Higher risk of anxiety for autistic middle-aged and older adults

Middle-aged and older adults with higher autistic traits are four times more likely to report worsening anxiety with age, according to a new study by King’s College London and University College London.

The study, led by researchers at the Institute of Psychiatry, Psychology & Neuroscience (IoPPN), was published in Nature Mental Health. It also highlights the potential value of adapted psychological therapies, such as tailored cognitive behavioural therapy (CBT), for this group, which could help prevent mild anxiety from becoming severe.

The majority of research on autism and anxiety has focused on children and young adults, but the authors say this study highlights the importance of early identification of anxiety among older autistic people and those with high autistic traits.

This age group is important because many older adults with autistic traits remain undiagnosed. Estimates from the study suggest that up to 9 in 10 may not have a formal diagnosis. Without robust evidence, health services may struggle to recognise their needs or provide appropriate support. Recognising this early and providing the right support could make a significant difference to the mental health and quality of life of this vulnerable minority.

Dr Gavin Stewart, senior author and Postdoctoral Research Fellow at the IoPPN, said: “Anxiety is a high priority concern raised by autistic people. Our study found that middle-aged and older adults with high autistic traits were more than four times more likely to develop clinically significant anxiety over time, even after taking other factors into account. They were also twice as likely to experience persistent low-level anxiety than those with low autistic traits. Even mild anxiety should be taken seriously, as it may increase over time.”

Autistic traits and anxiety in later life

Data were taken from the PROTECT study, a large UK-wide online study of ageing and health that includes over 5,000 adults aged 50–91 (average age 62). Participants were followed up over eight years, with annual assessments measuring autistic traits and general anxiety symptoms. Instead of looking only at average trends, the team used an advanced statistical method (growth mixture modelling) to identify different patterns of anxiety over time.

The researchers identified three distinct groups based on the patterns of their anxiety responses as people aged:

• The large majority of participants (85.5%) have very low anxiety levels that remain stable over the eight years of the study.
• 12.4% had slightly higher but still low anxiety that was also stable throughout the eight years of the study.
• A small group (2%) experienced anxiety that increased over the eight years, from mild to clinically significant levels.
• While people with high autistic traits were found across these three groups, they were 4 times more likely to be in the third group.

The researchers suggest several possible reasons why people with autistic traits may be at greater risk, including: higher levels of loneliness or social isolation, greater exposure to stress or trauma over the lifetime and barriers to healthcare, meaning anxiety may go untreated. Over time, these factors may combine, leading to worsening mental health as people age.

Dr Amber John, co-author and Senior Lecturer at the University of Liverpool, said: “These findings have important implications for healthcare providers and policymakers. There is an urgent need for tailored support for autistic adults. Researchers, clinicians and health policymakers should aim to collaborate with autistic people where possible, as their lived experience affords vital insight into their support needs during the transition into midlife and older age.”

Alison Bloomer

Alison Bloomer is Editor of Learning Disability Today.

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