Autscape2010
Stress in autistic people
1.Stress, cortisol and behaviour
2.Autism, sleep and Quality of Life
Mark Brosnan
M.J.Brosnan@Bath.ac.uk
1
Autscape2010
• Stress is the feeling of being under pressure. A
little bit of pressure can be motivating. However,
too much pressure or prolonged pressure can
lead to stress, which is unhealthy for the mind
and body. It can cause symptoms such as
difficulty concentrating and sleeping, sweating
and lack of appetite. Stress may cause further
health problems such as high blood pressure,
anxiety and depression (NHS, 2010).
2
Autscape2010
3
Autscape2010
• Alarm - detection of novelty
– ‘flight or fight’ response
– (or ‘fright, flight or fight’ response)
• Resistance – if the stressor persists the
stress needs to be coped with.
• Exhaustion – the body is no longer able to
cope with the stress
4
Autscape2010
• Detection of novelty (or unexpected
change) releases cortsiol (alarm)
– ‘The stress hormone’, detected in saliva
– Regulated by the brain (resistance)
– Amygdala Hippocampus
• The Cortisol Awakening Response (CAR)
• 2-3 times increase in cortisol in the first 30
minutes upon awakening, then decreases
over the day.
5
Autscape2010
• Typically, cortisol rises rapidly in the
morning and declines over the day
• Unexpected changes in routine can be
viewed as positive and can be motivating.
• The change would be detected (alarm cortisol rising), evaluated as nonthreatening (resistance - cortisol declining)
• What about autistic people?
6
Autscape2010
• Several studies report morning and
evening cortisol levels seem typical in
autistic people. One study found lower
levels of cortisol in autistic people.
• How can this be? Time of testing?
• We tested the Cortisol Awakening
Response (CAR) in 20 male students with
Asperger Syndrome
7
Autscape2010
8
Autscape2010
9
Autscape2010
• Autistic adults and children have been
found to display an exaggerated cortisol
response to stress compared to TD with a
mild stressor.
• Also to display a cortisol response when
no response is shown by TDs
• Could this be related to the lack of cortisol
awakening response?
10
Autscape2010
• Repetitive and restricted behaviours
(RRBs) are a core feature of ASD
• Described as a dysfunctional ability to
adapt to novel experiences and
environments, clinically referred to as a
‘need for sameness’ or ‘resistance to
change’ (APA, 2000; Kanner, 1943),
hereafter referred to an Insistence on
Sameness (IoS).
11
Autscape2010
6.00

4.00
•CAR
CAR (ng/ml)


2.00












0.00







2.00

-
4.00
6.00
8.00
Insistence on Sameness
•Insistence on Sameness
12
Autscape2010
• Hypothesis:
• The reduced Cortisol Awakening
Response results in a decreased ability to
regulate the cortisol stress response.
• Insistence on Sameness is a strategy to
reduce novelty (and consequently reduce
stress as it is difficult to regulate)
13
Autscape2010
• Parents and autistic people contacted me
as autistic people can report poor sleep
quality – is this related?
• Online survey to answer this question.
• ‘My aspie son can deal with some
changes and can be quite spontaneous
but after 7PM’ (Aspies for Freedom)
14
Autscape2010
• Quality of Life is central to well-being
• The World Health Organisation (WHO)
defines Quality of Life as an individual’s
perception of their position in life in the
context of the culture and value systems in
which they live and in relation to their
goals, expectations, standards and
concerns.
15
Autscape2010
• Improving quality of life is a universal goal and
does not assume ‘disability’.
• Research associated with quality of life for
autistic people is lacking.
• The WHO measure is an adequate and
appropriate instrument in the assessment of
caregivers of autistic children.
• Research is needed in order to include the
perspective of those with a diagnosis of ASD in
the evaluation of service provision.
16
Autscape2010
• In conclusion:
• Assessing quality of life in those with a
diagnosis of autism/ Asperger syndrome
using the WHO measure is the next step
• Understanding quality of life will enhance
well-being through a better understanding
of stress as perceived by those with a
diagnosis of autism/ asperger syndrome.
17
CyComp2010
•
•
•
•
Thank you for listening.
Do you have any questions or comments?
Contact: M.J.Brosnan@Bath.ac.uk
ASC sleep survey:
http://people.bath.ac.uk/pssmjb/
• ASC quality of life survey:
• Tinyurl.com/ascqol
18