Abstract
This study evaluated the suitability of an unpublished autistic burnout assessment tool, focusing on autistic women. Distinguishing autistic burnout from conditions like depression or anxiety is crucial for effective interventions, emphasizing the need for nuanced research and refined measures in understanding and addressing autistic burnout. The Dutch version of the AASPIRE Autistic Burnout Measure (AABM-NL) was evaluated within a sample of 45 autistic women from the Autism Expertise Center. Preliminary findings of the AABM-NL scores demonstrated promising evidence of good internal consistency and convergent validity. Positive associations were observed between AABM-NL scores and a Likert scale assessing identification with autistic burnout, as well as with an instrument measuring physical and psychological complaints (SCL-90-R; Symptom Checklist-90-Revised). Specifically, anxiety, somatization, cognitive-performance deficits, and depression were correlated with the severity of autistic burnout. There was no significant difference between work status and the severity of autistic burnout, implying no employment-related connection. The AABM-NL effectively differentiated between women with and without autistic burnout, with 62 points as a suitable cut-off point. However, these results may not be generalized to women requiring daily living support, individuals beyond outpatient psychiatric settings, or those in institutionalized populations. The preliminary findings provide empirical evidence supporting the use of the AABM-NL as a potential tool for assessing autistic burnout in women receiving outpatient psychiatric care. Its implementation may contribute to programs aimed at recognizing and preventing autistic burnout in women. Further research is needed to enhance intervention strategies for mitigating the risk of autistic burnout.
![](https://cdn.statically.io/img/media.springernature.com/m312/springer-static/image/art%3A10.1007%2Fs10803-024-06438-8/MediaObjects/10803_2024_6438_Fig1_HTML.png)
![](https://cdn.statically.io/img/media.springernature.com/m312/springer-static/image/art%3A10.1007%2Fs10803-024-06438-8/MediaObjects/10803_2024_6438_Fig2_HTML.png)
![](https://cdn.statically.io/img/media.springernature.com/m312/springer-static/image/art%3A10.1007%2Fs10803-024-06438-8/MediaObjects/10803_2024_6438_Fig3_HTML.png)
![](https://cdn.statically.io/img/media.springernature.com/m312/springer-static/image/art%3A10.1007%2Fs10803-024-06438-8/MediaObjects/10803_2024_6438_Fig4_HTML.png)
![](https://cdn.statically.io/img/media.springernature.com/m312/springer-static/image/art%3A10.1007%2Fs10803-024-06438-8/MediaObjects/10803_2024_6438_Fig5_HTML.png)
![](https://cdn.statically.io/img/media.springernature.com/m312/springer-static/image/art%3A10.1007%2Fs10803-024-06438-8/MediaObjects/10803_2024_6438_Fig6_HTML.png)
Similar content being viewed by others
Data Availability
The data supporting the findings of this study are available from the corresponding author upon reasonable request.
References
American Psychiatric Association (2013). Diagnostic and statistical manual of mental disorders (5th ed.). https://doi.org/10.1176/appi.books.9780890425596.
Arnold, S. R. C., Higgins, J. M., Weise, J., Desai, A., Pellicano, E., & Trollor, J. N. (2023). Towards the measurement of autistic burnout. Autism, 136236132211474. https://doi.org/10.1177/13623613221147401.
Arrindell, W. A., & Ettema, J. H. M. (1986). SCL-90. Handleiding Bij Een multidimensionele psychopathologie- indicator. (SCL-90: Revised manual for a multidimensional indicator of psychopathology). Swets & Zeitlinger.
Autisme Expertise Centrum (2021, December 3). Aanmelding diagnostiek en behandeling. Autisme Expertise.nl. Retrieved December 6, 2021, from https://www.autismeexpertise.nl/index.php/aanmelding-diagnostiek/.
Bargiela, S., Steward, R., & Mandy, W. (2016). The experiences of late-diagnosed women with Autism Spectrum conditions: An investigation of the female autism phenotype. Journal of Autism and Developmental Disorders, 46(10), 3281–3294. https://doi.org/10.1007/s10803-016-2872-8.
Bianchi, R., Schonfeld, I. S., & Verkuilen, J. (2020). A five-sample confirmatory factor analytic study of burnout-depression overlap. Journal of Clinical Psychology, 76(4), 801–821. https://doi.org/10.1002/jclp.22927.
Bianchi, R., Verkuilen, J., Schonfeld, I. S., Hakanen, J. J., Jansson-Fröjmark, M., Manzano-García, G., Laurent, E., & Meier, L. L. (2021). Is Burnout a Depressive Condition? A 14-Sample Meta-Analytic and Bifactor Analytic Study. Clinical Psychological Science, 9(4), 579–597. https://doi.org/10.1177/2167702620979597.
Boren, R. (2017, January 26). Autistic Burnout: The Cost of Masking and Passing. Ryan Boren. Retrieved April 8, 2022, from https://boren.blog/2017/01/26/autistic-burnout-the-cost-of-coping-and-passing/.
Cage, E., & Troxell-Whitman, Z. (2019). Understanding the reasons, contexts and costs of camouflaging for autistic adults. Journal of Autism and Developmental Disorders, 49(5), 1899–1911. https://doi.org/10.1007/s10803-018-03878-x.
Cassidy, S., Bradley, L., Shaw, R., & Baron-Cohen, S. (2018). Risk markers for suicidality in autistic adults. Molecular Autism, 9(1). https://doi.org/10.1186/s13229-018-0226-4.
Dell’Osso, L., & Carpita, B. (2022). What misdiagnoses do women with autism spectrum disorder receive in the DSM-5? CNS Spectrums, 1–2. https://doi.org/10.1017/s1092852922000037.
Evans, J. D. (1996). Straightforward statistics for the behavioral sciences. Journal of the American Statistical Association, 91(436), 1750. https://doi.org/10.2307/2291607.
Field, A. (2018). Discovering statistics using IBM SPSS statistics. SAGE.
Garfinkel, S. N., Tiley, C., O’Keeffe, S., Harrison, N. A., Seth, A. K., & Critchley, H. D. (2016, February). Discrepancies between dimensions of interoception in autism: Implications for emotion and anxiety. Biological Psychology, 114, 117–126. https://doi.org/10.1016/j.biopsycho.2015.12.003.
George, D., & Mallery, P. (2003). SPSS for Windows Step by Step: A Simple Guide and Reference, 11.0 Update (4th Edition). (4th ed.). Allyn & Bacon.
Higgins, J. M., Arnold, S. R., Weise, J., Pellicano, E., & Trollor, J. N. (2021). Defining autistic burnout through experts by lived experience: Grounded Delphi method investigating #AutisticBurnout. Autism, 25(8), 2356–2369. https://doi.org/10.1177/13623613211019858.
Huggins, C. F., Donnan, G., Cameron, I. M., & Williams, J. H. (2020). Emotional self-awareness in autism: A meta-analysis of group differences and developmental effects. Autism, 25(2), 307–321. https://doi.org/10.1177/1362361320964306.
Hull, L., Petrides, K. V., Allison, C., Smith, P., Baron-Cohen, S., Lai, M. C., & Mandy, W. (2017). Putting on my best normal: Social camouflaging in adults with Autism Spectrum conditions. Journal of Autism and Developmental Disorders, 47(8), 2519–2534. https://doi.org/10.1007/s10803-017-3166-5.
Hull, L., Petrides, K. V., & Mandy, W. (2020). The female autism phenotype and camouflaging: A narrative review. Review Journal of Autism and Developmental Disorders, 7(4), 306–317. https://doi.org/10.1007/s40489-020-00197-9.
Ketelaars, M. P., Velt, A. I., Mol, A., Swaab, H., & Van Rijn, S. (2016). Emotion recognition and alexithymia in high functioning females with autism spectrum disorder. Research in Autism Spectrum Disorders, 21, 51–60. https://doi.org/10.1016/j.rasd.2015.09.006.
Koutsimani, P., Montgomery, A., & Georganta, K. (2019). The relationship between burnout, depression, and anxiety: A systematic review and meta-analysis. Frontiers in Psychology, 10, 1–19. https://doi.org/10.3389/fpsyg.2019.00284.
Lai, M., & Baron-Cohen, S. (2015). Identifying the lost generation of adults with autism spectrum conditions. The Lancet Psychiatry, 2(11), 1013–1027. https://doi.org/10.1016/s2215-0366(15)00277-1.
Lai, M., Lombardo, M. V., Auyeung, B., Chakrabarti, B., & Baron-Cohen, S. (2015). Sex/Gender differences and autism: Setting the scene for Future Research. Journal of the American Academy of Child & Adolescent Psychiatry, 54(1), 11–24. https://doi.org/10.1016/j.jaac.2014.10.003.
Lai, M. C., Lombardo, M. V., Ruigrok, A. N., Chakrabarti, B., Auyeung, B., Szatmari, P., Happé, F., & Baron- Cohen, S. (2017). Quantifying and exploring camouflaging in men and women with autism. Autism, 21(6), 690–702. https://doi.org/10.1177/1362361316671012.
Lai, M. C., Kassee, C., Besney, R., Bonato, S., Hull, L., Mandy, W., Szatmari, P., & Ameis, S. H. (2019). Prevalence of Co-occurring Mental Health Diagnoses in the Autism Population: A systematic review and Meta-analysis. SSRN Electronic Journal. https://doi.org/10.2139/ssrn.3310628.
Livingston, L. A., Shah, P., & Happé, F. (2019). Compensatory strategies below the behavioural surface in autism: A qualitative study. The Lancet Psychiatry, 6(9), 766–777. https://doi.org/10.1016/s2215-0366(19)30224-x.
Lockwood-Estrin, G., Milner, V. S., Spain, D., Happé, F., & Colvert, E. (2021). Barriers to Autism Spectrum Disorder diagnosis for Young women and girls: A systematic review. Review Journal of Autism and Developmental Disorders, 8(4), 454–470. https://doi.org/10.1007/s40489-020-00225-8.
Mandrekar, J. N. (2010). Receiver operating characteristic curve in Diagnostic Test Assessment. Journal of Thoracic Oncology, 5(9), 1315–1316. https://doi.org/10.1097/jto.0b013e3181ec173d.
Mantzalas, J., Richdale, A. L., Adikari, A., Lowe, J., & Dissanayake, C. (2021). What is autistic burnout? A thematic analysis of posts on two online platforms. Autism in Adulthood, 4(1), 52–65. https://doi.org/10.1089/aut.2021.0021.
Mantzalas, J., Richdale, A. L., & Dissanayake, C. (2022). A conceptual model of risk and protective factors for autistic burnout. Autism Research, 15(6), 976–987. https://doi.org/10.1002/aur.2722.
Maslach, C., & Jackson, S. E. (1981). The measurement of experienced burnout. Journal of Organizational Behavior, 2(2), 99–113. https://doi.org/10.1002/job.4030020205.
Maslach, C., & Leiter, M. P. (2016). Understanding the burnout experience: Recent research and its implications for psychiatry. World Psychiatry, 15(2), 103–111. https://doi.org/10.1002/wps.20311.
Mikolajczak, M., Gross, J. J., Stinglhamber, F., Norberg, A. L., & Roskam, I. (2020). Is parental burnout distinct from Job Burnout and depressive symptoms? Clinical Psychological Science, 8(4), 673–689. https://doi.org/10.1177/2167702620917447.
Nadon, L., De Beer, L. T., & Morin, A. J. S. (2022). Should Burnout be conceptualized as a Mental Disorder? Behavioral Sciences, 12(3), 82. https://doi.org/10.3390/bs12030082.
Parker, G., & Tavella, G. (2021). Distinguishing burnout from clinical depression: A theoretical differentiation template. Journal of Affective Disorders, 281, 168–173. https://doi.org/10.1016/j.jad.2020.12.022.
Parker, G., Tavella, G., & Eyers, K. (2021). Burnout: A guide to identifying burnout and pathways to recovery. Allen & Unwin.
Pearson, A., & Rose, K. (2021). A conceptual analysis of autistic masking: Understanding the narrative of Stigma and the illusion of choice. Autism in Adulthood, 3(1), 52–60. https://doi.org/10.1089/aut.2020.0043.
Phung, J., Penner, M., Pirlot, C., & Welch, C. (2021). What I wish you knew: Insights on burnout, inertia, meltdown, and shutdown from autistic youth. Frontiers in Psychology, 12, 4981. https://doi.org/10.3389/fpsyg.2021.741421.
Qiao, H., & Schaufeli, W. B. (2011). The Convergent Validity of Four Burnout measures in a Chinese sample: A confirmatory factor-Analytic Approach. Applied Psychology, 60(1), 87–111. https://doi.org/10.1111/j.1464-0597.2010.00428.x.
Raymaker, D. M. (2019). Autism 206: Transition to Adulthood: My physical body and mind started shutting down: Autistic burnout and the costs of coping and passing [Lecture]. Seattle Children’s Hospital. https://facebook.com/seattlechildrens/videos/vl.948687718589668/380037906042266.
Raymaker, D. M., Teo, A. R., Steckler, N. A., Lentz, B., Scharer, M. Delos Santos, A., Kapp, S. K., Hunter, M., Joyce, A., & Nicolaidis, C (2020). "Having all of your internal resources exhausted beyond measure and being left with no clean-Up crew": Defining autistic burnout. Autism in Adulthood, 2(2), 132–143. https://doi.org/10.1089/aut.2019.0079.
Rose, K. (2018, May 21). An Autistic Burnout. The Autistic Advocate. Retrieved April 8, 2022, from https://theautisticadvocate.com/2018/05/an-autistic-burnout/.
Schaufeli, W. B., Bakker, A. B., & van Rhenen, W. (2009). How changes in job demands and resources predict burnout, work engagement, and sickness absenteeism. Journal of Organizational Behavior, 30(7), 893–917. https://doi.org/10.1002/job.595.
Schwarzkopf, K., Straus, D., Porschke, H., Znoj, H., & Von Känel, R. (2019). Is it all about Depression? Determinants of burnout among employees referred for Inpatient Treatment of Job-related stress disorders. Zeitschrift fur Psychosomatische Medizin Und Psychotherapie, 65(2), 183–197. https://doi.org/10.13109/zptm.2019.65.2.183.
Spek, A., & Kiep, M. (2021). Autistische burn-out Vragenlijst. Autisme Expertisecentrum.
Stagg, S. D., & Vincent, J. (2019). Autistic traits in individuals self-defining as transgender or nonbinary. European Psychiatry, 61, 17–22. https://doi.org/10.1016/j.eurpsy.2019.06.003.
Tavella, G., & Parker, G. (2020). Distinguishing burnout from depression: An exploratory qualitative study. Psychiatry Research, 291, 113212. https://doi.org/10.1016/j.psychres.2020.113212.
Tavella, G., Hadzi-Pavlovic, D., & Parker, G. (2020). Burnout: Re-examining its key constructs. Psychiatry Research, 287, 112917. https://doi.org/10.1016/j.psychres.2020.112917.
Tavella, G., Hadzi-Pavlovic, D., & Parker, G. (2021). Burnout: Redefining its key symptoms. Psychiatry Research, 302, 114023. https://doi.org/10.1016/j.psychres.2021.114023.
Tóth-Király, I., Morin, A. J. S., & Salmela‐Aro, K. (2021). Reciprocal associations between Burnout and Depression: An 8‐Year longitudinal study. Applied Psycholog, 70(4), 1691–1727. https://doi.org/10.1111/apps.12295.
Uljarević, M., Hedley, D., Rose-Foley, K., Magiati, I., Cai, R. Y., Dissanayake, C., Richdale, A., & Trollor, J. (2019). Anxiety and depression from adolescence to Old Age in Autism Spectrum Disorder. Journal of Autism and Developmental Disorders, 50(9), 3155–3165. https://doi.org/10.1007/s10803-019-04084-z.
Verkuilen, J., Bianchi, R., Schonfeld, I. S., & Laurent, E. (2021). Burnout–depression overlap: Exploratory Structural Equation Modeling Bifactor Analysis and Network Analysis. Assessment, 28(6), 1583–1600. https://doi.org/10.1177/1073191120911095.
Wood-Downie, H., Wong, B., Kovshoff, H., Mandy, W., Hull, L., & Hadwin, J. A. (2020). Sex/Gender differences in camouflaging in children and adolescents with autism. Journal of Autism and Developmental Disorders, 51(4), 1353–1364. https://doi.org/10.1007/s10803-020-04615-z.
World Health Organization (2019) Burn-out an “occupational phenomenon”: International Classification of Disease. https://www.who.int/news/item/28-05-2019 -burn-out-an-occupational-phenomenon-internationalclassification-of-diseases.
Zener, D. (2019). Journey to diagnosis for women with autism. Advances in Autism, 5(1), 2–13. https://doi.org/10.1108/aia-10-2018-0041.
Acknowledgements
We would like to thank Dora Raymaker, the Academic Autistic Spectrum Partnership in Research and Education (AASPIRE) group and colleagues for providing a pre-publication version of the AASPIRE Autistic Burnout Measure that was used in this study.
Funding
No funding was received for conducting this study.
Author information
Authors and Affiliations
Contributions
All authors contributed to the study conception and design. Material preparation, data collection and analysis were performed by Fleur Schoondermark. The first draft of the manuscript was written by Fleur Schoondermark and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.
Corresponding author
Ethics declarations
Ethical Approval and Consent to Participate
This retrospective study utilized anonymized data from patient files collected during routine diagnostic procedures at the Autism Expertise Center. Patients were informed via the center’s website about the various research projects being conducted. Given that the data collection was part of treatment as usual, obtaining informed consent for participation or publication was not required according to the Medical Research Involving Human Subjects Act (WMO).
Competing Interests
The authors have no competing interests to declare that are relevant to the content of this article.
Additional information
Publisher’s Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.
About this article
Cite this article
Schoondermark, F., Spek, A. & Kiep, M. Evaluating an Autistic Burnout Measurement in Women. J Autism Dev Disord (2024). https://doi.org/10.1007/s10803-024-06438-8
Accepted:
Published:
DOI: https://doi.org/10.1007/s10803-024-06438-8