(PS2-62) Identifying the most relevant and impactful components of autistic burnout in autistic adults.

Autistic burnout (ABO) is a debilitating condition characterized by prolonged exhaustion resulting from the unique stressors and demands faced by autistic people navigating life in a systemically inaccessible neurotypical world (Raymaker et al. 2020). However, only within the past 5 years has academic literature on ABO emerged, with attempts to measure the unique components of the construct in their infancy (e.g., Mantzalas et al., 2024). Moreover, little work has yet disentangled the experience of ABO itself from its primary impacts on day-to-day life. Valid measures that capture the breadth of experiences associated with ABO, while identifying its most impairing components in distinction from other conditions that may present similarly (e.g. depression) are critically needed to inform treatment selection and avoid potential iatrogenic effects when working with autistic individuals.
Twenty-two autistic adults with personal experience of ABO completed an online survey prompting them to evaluate a series of 60 preliminary ABO self-report items (obtained from comprehensive review of published and unpublished literature to date). Participants rated how much each item (a) was Relevant to the experience of ABO and (b) described the Impact of ABO on their day-to-day life. Descriptive analyses were run to calculate average Relevance and Impact ratings for each item. Histograms of each of these average scores for each item were examined to identify if there were any “natural” cut points to distinguish “top” and “bottom” rated items (and discrepancies). If no clear-cut points were identified, the top and bottom 5 items for each rating were selected for interpretation.
No natural cut points in the distributions of average Relevance and Impact ratings were observed. The top and bottom 5 items for Relevance and for Impact were largely the same (e.g., top 3 items in both lists referring to “burned out”, “mentally exhausted”, and “draining” to “blend in” with others) , aside for a few exceptions (e.g., “I couldn't take care of my responsibilities...” item appearing in top 5 for Impact but not Relevance; Table 1). Additionally, most (but not all, see Table 2) items had higher average Relevance ratings than Impact ratings.
The top Relevance and Impact items captured various descriptions of exhaustion and its impact on one’s ability to complete obligations, including social expectations. Taken together, top-rated items represent a set of salient, face valid (to those with lived experience in the present sample) phenomena comprising a content valid operationalization of ABO. In particular, the item set describes pervasive exhaustion resulting from an intersection of both individual traits uniquely characteristic of autism and the unique stressors and demands faced by individuals who possess these traits in an exclusionary, inaccessible world. Measurement of ABO that captures this intersection and comports with lived experiences will be essential for neurodiversity-affirming assessment and case conceptualization, pointing toward tailored interventions for autistic adults that avoid perpetuating harmful expectations of neurotypicality while nonetheless empowering individuals to achieve their personal and community health goals.