Quality of life in adults with autism spectrum disorder: influence of age, sex, and a controlled, randomized mindfulness-based stress reduction pilot intervention

Abstract

Purpose: Adults with autism spectrum disorder (ASD) consistently report worse functional health and well-being, compared to neurotypical (NT) peers. In a series of studies, we aimed to elucidated the effects of sex, age, and their interaction on health-related quality of life (HRQoL) and evaluated the effectiveness of mindfulness-based stress reduction (MBSR) for improving health-, disability-, and autism-related QoL, with possible sex and age outcome moderators, in adults with ASD.

Methods: Study 1 used the 36-Item Short Form Survey to compare mental and physical HRQoL composite scores in adults with ASD (n = 67) and matched NT adults (n = 66). Study 2 was a randomized pilot evaluation of the effect of MBSR, compared to an active control intervention with social support and relaxation education (support/education; n = 56), on the World Health Organization QoL BREF, Disability, and Autism-Specific scales in adults with ASD.

Results: In Study 1, we replicated findings that mental HRQoL is worse in both men and women with ASD, compared to NT counterparts, but physical HRQoL is only worse in women with ASD. We present novel findings that older age is associated with better mental HRQoL in women with ASD only. In Study 2, MBSR improved disability-related QoL in adults with ASD over and above the support/education intervention, but both interventions improved mental HRQoL. Lastly, both interventions were more effective for HRQoL improvements in women with ASD.

Conclusion: Findings encourage precision medicine approaches tailored to age and sex groups for best HRQoL outcomes in adults with ASD.

Clinicaltrials: gov Identifier: NCT04017793.

Keywords: Aging; Autism spectrum disorder; Mental health; Mindfulness; Quality of life; Sex differences.

Conflict of interest statement

Conflict of interest The authors have no conflicts to disclose.

© 2021. The Author(s), under exclusive licence to Springer Nature Switzerland AG.

Figures

Fig. 1

Consolidated standards of reporting trials (CONSORT) flow diagram

Fig. 2

A Mean (± SE) SF-36 physical composite scores (PCS) in ASD and NT groups separated by sex. Women with ASD had reduced physical health-related quality of life (HRQoL) compared to other groups. B The relationship between age and physical HRQoL across all participants shows worse physical HRQoL is associated with older age. C Mean (± SE) SF-36 mental composite scores (MCS) in ASD and NT groups separated by sex. Adults with ASD had reduced mental (HRQoL) with no sex differences. D The relationship between age and mental HRQoL in ASD and NT groups separated by sex. Only women with ASD show a significant positive association between age and mental HRQoL

Fig. 3

Pre- and post-intervention mean (± SE) WHOQOL scores in mindfulness-based stress reduction (MBSR) and support/education groups on A the BREF psychological domain, B self-report disability assessment schedule (DAS), and C proxy-report DAS. Both groups improved in mental health-related quality of life (HRQoL), but only the MBSR group improved in disability-related QoL

Fig. 4

Pre- and post-intervention mean (± SE) WHOQOL BREF scores in mindfulness-based stress reduction (MBSR) and support/education groups separated by sex on A the physical and B psychological domain. Women with ASD in both intervention groups improved in physical and mental HRQoL, but men did not significantly change