Enhancing the mental health and well-being of aging autistic adults

Autism spectrum disorder (ASD) is a neurodevelopmental disorder characterized by social-communication difficulties and restricted, repetitive behaviors and interests. Although initially conceptualized as a childhood disorder, ASD is a lifelong condition affecting between one and two percent of adults in the US. This session features a combination of findings from cross-sectional and longitudinal studies of autistic adults, focusing on psychiatric co-occurring conditions, functioning, and cognition. The session begins with an introduction to psychiatric conditions in autistic adults, specifically anxiety, one of the most common psychiatric illnesses in ASD. Anxiety disorders can present in unique ways that do not fit into DSM 5 diagnostic categories. Although there have not been many robust medication trials for anxiety in autistic adults, slow, careful titration of SSRIs, propranolol, and alpha agonists can be effective. There is also anecdotal evidence for cannabidiol to treat anxiety in ASD. Treatment of anxiety should include assessment of the environment and caregiver approach, psychotherapy, and occupational therapy in many cases. The next session presents findings from a cross-sectional study of psychiatric and medical morbidity in over 6,000 independent autistic adults in a US research cohort, 13% of whom are age 50 and older. The older participants were less likely to have a reported mood or anxiety disorder yet more likely to have sleep disorders/problems. Next, a longitudinal study of 406 individuals with ASD estimates developmental trajectories into early old age, as very few studies have examined longitudinal changes in ASD. In this study, results suggested that most autism symptoms improved through adulthood, while health worsened, and although functioning improved from adolescence until midlife, it leveled off and then worsened. Autistic adults without intellectual disability (ID) had increased somatic medication use and worsening repetitive behaviors, compared to those without ID. The final session presents data from longitudinal cognitive and brain aging studies in middle-age and older adults with ASD. Older autistic adults show accelerated decline of memory and hippocampal volume and have challenges in executive functioning. The research group also developed a meaningful support program of social strategies, mindfulness, and cognitive training, which showed feasibility and improvements in functional independence and quality of life.