People with high autistic traits face worsening anxiety in older age

A major UK study has found that while most middle-aged and older adults experience low levels of anxiety, a small group of people with higher autistic traits are much more likely to report that their anxiety worsens as they age. 

The study was led by researchers at the Institute of Psychiatry, Psychology & Neuroscience (IoPPN) at King's College London and University College London and published in Nature Mental Health. 

Anxiety is one of the most common mental health conditions and is especially prevalent among autistic people. It has also been identified as one of the top two priorities in autism research by autistic people . 

However, most research to date has focused on children and younger adults. Much less is known about how anxiety develops later in life, particularly for people who may be autistic but have never received a diagnosis. This gap is important because many older adults with autistic traits remain undiagnosed – King's research has estimated up to 9 in 10 may not have a formal diagnosis. Without good evidence, health services may struggle to recognise their needs or provide appropriate support. 

Researchers analyzed data from the PROTECT study, a large UK-wide online study of ageing and health which included 5,270 adults aged 50–91 (average age 62). The PROTECT study is run by King's College London and the University of Exeter. 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 remains 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. 

Although this third group was small, it is important because it represents people whose mental health worsens in later life. The findings highlight the importance of early identification of anxiety in autistic people and people with high autistic traits. 

This large study shows that while most people maintain low anxiety in later life, a vulnerable minority especially those with higher autistic traits, face a growing risk of worsening anxiety. Recognising this early and providing the right support could make a significant difference to mental health and quality of life in older age. 

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." 

Dr. Gavin Stewart, senior author and Postdoctoral Research Fellow at the IoPPN

Professor Josh Stott, co-senior author and Professor of Ageing and Clinical Psychology at UCL, said: "It is also important that clinicians are autism-aware, as many autistic people are likely to be undiagnosed but still needing appropriate help and support for their mental health, particularly as they age." 

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." 

The study also highlights the potential value of adapted psychological therapies, such as tailored cognitive behavioral therapy (CBT), for this group which could help prevent mild anxiety from becoming severe. 

This research was funded by the Dunhill Medical Trust (now Vivensa Foundation), the British Academy, the National Institute for Health and Care Research (NIHR), the NIHR Maudsley Biomedical Research Centre, the NIHR Exeter BRC, the NIHR Applied Research Collaboration (ARC) South West, formerly ARC South West Peninsula and the NIHR Exeter Clinical Research Facility.