Repetitive negative thinking (RNT) in autism involves persistent, intrusive thoughts focused on negative experiences or concerns.
This includes rumination, where individuals dwell on past events or problems, and obsessive thinking.
For autistic individuals, RNT may be more intense or frequent, potentially exacerbating anxiety and depression.
This cognitive pattern can amplify distress, interfere with problem-solving, and contribute to higher rates of mental health issues in the autistic population.
Cooper, K., & Russell, A. (2024). Insistence on sameness, repetitive negative thinking and mental health in autistic and non-autistic adults. Autism, 13623613241275468. https://doi.org/10.1177/13623613241275468
Key Points
- Autistic adults experience higher rates of mental health problems compared to non-autistic adults, with repetitive negative thinking (RNT) potentially contributing to this difference.
- Insistence on sameness, a core feature of autism, was associated with higher levels of depression and anxiety, mediated by RNT (rumination and obsessing).
- Autistic community participants showed significantly higher levels of insistence on sameness, rumination, and obsessing compared to non-autistic community participants.
- The study supports a transdiagnostic approach to understanding mental health in autistic individuals, highlighting the importance of considering RNT in assessments and interventions.
- The research suggests that cognitive processes underlying depression and anxiety may be similar for autistic and non-autistic individuals, influenced by restricted and repetitive behaviors across neurotypes.
Rationale
Autistic individuals experience higher rates of mental health problems, with a lifetime prevalence of 42% for anxiety conditions and 37% for depression (Hollocks et al., 2019).
While multiple factors contribute to this elevated risk, repetitive cognitive processes like worry and rumination have been associated with anxiety and depression in autistic people (Gotham et al., 2014; van Heijst et al., 2020).
However, these processes are understudied as transdiagnostic factors in mental health problems for autistic individuals.
This study aimed to investigate repetitive negative thinking (RNT) as an important transdiagnostic factor in common mental health problems for autistic and non-autistic adults, exploring the relationships between insistence on sameness, RNT, and depression-anxiety.
Method
The study employed a cross-sectional design using self-report measures to assess insistence on sameness, depression-anxiety, rumination, and obsessing in autistic and non-autistic adults.
Procedure
Participants completed questionnaires either via tablet, paper copies, or online through Qualtrics, depending on their preference and study group.
Sample
The study included 187 adults aged 18 years and older, divided into three groups:
- Autistic clinical cohort (n=67): Recruited from clinical settings with moderate-to-severe depression
- Autistic community participants (n=54): Recruited from community settings
- Non-autistic community participants (n=66): Recruited from community settings
Measures
- Demographics questionnaire
- Adult Repetitive Behaviours Questionnaire (RBQ-2A) – Insistence on sameness subscale: Measures higher-order repetitive behaviors including routines and special interests.
- Patient Health Questionnaire Anxiety-Depression Scale (PHQ-ADS): Assesses symptoms of anxiety and depression, combining the widely used GAD-7 and PHQ-9 measures into a single questionnaire.
- Obsessing subscale of the Obsessive-Compulsive Inventory (OCI-R): Evaluates the presence and severity of obsessive thoughts, a key symptom of obsessive-compulsive disorder.
- Rumination subscale of the Rumination-Reflection Questionnaire (RRQ): Measures the tendency to engage in repetitive, passive focus on one’s negative emotions and their possible causes and consequences.
Statistical measures:
- Preliminary correlations
- One-way multivariate analysis of variance (MANOVA)
- Parallel mediation analysis using the PROCESS macro in SPSS
Results
- Hypothesis 1: Autistic community participants had significantly higher insistence on sameness scores than non-autistic community participants (p<.001, η2=.55).
- Hypothesis 2: Autistic community participants had significantly higher rumination scores (p<.001, η2=.28) and obsessing scores (p<.001, η2=.37) than non-autistic community participants.
- Hypothesis 3: The mediation analysis showed that the relationship between insistence on sameness and depression-anxiety was significantly mediated by both rumination and obsessing in the full neurodiverse sample.
Insight:
This study provides evidence that repetitive negative thinking (RNT) is an important transdiagnostic factor in common mental health problems for both autistic and non-autistic adults.
The findings suggest that higher rates of insistence on sameness, whether in individuals with an autism diagnosis or those experiencing high insistence on sameness without a diagnosis, increase the risk of depression and anxiety through RNT processes.
This extends previous research by demonstrating that the cognitive processes underlying depression and anxiety may be similar for autistic and non-autistic individuals, influenced by restricted and repetitive behaviors across neurotypes.
Future research could focus on developing and testing interventions specifically targeting RNT in autistic individuals or investigating the role of other potential mediating factors, such as executive functioning or social cognition, in the relationship between autism traits and mental health outcomes.
Implications
The findings have significant implications for clinical practice and future research.
For clinical practice, the results suggest that mental health assessments and interventions for autistic people should consider transdiagnostic factors, including multiple forms of repetitive negative cognition and behavior.
This approach may lead to more efficient and effective treatments that address both anxiety and depression simultaneously.
For future research, the study highlights the need for further investigation into the mechanisms underlying the relationship between autism traits, RNT, and mental health outcomes.
Additionally, the development and evaluation of targeted interventions for RNT in autistic individuals could be a promising avenue for improving mental health outcomes in this population.
Strengths
This study had several methodological strengths, including:
- The study used a neurodiverse sample, including both autistic and non-autistic participants, allowing for comparisons between groups.
- The research employed validated measures for assessing insistence on sameness, depression-anxiety, rumination, and obsessing.
- The study took a transdiagnostic approach, considering both depression and anxiety symptoms together.
- The inclusion of both clinical and community samples of autistic participants provided a more comprehensive view of the relationships between variables across different levels of symptom severity.
Limitations
This study also had several methodological limitations, including:
- The convenience sample limits the generalizability of the findings to the wider population, particularly due to the predominantly White sample and highly educated non-autistic community participants.
- The cross-sectional design does not allow for the establishment of causality or directionality in the relationships between variables.
- The study did not include a comprehensive measure of OCD symptoms, limiting the analysis to anxiety and depression.
- The mediation analysis included all participant groups, which may have influenced the results due to the inclusion of the clinical cohort with moderate-to-severe depression.
References
Primary reference
Cooper, K., & Russell, A. (2024). Insistence on sameness, repetitive negative thinking and mental health in autistic and non-autistic adults. Autism, 13623613241275468. https://doi.org/10.1177/13623613241275468
Other references
Gotham, K., Bishop, S. L., Brunwasser, S., & Lord, C. (2014). Rumination and perceived impairment associated with depressive symptoms in a verbal adolescent–adult ASD sample. Autism Research, 7(3), 381-391. https://doi.org/10.1002/aur.1377
Hollocks, M. J., Lerh, J. W., Magiati, I., Meiser-Stedman, R., & Brugha, T. S. (2019). Anxiety and depression in adults with autism spectrum disorder: a systematic review and meta-analysis. Psychological medicine, 49(4), 559-572.
van Heijst, B. F., Deserno, M. K., Rhebergen, D., & Geurts, H. M. (2020). Autism and depression are connected: A report of two complimentary network studies. Autism, 24(3), 680-692.
https://doi.org/10.1177/1362361319872373
Keep Learning
- How might the relationship between insistence on sameness and mental health outcomes differ across the lifespan for autistic individuals?
- What are the potential cultural differences in the manifestation of repetitive negative thinking among autistic individuals, and how might this impact mental health interventions?
- How can we effectively adapt existing interventions for repetitive negative thinking to better suit the needs of autistic individuals?
- What role might special interests play in moderating the relationship between insistence on sameness and mental health outcomes in autistic individuals?
- How does the inclusion of autistic individuals in research design and implementation impact the validity and applicability of mental health studies in autism?
