Mental Health as a Key Mediator for Outcomes in Postsecondary Education, Employment, and Everyday Living in Autistic Adults.

Abstract

Background: As the number of adults who identify as autistic increases, it is vital to understand factors that improve autonomy and achievement of a good life for autistic adults. Postsecondary education and employment may contribute to higher levels of independence but may also add stress and increase mental health concerns. This study aimed to explore interactions of mental health concerns with adaptive daily living (ADL) outcomes, defined for this study as postsecondary education and employment outcomes, in verbally fluent autistic adults.

Methods: We surveyed 140 adults with confirmed (n = 114) or self-reported (n = 26) autism diagnosis regarding autism traits, camouflaging traits, and mental health concerns including anxiety, depression, and intolerance of uncertainty. At the same time, we asked for detailed reports of postsecondary educational and employment activities for data needed to rate an adapted version of the Vocational Index and also for report of daily activities using the WHO Disability Assessment Schedule 2.0 scale. A structural equation model tested hypothesized relationships among these factors.

Results: Autistic traits and camouflaging traits did not directly predict ADL outcomes. However, the mental health latent variable was a strong direct predictor of ADL outcomes in that worse mental health predicted better ADL; mental health also significantly mediated the relationships between autism traits and ADL and camouflaging traits and ADL.

Conclusions: This sample self-reported substantial education and work experience, though not always at levels high enough to support independence. Nonetheless, overall success in adaptive daily activities remains a significant challenge. Importantly, success in school and work was predicted by poor mental health, an indicator of the high cost of fitting in with neurotypical expectations that highlights the need for neurotypical systems to better understand and accommodate unique strengths and support needs to facilitate success and well-being for autistic adults.