression. We hypothesized that emotion regulation would mediate the relationship between self-compassion and anxiety or depression, and self-compassion would not mediate the relationship between emotion regulation and anxiety or depression.
Results: As predicted, only emotion regulation mediated the relationship between self-compassion and mental health outcomes. Self-compassion did not mediate the relationship between emotion regulation and mental health outcomes.
Conclusion: This study provides preliminary evidence for the role that self-compassion plays in improving emotion regulation and mental health in autistic adults. If this mechanism of emotion regulation mediating the relationship between self-compassion and mental health is consistently found in future studies, then it would be helpful for future research to examine the clinical benefits of including a self-compassion component in emotion regulation interventions to improve mental health outcomes of autistic adults.

Abstract

Community brief

Why is this an important issue?

Many autistic individuals are diagnosed with mental illnesses such as anxiety or depression. Having a mental illness leads to negative consequences such as feelings of loneliness and sleep problems. Research findings show that improving autistic people's ability to regulate emotions can reduce symptoms of mental illnesses. Being compassionate toward ourselves during stressful and difficult moments can help us better regulate our negative emotions such as anger, sadness, and fear. Better emotion regulation then improves mental health. Research in the general population supports this proposal. But no research has studied the relationship between self-compassion, emotion regulation, and mental health in autistic adults.

What was the purpose of this study?

This study aims to look at the relationship between self-compassion, emotion regulation, and mental health in a sample of autistic adults.

What did the researchers do?

We designed an online survey and asked autistic adults to complete this survey. Several autism and autistic organizations around the world helped us spread the word about this study (we are grateful for their support!). The survey contained questions capturing people's self-compassion levels, emotion regulation difficulties, and symptoms of anxiety and depression. One hundred and fifty-three autistic adults completed the survey. These participants either self-reported a diagnosis of autism or self-identified as autistic.

What were the results of the study?

We found that autistic adults with higher levels of self-compassion had better emotion regulation and fewer symptoms of anxiety and depression.

What do these findings add to what was already known?

Researchers and clinicians have designed various treatments to improve autistic people's emotion regulation. And we know that some of these treatments also improve mental health. We need to identify the components that should be included in the treatments to make them most effective. If future research continues to find this relationship between self-compassion, emotion regulation, and mental health, then adding a self-compassion component to emotion regulation treatments may be helpful.

What are potential weaknesses in the study?

This study has several weaknesses:
Online survey design—we could not conduct diagnostic assessments to confirm the participant's autism diagnosis. But we have used a questionnaire called the Autism Spectrum Quotient; all participants who self-identified as autistic met the cutoff for autism.
Data collection—we collected data from participants at one point, which meant we could not identify the direction of the relationships between variables.
Gender of autistic people—a larger proportion of our participants were women, which does not match the typical autism gender ratio of 1:4 (female:male).

How will these findings help autistic adults now or in the future?

We hope this study will start the conversation on the relevance of increasing self-compassion for improving emotion regulation and mental health in autistic adults. Therefore, this study may inform the design of future interventions for improving autistic adults' emotion regulation and mental health.

Introduction

Many autistic individuals experience mental health difficulties throughout their lifetime. There is consistent evidence that higher proportions of autistic individuals experience poor mental health than the general population.1,2 For instance, Hollocks et al conducted a systematic review and meta-analysis that showed the pooled lifetime prevalence of anxiety and depressive disorders were 42% and 37%, respectively, in autistic adults.1 They also found an estimate of any current anxiety and depression of 27% and 23%, respectively, which is considerably higher than the estimates of 1%–12% in the general population.3 Having a mental illness such as anxiety or depression leads to a variety of negative consequences, including increased loneliness, sleep problems, and suicidal ideation in autistic individuals.4–7 Researchers have attempted to identify modifiable risk factors associated with the development and maintenance of these conditions.
A prominent factor consistently shown to predict both internalizing and externalizing symptoms in autism is emotion regulation.8 Emotion regulation processes allow individuals to manage the intensity, duration, and types of emotions experienced and how they are expressed.9,10 Autistic children and adults tend to display poorer emotion regulation abilities compared with nonautistic people.11–13 Neurobiological mechanisms appear to play a part in the emotion regulation differences observed in autistic individuals. For instance, there is lower structural connectivity between frontal regions and the lower limbic brain in autistic individuals.14 In addition, during tasks involving downregulation of negative emotions, there is decreased engagement of prefrontal regions and lack of amygdala downregulation in autism spectrum disorder (ASD).15,16
The first crucial step of successful emotion regulation is to detect one's own emotions. Alexithymia (difficulties with identifying, differentiating, and describing emotions)17 seems to reduce autistic people's ability to regulate emotions,18,19 and autistic individuals experience higher rates of alexithymia than nonautistic people.20 Autistic adults tend to use more emotion regulation strategies shown to be associated with mental illnesses (such as expressive suppression) and less strategies shown to be associated with better mental health (such as cognitive reappraisal).8 Other than mental health outcomes, poor emotion regulation is related to a variety of negative outcomes across the lifespan for autistic people, including increased problem behaviors and worse social engagement and academic performance.21,22
A construct that interacts with emotion regulation to influence mental health outcomes in nonautistic individuals is self-compassion.23 Self-compassion is a gentle way of relating to oneself through kindness, mindful awareness, and common humanity.24 Self-compassion also means we are not critical of ourselves.25 In nonautistic samples, higher levels of self-compassion are associated with higher levels of happiness, well-being, and resilience, better sleep, and lower levels of anxiety, depression, stress, and self-harm.26–31 Self-compassion also reduces activation of neural networks associated with threat such as the amygdala.32
Researchers have proposed that being compassionate toward oneself can help reduce mental illness symptoms through effective emotion regulation. Berking and Whitley suggested that when a person responds to stressful events with self-criticism, negative emotions such as anger and shame are triggered, and the amygdala is activated to increase the body's stress response.33 The activation of amygdala and negative emotions then leads the person to be even more self-critical, causing a vicious cycle that makes it extremely difficult to regulate emotions. In contrast, if a person responds to situations with self-compassion, the neural networks associated with threat are not activated, leading to less negative emotions and arousal, making it much easier to regulate emotions using adaptive regulation strategies such as cognitive reappraisal. It is much harder to access cognitive resources required for successful emotion regulation when one is highly aroused. For instance, cognitive reappraisal is not as effective when one has high emotional intensity levels.34
Preliminary research findings in nonautistic individuals support the hypothesis that self-compassion may reduce mental illness symptoms through better emotion regulation. Finlay-Jones and colleagues found that emotion regulation difficulties cross-sectionally mediated the relationship between self-compassion and stress in a sample of psychologists and trainees, which indicates that self-compassion indirectly impacts stress through a reduction in emotion regulation difficulties.35 Similarly, emotion regulation skills cross-sectionally mediated the relationship between self-compassion and depression in a group of individuals with unipolar depression.36
However, when the predictor and mediator variables were reversed (self-compassion as the mediator and emotion regulation as the independent variable), the indirect effect was no longer significant. More recently, Inwood and Ferrari conducted a systematic review to examine the mechanisms of change in the relationship between self-compassion, emotion regulation, and mental health.23 They found that emotion regulation mediated the relationship between self-compassion and mental health across various community and clinical samples, for a range of mental health outcomes such as stress, depression, and post-traumatic stress disorder. The authors concluded that self-compassion may be a relevant initial treatment target for people who experience emotion regulation difficulties.
Analogous to the general population, self-compassion might facilitate mental health and psychological well-being in autistic adults.37 Indeed, initial findings suggest that as a group, autistic adults self-report lower levels of self-compassion than nonautistic adults, and self-compassion levels are negatively associated with symptoms of depression and positively related to psychological well-being.38 Being victimized and exposed to stigma are likely to contribute to the lower levels of self-compassion reported by autistic adults. A recent review of victimization in autistic individuals found that 84% of autistic individuals experienced multiple forms of victimization, including bullying, child abuse, sexual victimization, and cyberbullying.39 In addition, autistic individuals often experience stigma.40,41 These traumatic experiences are likely to cause many autistic people to internalize negative self-views that is detrimental to their ability to be self-compassionate.
Given that autistic adults tend to experience more emotion regulation difficulties than nonautistic adults,11,42 and there is a significant negative correlation between self-compassion and mental illness symptoms in autistic adults,34 it would be fruitful to determine whether this relationship between self-compassion levels and mental health is through emotion regulation. If this mechanism exists in autism, it is possible that increasing autistic people's self-compassion levels may improve their ability to regulate emotions, which then has a flow-on effect on mental health outcomes. Therefore, as a first step, the aim of this study was to determine whether emotion regulation mediates the relationships of self-compassion with anxiety and depression in a sample of autistic adults cross-sectionally.
The reverse models, where self-compassion mediates the relationships between emotion regulation and anxiety/depression will also be examined, replicating Diedrich et al's study.41 It is important to determine the direction of the mediation to more fully characterize how emotion regulation and self-compassion interacts to influence mental health in autistic adults. If emotion regulation mediates the relationship between self-compassion and mental health (and not the reverse model), then this study would provide preliminary evidence that self-compassion may be a relevant target for mental health interventions. We hypothesized as follows: (H1) Emotion regulation would mediate the relationship between self-compassion and anxiety or depression (i.e., the indirect effects will be significant); and (H2) Self-compassion would not mediate the relationship between emotion regulation and anxiety or depression (i.e., the indirect effects will not be significant).

Methods

Participants

Participants were 153 autistic adults aged 18–75 years (mean [M]age = 35.70, standard deviation [SD]age = 12.62; female = 63%, male = 27%, nonbinary = 9%, other/don't want to say = 1%) who had either self-reported a clinical diagnosis of ASD or self-identified as autistic. Self-identified adults were included to account for the often-significant delays in gaining a clinical diagnosis.43 The majority (n = 114, 75%) reported receiving a formal clinical diagnosis of autism at a mean age of 30 years (SD = 16.32; range 3–72 years of age), including ASD (n = 59; 52%), Asperger's syndrome (n = 21; 18%), autism or autistic disorder (n = 23; 20%), pervasive developmental disorder, not otherwise specified (n = 10; 9%), and childhood disintegrative disorder (n = 1; 1%).
Only a small proportion of participants received a diagnosis of ASD in childhood (n = 27). Participants who identified as female were diagnosed significantly later in life than those who identified as male (U = 535, z = −2.86, p = 0.004, r = 0.30) or nonbinary (U = 206, z = −2.19, p = 0.029, r = 0.25). The remaining 39 autistic participants identified as autistic. All self-identified participants scored above the cutoff score on the Autism Spectrum Quotient-Short Form (AQ-Short)44 and all autistic participants who reported receiving a formal diagnosis were included regardless of AQ-Short score (five did not meet cutoff for AQ-Short). There was no significant difference on the AQ-Short scores between participants who reported a formal diagnosis (M = 84.80; SD = 11.77; range = 55–105) and those who did not (M = 82.43; SD = 9.76; range = 67–106), U = 76, z = −13.00, p < 0.001, r = 0.83.
Participants lived in Oceania (60%), North America (24%), Europe (8%), Asia (4%), South America (2%), and Africa (1%; 1% did not specify). The ethnicity of the majority was White (82%), followed by Asian (7%), Pacific Islander (5%), and Hispanic (4%). Most participants had at least one health condition (82%), including anxiety disorder (58%), mood disorder (48%), attention-deficit/hyperactivity disorder (27%), sensory processing disorder (14%), obsessive compulsive disorder (12%), speech or language impairment (10%), and learning impairment (6%).
More than half of the participants had completed university/college education (36% undergraduate and 26% postgraduate), with the rest completed trade or diploma level (24%), high/secondary school (13%), and primary/elementary school (1%). Half of the participants were single (50%), and the other half were either married (21%) or in a de facto relationship (lived with a partner without being legally married; 27%). Three people did not specify their current relationship status. Most were not studying (63), and the rest were studying part- (23%) or full-time (14%). More than half were working full time (32%), part time (24%), or casually (14%), and the rest did not work at all (30%).

Procedure and measures

At the start of the study, a summary of the research proposal was initially approved by a committee comprising two autistic individuals and one senior researcher. Then, we worked with an autistic research assistant (A.R.) throughout the project. The autistic research assistant was consulted for the study design, provided feedback on research documentation (such as the participant information statement and data collection questions), assisted with recruitment, and article preparation. Approval for conducting the study was obtained from the University of Sydney Human Research Ethics Committee (project no. 2020/762).
Participants were recruited through various channels, including social media platforms of Autism Spectrum Australia (Aspect) as well as autistic and autism communities in Australia, United States, Canada, and United Kingdom, such as Different Journeys, Organization for Autism Research, Autism Canada, and Scottish Autism. Therapists and clinicians who supported autistic clients in these countries and who were known to the research team were also emailed about the study. Individuals interested in the study were directed to the survey, which was housed on the Qualtrics platform, through which they could read the information statement about the study, provide their informed consent online, and complete the questions anonymously.
The online survey included questions about participant demographic information, including age, gender identity, place of residence, ethnicity, and health conditions. Five other scales also formed part of the survey. All five measures have been used in autistic samples.
Autistic traits were measured using the 28-item AQ-Short,44 an abbreviated version of the full 50-item screening questionnaire that assessed behaviors associated with autism.45 Items are rated on a 4-point Likert scale ranging from definitely agree (score of 1) to definitely disagree (score of 4). Sample items are “I find it difficult to work out people's intentions” and “I enjoy doing things spontaneously.” Items are summed to obtain a total score (some items are reverse scored), ranging between 28 and 112. Correlation with the 50-item AQ is very high, with rs ranging from 0.93 to 0.95 and comparable estimates of sensitivity (0.97) and specificity (0.82) for autism using an AQ-Short cutoff score of 65.
The Self-Compassion Scale (SCS)24 was used to measure participants' self-compassion levels. The scale uses 26 items to measure six subdomains: self-kindness, self-judgment (reverse scored), common humanity, isolation (reverse scored), mindfulness, and overidentification (reverse scored). Items are rated on a 5-point Likert scale ranging from Almost never (score of 1) to Almost always (score of 5). Sample items are “When I'm feeling down, I tend to feel like most other people are probably happier than I am” and “I try to be loving towards myself when I'm feeling emotional pain.” Some items are reverse scored. Items are averaged to obtain subdomain and total scores (total scores range between 1 and 5). Research has shown that total SCS scores demonstrate good internal reliability (α = 0.92) and test–retest reliability (α = 0.93) for a 3-week period.
Emotion dysregulation was measured using the 36-item Difficulties in Emotion Regulation Scale (DERS),46 consisting of six subscales: nonacceptance of emotional responses, difficulty engaging in goal-directed behavior, impulse control difficulties, lack of emotional awareness, limited access to emotion regulation strategies, and lack of emotional clarity. Items are rated on a 5-point Likert scale ranging from Almost never (score of 1) to Almost always (score of 5). Sample items are “I care about what I am feeling” and “When I'm upset, I feel out of control.” Some items are reverse scored. Items are summed to obtain subscale and total scores (total scores range between 36 and 180). The DERS has high internal consistency (α = 0.93), good test–retest reliability (α = 0.88), and adequate construct and predictive validity.
Anxiety symptoms were assessed using the Diagnostic and Statistical Manual of Mental Disorders-5 Generalized Anxiety Disorder Dimensional Scale (DSM-5 GAD-D),47 which is a norm-referenced, 10-item self-report questionnaire. Items are rated on a 5-point scale ranging from Never (score of 0) to All of the time (score of 4). Sample items are “During the past month, I have felt anxious, worried, or nervous” and “During the past month, I have avoided, or did not approach or enter, situations that made me anxious.” Items are summed to obtain total scores, which range between 0 and 40. The cutoff score for clinically significant anxiety is 14,48 with both sensitivity and specificity being 0.73.
Depression symptoms was measured using the Patient Health Questionnaire-9 (PHQ-9),49 a 9-item, norm-referenced questionnaire designed to screen for the presence of depression in general and clinical populations. Items are rated on a 4-point scale ranging from Not at all (score of 0) to Nearly every day (score of 3). Questions focus on experiences of respondents for the past 2 weeks. Sample items are “Poor appetite or overeating” and “Little interest or pleasure in doing things.” Items are summed to obtain total scores, which range between 0 and 30. Cutoff scores of 20, 15, 10, and 5 represent severe, moderately severe, moderate, and mild depression, respectively. A score of 10 or above had both a sensitivity and a specificity of 0.88 for major depression.

Statistical analysis

Pearson's r correlations were used to explore the associations between the variables of interest, with exclude cases pairwise and bias-corrected bootstrapping (2000 resamples) to account for the non-normal distributions of variables. Four simple mediation analyses were conducted to test the indirect effects of the models.50 We used Preacher and Hayes's recommendation of generating nonparametric confidence intervals (CIs) using a bootstrap resampling procedure.51 For this study, we used 10,000 bootstrap resamples as recommended by Hayes.50 Fritz and MacKinnon suggested a sample of at least 50 participants to detect single mediation effects with the bootstrapping technique.52 Our study's sample size (n = 153) exceeded the recommended amount. An indirect effect is considered significant when the range of the two CIs fall outside of zero.51 SPSS Statistics 21 for Mac was used for statistical analysis and the PROCESS macro v2.16 was used for the mediation analyses.50

Results

Descriptive statistics showed that autism traits were weakly and positively correlated with emotion dysregulation and moderately and negatively correlated with self-compassion (Table 1). Self-compassion was weakly and negatively associated with anxiety and depression and strongly and negatively correlated with emotion dysregulation. Emotion dysregulation was moderately and positively associated with both anxiety and depression.
Table 1. Descriptive Statistics of Scales
 nM (SD)RangeCronbach's alphaAQ-ShortSCSDERSDSM-5 GAD-D
AQ-Short15384.23 (11.33)55–1060.85    
SCS1532.50 (0.67)1.08–4.250.93−0.412**   
DERS153106.63 (20.13)54–1640.910.286**−0.657** .
DSM-5 GAD-D14918.67 (8.04)0–400.890.003−0.230*490** 
PHQ-915211.57 (6.28)0–270.870.052−0.298**0.536**0.713**
AQ-Short, Autism Spectrum Quotient-Short Form; DERS, Difficulties in Emotion Regulation Scale; DSM-5 GAD-D, Diagnostic and Statistical Manual of Mental Disorders-5 Generalized Anxiety Disorder Dimensional Scale; M, mean; PHQ-9, Patient Health Questionnaire-9; SCS, Self-Compassion Scale; SD, standard deviation.
*
p < 0.01; **p < 0.005 (Bonferroni adjustment).
The first mediation model examined whether emotion regulation mediated the relationship between self-compassion and anxiety (Fig. 1a). As predicted, this model was statistically significant, accounting for unique variance in anxiety, R2 = 0.43, F(1,147) = 112.11, p < 0.001. As the CI was outside zero, emotion regulation mediated the relationship between self-compassion and anxiety, b = −0.18, 95% CI (−0.25 to −0.12). The second mediation model examined whether emotion regulation mediated the relationship between self-compassion and depression (Fig. 1b). This model was also statistically significant, R2 = 0.43, F(1,150) = 113.14, p < 0.001, and the indirect effect was also statistically significant, b = −0.14, 95% CI (−0.20 to −0.09).
FIG. 1. Mediation models (a–d).
The third and fourth mediation models (Fig. 1c, d) explored whether self-compassion mediated the relationships between emotion regulation and anxiety or depression. Since CIs of the indirect effects included zero for both models, self-compassion did not significantly mediate the relationships between emotion regulation and anxiety, b = −0.04, 95% CI (−0.09 to 0.01), or between emotion regulation and depression, b = −0.02, 95% CI (−0.05 to 0.02).

Discussion

The mental health outcomes of autistic adults are generally poor.1,2 Identifying modifiable transdiagnostic factors that influence mental health allows effective interventions and support programs to be developed, with the ultimate goal of enabling autistic individuals to achieve better psychological well-being and quality of life. Since both emotion regulation and self-compassion have separately been shown to be associated with mental health outcomes in autistic adults, the aim of this study was to examine the inter-relationship between emotion regulation, self-compassion, and anxiety/depression in a sample of autistic adults through mediation models.
As predicted, emotion regulation mediated the relationships between self-compassion and anxiety or depression, whereas self-compassion did not mediate the relationships between emotion regulation and anxiety or depression. Specifically, higher levels of self-compassion levels were negatively correlated with anxiety and depression symptoms through better emotion regulation. These findings support previous research in nonautistic samples (see systematic review by Inwood & Ferrari).23
For instance, Diedrich and colleagues found that emotion regulation mediated the relationship between self-compassion and depressive symptoms in a sample of individuals with unipolar depression.41 Similar to our results, they also found when self-compassion and emotion regulation were reversed in the mediation model predicting depression, the indirect effect was no longer significant. These existing findings and this study align with Berking and Whitley's theory that self-compassion reduces mental illness symptoms through effective emotion regulation.38
The results of this study should be interpreted with a few limitations in mind. First, as this study involved an online survey, we were unable to independently verify the autism diagnostic status of participants using more established instruments such as the Autism Diagnostic Interview-Revised or Autism Diagnostic Observation Schedule. However, all participants who self-identified as autistic included in this research scored above the AQ-Short cutoff score for autism, which has good sensitivity and specificity (see Procedure and Measures section). Second, we were not able to establish the temporal sequencing of the variables in the models due to the cross-sectional design; therefore, our findings are only correlational and we are unable to infer causal relationships between the variables. Future research using more rigorous research designs including prospective longitudinal studies and intervention studies targeting self-compassion will be able to shed further light on the relationship between self-compassion and emotion regulation, mental health and other outcomes.
Third, McVey and colleagues recently conducted a preliminary psychometric analysis of the scale used to measure emotion regulation in this study (DERS) and found the final factor structure was not unidimensional or bifactor model; therefore, they did not recommend using the DERS total score with autistic youth or adults.53 However, given the factor structure of the DERS has been shown to be unstable across studies and samples,54 it is too early to make conclusions about the best use of the DERS in autistic samples. Finally, as we have used convenience sampling, the sample is not a representative sample of the autistic population. For instance, more women volunteered to participate in our study and the gender composition does not match the typical gender ratio of 1:4 (female:male) found in the autism population.55 Furthermore, more than half of our participants had completed a university or college education (36% undergraduate and 26% postgraduate). Hence, the study's results may not be generalizable to autistic adults with co-occurring intellectual disability or those without higher education experience.
This study provides preliminary evidence for the role that self-compassion plays in improving emotion regulation and mental health in autistic adults. Emotion regulation problems are consistently found in autistic children, adolescents, and adults,8,12 and associated with different aspects of the autism phenotype.18 Studies evaluating a range of emotion regulation treatments for autistic individuals, including cognitive behavioral therapy, school-based approaches, and mindfulness-based techniques are promising.56–58 However, to our knowledge, no existing emotion regulation interventions for autistic people incorporate self-compassion.
The findings of this study suggest that participating in self-compassion interventions may improve autistic people's emotion regulation abilities and mental health outcomes. We hypothesize that self-compassion practices may also positively impact autistic people's well-being and management of social stigma related to being autistic. Existing self-compassion interventions that have been shown to be effective in the general and clinical populations, including nonautistic adults with intellectual disability,59,60 may also help to improve the self-compassion levels among autistic people.
Some modifications that consider the particular support needs of autistic people may be required, such as longer or more sessions, simplifying language and avoiding the use of metaphors. Although we have previously provided some recommendations on the considerations needed when designing self-compassion supports for autistic individuals,37 further research is needed to examine the effectiveness of such interventions, particularly in relation to flow on effects to mental health and well-being, and how self-compassion practices can be tailored and modified to support autistic people.

Acknowledgments

We would like to thank all those who participated in the self-compassion study. We would also like to thank Ms. Anna Gould for her support on this project, as an autistic individual with previous experiences of practicing self-compassion.

Authorship Confirmation Statement

R.Y.C. conceived the original idea for the study, collected and analyzed the data, and drafted the initial article. All authors contributed to the design of the study, and reviewed and approved the article before submission. The article has been submitted solely to this journal and is not published, in press, or submitted elsewhere.

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cover image Autism in Adulthood
Autism in Adulthood
Volume 5Issue Number 3September 2023
Pages: 335 - 342
PubMed: 37663445

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Published in print: September 2023
Published online: 30 August 2023
Published ahead of print: 27 January 2023

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Aspect Research Centre for Autism Practice, Autism Spectrum Australia, Frenchs Forest, Australia.
School of Psychological Sciences, Monash University, Clayton, Australia.
Abigail Love
Aspect Research Centre for Autism Practice, Autism Spectrum Australia, Frenchs Forest, Australia.
Ainslie Robinson
Aspect Research Centre for Autism Practice, Autism Spectrum Australia, Frenchs Forest, Australia.
Vicki Gibbs
Aspect Research Centre for Autism Practice, Autism Spectrum Australia, Frenchs Forest, Australia.
Faculty of Medicine and Health, University of Sydney, Camperdown, Australia.

Notes

Address correspondence to: Ru Ying Cai, Aspect Research Centre for Autism Practice, Autism Spectrum Australia, 173 Wellington Street, Flemington 3031, Australia [email protected]

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No competing financial interests exist.

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No funding was received for this study.

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