The Role of Decision-Making in Psychological Wellbeing and Risky Behaviours in Autistic Adolescents Without ADHD: Longitudinal Evidence from the UK Millennium Cohort Study.
Mariko Hosozawa, William Mandy, Noriko Cable and 1 others
PMID 33196916WHAT IT FOUND
After accounting for background differences, autistic adolescents' decision quality was similar to peers, but they took longer to decide.
Only in autistic adolescents, longer deciding was linked with greater happiness, higher self-esteem, and fewer antisocial behaviours.
Key findings
01In the final analytic sample of 9,983 children, including 270 autistic and 9,713 typically developing children, autistic adolescents did not differ from peers in quality of decision-making at age 14 after accounting for background differences, but showed longer deliberation time and less reduction in deliberation time with age.
02Better quality of decision-making at age 14 was associated with better psychological wellbeing and fewer risky behaviours in both groups, and improvement between ages 11 and 14 was also associated with better wellbeing and fewer antisocial behaviours and drug use.
03Only in autistic adolescents, longer deliberation time at age 14 and change between ages 11 and 14 were associated with greater happiness, higher self-esteem, and fewer antisocial behaviours.
STILL TO COME
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What it does not show
Autism status came from parent report and was not externally confirmed. No autism symptom severity data were available, so differences within the autism group could not be examined. The analysis only included children who completed the gambling task at age 14, so it does not represent all cohort participants. The study assumes that taking longer to choose a box colour means more deliberation, but slower responses could also reflect perception, movement, mind wandering, or wanting to finish. Nearly 90% of autistic participants had normal-range cognitive ability, so findings may not apply to autistic adolescents with lower cognitive ability. Children with ADHD were excluded, and ADHD is common alongside autism, so findings may not apply across the autism spectrum. The gambling task had not been tested in autistic children or adolescents. The study is observational, so associations do not show that decision-making style caused wellbeing or behaviour outcomes.
Declared interests
Funding was named as ESRC and University College London. The paper does not state author conflicts of interest.
The easy way to misread this
Do not conclude that giving autistic adolescents more time will improve wellbeing or reduce antisocial behaviour. The study is observational and reports associations, not a tested intervention. The sample also excluded ADHD, and nearly 90% of autistic participants had normal-range cognitive ability, so it does not speak for all autistic adolescents.