“Utterly Overwhelming”—A Mixed-Methods Exploration of Sensory Processing Differences and Mental Health Experiences in Middle-Aged and Older Autistic Adults

Background: Sensory processing differences (SPDs) and mental health symptoms are not limited to young autistic people but continue to occur into adulthood. However, existing quantitative research has predominantly focused on younger autistic people. Less work has been done to investigate SPDs and relationships with mental health conditions in older autistic adults (i.e., aged 40 and older) across their midlife and older adulthood. Methods: A total of 432 participants (autistic n = 265; non-autistic n = 167) aged 40–93 years completed online questionnaires related to SPDs and mental health (i.e., anxiety and depression symptoms). Neurotype and gender differences, age associations, and associations between SPDs and mental health were examined. Participants’ contextualization of their lived experiences of SPDs was analyzed qualitatively. Results: Overall, SPDs and mental health symptoms were more apparent in the autistic group than the non-autistic group, with autistic women showing higher levels of SPDs and poorer mental health than autistic men. SPDs were more often reported to worsen across adulthood by those in the autistic group than those in the non-autistic group, with older autistic people more often reporting worse coping abilities. Furthermore, positive associations between SPDs and anxiety/depression symptoms were observed in the autistic group, with the strength of associations increasing with age. From the qualitative data, we developed six topics reflecting participants’ lived experience of SPDs. Conclusion: Quantitative and qualitative evidence suggest that autistic adults in older age may be more likely to have a heightened risk of SPDs and associated poorer mental health. This study extends previous understanding of SPDs with mainly younger autism populations and highlights the necessity of exploring sensory difficulties in autistic adults in midlife and older adulthood. Community Brief Why is this an important issue? Autistic people often experience sensory processing differences (SPDs), for example, difficulties with sound/noise, textures, tastes, smells, and temperatures. In addition, these SPDs often impact their mental health. Although these SPDs are not unique to autistic people, they experience SPDs at higher rates than the general population. What was the purpose of this study? People of all ages can experience SPDs and mental health conditions. Despite this, much of the existing research on sensory and mental health experiences has focused on young autistic people. This study aimed to explore these experiences in middle-aged (age 40–59) and older (age 60+) autistic people. What did the researchers do? Using an online survey, we asked middle-aged and older autistic and non-autistic adults questions about their experiences of SPDs and their mental health. A total of 265 autistic and 167 non-autistic adults aged 40–93 took part in our survey. About half of our sample were women. What were the results of the study? Compared with the non-autistic participants, the autistic people in our study reported more SPDs, a higher frequency of overwhelming sensory experiences, and lower abilities to cope with their sensory experiences as they aged. SPDs and mental health conditions were found to co-occur, and this was reported more often by older autistic participants. In the open-text responses, autistic and non-autistic people reported that noise was a particular issue, but autistic people were more likely to stress the impacts on their mental health than non-autistic people. Several autistic people mentioned that they had developed coping strategies for managing their sensory experiences, for example, wearing noise-canceling headphones. What do these findings add to what was already known? These findings further our understanding of the experience of SPD in autistic populations. Much of the existing research has focused on younger people, and these findings highlight that middle-aged and older autistic people may need additional support for managing their sensory environments as they get older. It also highlights that sensory experiences should be considered when supporting autistic people with their mental health, and this may be particularly important for older autistic people. What are potential weaknesses in the study? First, our findings are based on cross-sectional data, and thus, we are unable to generate predictive relationships between SPDs and mental health conditions. Second, the subscale used to measure the presence of SPDs included only three items. Third, most current participants are from the United Kingdom, and very few non-binary/trans/gender-fluid individuals took part in this study. Last, there may also be other factors that are influencing the SPDs of middle-aged and older autistic adults that are not taken into consideration in this study, for example, their physical health or their living situation. How will these findings help autistic adults now or in the future? These findings highlight that autistic people in midlife and older age may be particularly susceptible to SPDs, which may impact their mental health. This emphasizes the need for evidence-based interventions to address SPDs and support autistic people with their sensory environments as they age.

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