Autistic adults experience diverse inner thought patterns, including inner speech and sensory awareness.
These internal experiences may influence their mental health and well-being in unique ways.
Studying this area provides insights into the autistic mind, challenges assumptions about visual thinking in autism, and could inform more effective mental health interventions.
Understanding these inner experiences is crucial for developing personalized support strategies and promoting well-being in the autistic community.
Mazurek, M. O., Pappagianopoulos, J., Brunt, S., Nevill, R., Menezes, M., Burroughs, C., ... & Howard, M. (2024). Inner experiences, mental health, and well‐being in autistic and non‐autistic adults. Autism Research. https://doi.org/10.1002/aur.3273
Key Points
- Autistic and non-autistic adults show similarities in overall patterns of inner thinking, but autistic adults report higher frequency of inner speaking and sensory awareness.
- Inner speaking was the most common primary mode of inner experience for both autistic (31%) and non-autistic (33.2%) adults.
- Fewer autistic adults (16.8%) reported feelings as their primary inner experience modality compared to non-autistic adults (28.4%).
- Autistic adults reported more frequent use of self-talk for social assessment, self-criticism, and self-management purposes compared to non-autistic adults.
- Experiencing thoughts as feelings was associated with depression and anxiety in both groups.
- Inner speaking was associated with anxiety in both groups but only with depression in non-autistic adults.
- Self-talk for social assessment and self-criticism purposes was associated with greater anxiety and depression in both groups.
- Self-talk for self-management was associated with anxiety and depression only in autistic adults.
- The study had limitations in generalizability due to the online survey format and exclusion of individuals with significant cognitive or language difficulties.
- This research provides new insights into the inner experiences of autistic adults and their relationship to mental health and well-being.
Rationale
The study aimed to address significant gaps in autism research by focusing on the experiences of autistic adults, particularly their inner experiences and mental health.
Despite autistic adults representing about 2.2% of the US population (Dietz et al., 2020), most autism research has not included adults (Howlin & Magiati, 2017; Kirby & McDonald, 2021).
This lack of representation contradicts the autism community’s expressed desire for research on lifespan issues, well-being, and mental health (Benevides et al., 2020; Gotham et al., 2015; Robertson, 2010; Roche et al., 2021).
The researchers sought to explore the range of internal experiences among autistic adults, compare them to non-autistic adults, and investigate their relationship to mental health outcomes.
This approach aligns with the neurodiversity perspective, which frames autism as a difference rather than a deficit (Blume, 1998; Den Houting, 2019).
The study aimed to contribute to a more comprehensive understanding of autistic experiences beyond the diagnostic criteria, addressing the limited research on everyday inner experiences of autistic adults.
Method
The study employed a cross-sectional, comparative design using online surveys to collect data from autistic and non-autistic adults.
Participants completed measures assessing inner experiences, self-talk, mental health, and well-being.
Procedure
Participants were recruited through various online platforms and completed a series of online surveys.
The autistic group was recruited through the SPARK ResearchMatch process, while the non-autistic group was recruited through Amazon Mechanical Turk and ResearchMatch.
Sample
The study included 592 adults (ages 21-82 years, M = 38.6, SD = 12.9) in the United States.
The sample comprised 303 autistic adults and 289 non-autistic adults.
Participants were predominantly White (77.4%) and cisgender women (52.2%).
Measures
- Demographic survey
- Autism Spectrum Quotient–Short (AQ-Short)
- Nevada Inner Experience Questionnaire (NIEQ)
- Self-Talk Scale (STS)
- Patient Health Questionnaire Anxiety-Depression Scale (PHQ-ADS)
- Satisfaction with Life Scale (SWLS)
- Subjective Happiness Scale (SHS)
Statistical measures
The study used descriptive statistics, Mann-Whitney U tests, chi-square tests, Pearson’s correlations with Bonferroni corrections, Fisher’s r to z transformations, and multiple linear regressions for data analysis.
Results
- Autistic adults reported higher frequency of inner speaking and sensory awareness compared to non-autistic adults.
- Inner speaking was the most common primary mode of inner experience for both autistic (31%) and non-autistic (33.2%) adults.
- Fewer autistic adults (16.8%) reported feelings as their primary inner experience modality compared to non-autistic adults (28.4%).
- Autistic adults reported more frequent use of self-talk for social assessment, self-criticism, and self-management purposes compared to non-autistic adults.
- Experiencing thoughts as feelings was associated with anxiety and depression in both autistic and non-autistic groups.
- Inner speaking was associated with anxiety in both groups but only with depression in non-autistic adults.
- Self-talk for social assessment and self-criticism purposes was associated with greater anxiety and depression in both autistic and non-autistic groups.
- Self-talk for self-management was associated with anxiety and depression only in autistic adults.
- Unsymbolized thinking was associated with both internalizing symptoms and subjective happiness in non-autistic adults, but not in autistic adults.
- None of the inner experience or self-talk variables were significantly associated with measures of well-being (life satisfaction and subjective happiness) in autistic adults.
- Multiple regression analyses revealed that experiencing thoughts as feelings was predictive of both depression and anxiety in both groups.
- In non-autistic adults, unsymbolized thinking was predictive of depression, anxiety, life satisfaction, and subjective happiness, while these associations were not found in autistic adults.
Insight
This study provides novel insights into the inner experiences of autistic adults and their relationship to mental health.
Contrary to prevailing views, autistic adults reported a higher frequency of inner speaking compared to non-autistic adults, challenging assumptions about visual thinking dominance in autism.
The findings suggest that autistic adults may use self-talk strategies more frequently to navigate social situations and manage daily challenges, possibly as a compensatory mechanism for executive functioning difficulties.
The association between certain types of self-talk and negative mental health outcomes in autistic adults highlights the complex relationship between inner experiences and well-being.
This complexity underscores the need for personalized approaches in mental health treatment for autistic individuals, considering their unique patterns of inner experiences.
The study extends previous research by focusing on everyday inner experiences rather than task-specific cognitive processes, providing a more holistic view of autistic thinking patterns.
Future research could explore the qualitative differences in inner speech between autistic and non-autistic individuals, such as the distinction between dialogic and monologic internal speech.
Implications
The findings have significant implications for clinical practice and future research in autism.
Mental health professionals working with autistic adults should consider the role of inner experiences and self-talk patterns in assessment and treatment planning.
Therapeutic approaches that address negative self-talk and promote adaptive use of inner speech might be particularly beneficial for autistic individuals.
For researchers, this study opens new avenues for investigating the relationship between inner experiences, cognitive processes, and mental health in autism.
Future studies could employ longitudinal designs to examine how these patterns change over time and their long-term impact on well-being.
The higher prevalence of self-critical self-talk among autistic adults suggests a need for interventions addressing internalized stigma and promoting self-acceptance within the autistic community.
Additionally, the findings highlight the importance of developing strategies to support autistic adults in managing social interactions and daily tasks without exacerbating anxiety or depression.
Strengths
This study had several methodological strengths, including:
- Large sample size including both autistic and non-autistic adults
- Use of validated measures for assessing inner experiences and mental health
- Consideration of multiple aspects of inner experiences beyond just inner speech
- Inclusion of both mental health symptoms and well-being measures
- Analysis of associations between inner experiences and mental health outcomes
- Comparison between autistic and non-autistic groups, allowing for identification of autism-specific patterns
Limitations
The study’s online survey format may have excluded individuals with significant cognitive or language difficulties, limiting generalizability to the broader autism spectrum.
The sample was predominantly White and included a high proportion of cisgender women, which may not fully represent the diverse autism community.
The cross-sectional design prevents determination of causal relationships between inner experiences and mental health outcomes.
Self-report measures, while valuable, may not capture the full complexity of inner experiences and are subject to recall bias.
The study did not include individuals with legal guardians, potentially excluding those with more significant support needs.
This limitation means the findings may not apply to autistic individuals across the full spectrum of abilities and support needs.
Future research should address these limitations by including more diverse samples, employing multiple assessment methods (e.g., qualitative interviews, ecological momentary assessment), and using longitudinal designs to better understand the dynamics of inner experiences and mental health in autism.
References
Primary reference
Mazurek, M. O., Pappagianopoulos, J., Brunt, S., Nevill, R., Menezes, M., Burroughs, C., … & Howard, M. (2024). Inner experiences, mental health, and well‐being in autistic and non‐autistic adults. Autism Research. https://doi.org/10.1002/aur.3273
Other references
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: American Psychiatric Publishing.
Benevides, T. W., Shore, S. M., Andresen, M. L., Caplan, R., Cook, B., Gassner, D. L., … & Wittig, K. (2020). Interventions to address health outcomes among autistic adults: A systematic review. Autism, 24(6), 1345-1359. https://doi.org/10.1177/1362361320913664
Bird, G., & Cook, R. (2013). Mixed emotions: the contribution of alexithymia to the emotional symptoms of autism. Translational psychiatry, 3(7), e285-e285. https://doi.org/10.1038/tp.2013.61
Blume, H. (1998). Neurodiversity: On the neurological underpinnings of geekdom. The Atlantic, 30, 1-6.
Den Houting, J. (2019). Neurodiversity: An insider’s perspective. Autism, 23(2), 271-273.
Dietz, P. M., Rose, C. E., McArthur, D., & Maenner, M. (2020). National and state estimates of adults with autism spectrum disorder. Journal of autism and developmental disorders, 50, 4258-4266. https://doi.org/10.1007/s10803-020-04494-4
Gotham, K., Marvin, A. R., Taylor, J. L., Warren, Z., Anderson, C. M., Law, P. A., … & Lipkin, P. H. (2015). Characterizing the daily life, needs, and priorities of adults with autism spectrum disorder from Interactive Autism Network data. Autism, 19(7), 794-804. https://doi.org/10.1177/1362361315583818
Grandin, T. (2006). Thinking in pictures: And other reports from my life with autism. Vintage.
Howlin, P., & Magiati, I. (2017). Autism spectrum disorder: Outcomes in adulthood. Current opinion in psychiatry, 30(2), 69-76.
Kirby, A. V., & McDonald, K. E. (2021). Engaging autistic adults in research: Implications for responsible inclusion practices. Autism in Adulthood, 3(1), 80-92.
Robertson, S. M. (2010). Neurodiversity, quality of life, and autistic adults: Shifting research and professional focuses onto real-life challenges. Disability Studies Quarterly, 30(1). https://doi.org/10.18061/dsq.v30i1.1069
Roche, L., Adams, D., & Clark, M. (2021). Research priorities of the autism community: A systematic review of key stakeholder perspectives. Autism, 25(2), 336-348. https://doi.org/10.1177/1362361320967790
Keep Learning
- How might the differences in inner experiences between autistic and non-autistic adults inform our understanding of neurodiversity?
- What are the potential implications of higher rates of self-critical self-talk among autistic adults for mental health interventions?
- How could future research address the limitations of self-report measures in studying inner experiences?
- In what ways might the relationship between inner experiences and mental health differ across the autism spectrum, including those with more significant support needs?
- How could the findings on self-talk patterns in autistic adults be applied to develop more effective social skills interventions?
