Autism and anxiety: are key diagnostic 'deficit criteria' actually effective strategies for the self-management of anxiety in autistic adults?

AIM
The aim is to explore whether key autism diagnostic criteria, often seen as deficit traits or behaviours, are actually effective strategies for reducing anxiety in autistic individuals. For instance, "persistent deficits in social communication and social interaction," "restricted, repetitive patterns" and "insistence on sameness" may all be necessary strategies in reducing levels of novel or challenging stimuli to be processed and thus, reducing anxiety.

RESEARCH QUESTIONS
1. Are 'spending time alone,' 'following routines' and 'creating or finding a preferred sensory environment' strategies which autistic adults use to reduce anxiety?
2. How do autistic adults use these strategies in their day-to-day life?
3. Is there a correlation between using these strategies and self-reported anxiety levels?

METHODOLOGY
This proposal is for an exploratory sequential study within a participatory framework in order to actively involve stakeholder individuals in the research; generating evidence which may be viewed as more credible to community members, and so more likely to bring about change. While the student will have a reflexive stance as an autistic researcher, additional stakeholder input throughout the study design is important for the validity and reach of this project. An initial qualitative study will explore participants' previous experiences of using the outlined strategies and inform quantitative work designed to measure the effectiveness of prioritising these strategies.

Depending on participatory group input, qualitative data will be collected from 15 recorded and transcribed semi-structured interviews, and/or researcher directed written diaries to explore how and why autistic people might spend time alone, follow routines and create or find preferred sensory environments to reduce anxiety. The sample size is large enough to demonstrate patterns across the dataset but small enough to focus on individual experiences. Autism research studies, both qualitative and quantitative, commonly recruit participants via social media where the range and diversity of genders, ages, ethnicities and incomes are likely to be varied.

Thematic analysis of the qualitative data will inform development of an online questionnaire developed with the participatory group to measure how effective adult autistic participants feel the outlined strategies are in reducing anxiety. This questionnaire, repeated twice at two-monthly intervals to compare results, will incorporate the Depression, Anxiety and Stress Scale (DASS-21) as used by other studies with autistic adults for its reliability and validity. 250 participants will be recruited, with an expected drop-off of 50%, to have 120 completed surveys, similarly to other studies with autistic adults. To increase the educational diversity of participants a range of options such as read-aloud features may be offered, in line with recommended practice-based guidelines for including autistic adults in research. Responses to survey questions will be summarised using descriptive statistics. To address the question of correlations between the outlined strategies and self-reported anxiety, the questionnaire results will be analysed using multivariate regression, controlling for potential confounders such as age, gender and education.