Social and nonsocial reward moderate the relation between autism symptoms and loneliness in adults with ASD, depression, and controls

Abstract

Individuals with autism spectrum disorder (ASD) report high levels of co-occurring mood disorders. Previous work suggests that people with ASD also experience aberrant responses to social reward compared to typically developing (TD) peers. In the TD population, aberrant reward processing has been linked to anhedonia (i.e., loss of pleasure), which is a hallmark feature of depression. This study examined the interplay between self-reported pleasure from social and non-social rewards, autism symptom severity, loneliness, and depressive symptoms across adults with autism spectrum disorder (ASD; N=49), TD currently depressed adults (TD-dep; N=30), and TD never depressed controls (TD-con; N=28). The ASD cohort reported levels of social and non-social anhedonia that were greater than TD-con but not significantly different from TD-dep. Across cohorts, both social and non-social hedonic capacity moderated the relationship between autism symptoms and loneliness: individuals with low capacity for pleasure experienced elevated loneliness regardless of autism symptom severity, while those with intact capacity for pleasure (i.e., less anhedonia) experienced greater loneliness as a function of increased autism symptoms. Loneliness was the strongest predictor of depressive symptoms across clinical cohorts. Our findings suggest a putative pathway from trait-like anhedonia in ASD to depression via elevated loneliness and indicate that variability in hedonic capacity within the autism spectrum may differentially confer risk for depression in adults with ASD. Results underscore potential mental health benefits of social skills interventions and community inclusion programs for adults with ASD.

Socio-emotional determinants of depressive symptoms in adolescents and adults with autism spectrum disorder: A systematic review

“…Rich & Scovel, 1987). In ASD samples, loneliness has been associated with depression, aberrant responses to social reward, and thoughts of self-harm (Han et al, 2019; Hedley et al, 2018b). In this moderated mediation model (Figure 3), the indirect effect of the social deficit (a) on depression (c) would be predicted to be significant via loneliness (b) in cases where social motivation is intact, whereas the model would not hold in individuals with severely diminished social motivation (Kline, 2011).…”

Measuring Depression in Autistic Adults: Psychometric Validation of the Beck Depression Inventory–II

“…Participants with ASD were drawn primarily from the Simons Foundation Powering Autism Research for Knowledge (SPARK) cohort, a U.S.-based online community that allows people with ASD and their families to participate in ASD research studies (Feliciano et al, 2018). These data were combined with a well-characterized community sample of adults with and without ASD who completed paper-and-pencil BDI-II forms as part of laboratory studies conducted at Vanderbilt University Medical Center (Gotham et al, 2018;Han et al, 2019;Unruh et al, 2018). To construct a sample of TD adults large enough for adequate DIF testing, BDI-II data from a general population comparison group were drawn from four online studies of cognitive biases and depressive symptoms that recruited participants using Amazon's Mechanical Turk (MTurk;Everaert et al, 2018Everaert et al, , 2020Everaert & Joormann, 2019).…”

Depression in Youth with Autism Spectrum Disorder

“…33 • Social motivation: A desire to make meaningful connections paired with social communication impairments and negative social feedback in ASD could increase risk for depression. 34,35 In adults with ASD as a proxy, greater social interest was associated with loneliness 36 , and loneliness in turn has been associated with higher rates of depression and suicidality in individuals with ASD. [36][37][38] External variables that may function as vulnerability factors for depression in ASD…”