Understanding self-reported difficulties in decision-making by people with autism spectrum disorders

Abstract

Autobiographical accounts and a limited research literature suggest that adults with autism spectrum disorders can experience difficulties with decision-making. We examined whether some of the difficulties they describe correspond to quantifiable differences in decision-making when compared to adults in the general population. The participants (38 intellectually able adults with autism spectrum disorders and 40 neurotypical adults) were assessed on three tasks of decision-making (Iowa Gambling Task, Cambridge Gamble Task and Information Sampling Task), which quantified, respectively, decision-making performance and relative attention to negative and positive outcomes, speed and flexibility, and information sampling. As a caution, all analyses were repeated with a subset of participants ( n = 29 and n = 39) who were not taking antidepressant or anxiolytic medication. Compared to the neurotypical participants, participants with autism spectrum disorders demonstrated slower decision-making on the Cambridge Gamble Task, and superior performance on the Iowa Gambling Task. When those taking the medications were excluded, participants with autism spectrum disorders also sampled more information. There were no other differences between the groups. These processing tendencies may contribute to the difficulties self-reported in some contexts; however, the results also highlight strengths in autism spectrum disorders, such as a more logical approach to, and care in, decision-making. The findings lead to recommendations for how adults with autism spectrum disorders may be better supported with decision-making.

The Role of Decision-Making in Psychological Wellbeing and Risky Behaviours in Autistic Adolescents Without ADHD: Longitudinal Evidence from the UK Millennium Cohort Study

“…Our finding that quality of decision-making at both ages 11 and 14 was comparable between groups indicates that autistic adolescents have the same ability as their TD peers to make good decisions, at least during an experimental decision-making task. Our result is in line with another study using the CGT in adults which found similar performance between autistic and comparison groups (Vella et al, 2018). However, our result contradicts findings from other studies, including from a recent cross-sectional study that showed inferior quality of decision-making throughout from age 7 to age 10 in children with autism (Kouklari et al, 2019).…”

“…Despite the lack of research on 'naturally-occuring' within-person change in 'objectively measured' decision-making in young people with ASD, there is much experimental research investigating differences in such decision-making between autistic and typically developing individuals in both childhood and adulthood. However, results are largely mixed for both children (Faja, Murias, Beauchaine, & Dawson, 2013;Johnson et al, 2006;Mussey, Travers, Klinger, & Klinger, 2015;South et al, 2014;Yechiam, Arshavsky, Shamay-Tsoory, Yaniv, & Aharon, 2010) and adults (South et al, 2008;Vella et al, 2018), with some studies reporting deficits and others reporting no differences (Vella et al, 2018). For example, a recent metaanalysis of studies using the Iowa Gambling Task (IGT), a widely used gambling task in studies of both typically developing individuals and those with neurodevelopmental conditions including ASD, showed that autistic people do not differ in IGT performance (Zeif & Yechiam, 2020).…”

“…Therefore, using tasks that are minimally sensitive to 'learning' -such as the Cambridge Gambling Task (CGT) -and assessing both accuracy and speed of decision-making may better capture the decision-making skills of autistic people (Deakin, Aitken, Robbins, & Sahakian, 2004). To date, only one study, with adults, has used the CGT in this population (Vella et al, 2018), and showed that quality of decisionmaking was similar to that of the comparison group but deliberation time was longer. The researchers hypothesized that a 'deliberative decision-making style' may be beneficial in some situations for autistic people but may also be exactly what underlies their difficulties in social contexts where rapid and intuitive reasoning is needed to make effective and efficient decisions.…”

“…Due to lack of previous research we were not able to make specific predictions about either developmental change in the CGT or its links with psychological and behavioural outcomes in autistic adolescents. However, based on the one study to date using the CGT in autistic adults (Vella et al, 2018), we hypothesized that deliberation time would be longer in autistic adolescents. We also expected that it would be associated with less risky behaviour in them.…”

An exploration from a life course perspective of the transition from school for autistic young people ​​​​​​​

“…Difficulties for autistic young people without intellectual impairment when engaging in decision-making processes generally relate to anxiety and inflexible thinking (Luke, Clare, Ring, Redley & Watson, 2012;Vella et al, 2017). However, current legislation and policies typically "seek to promote autonomous decision-making by adults with capacity" (Luke, Clare, Ring, Redley & Watson, 2012, p. 613).…”