Cognitive Flexibility Mediates the Associations Between Perceived Stress, Social Camouflaging and Mental Health Challenges in Autistic Adults.

Autistic people are at an elevated risk of experiencing co-occurring anxiety and depression. The contributors to this are likely multifaceted and complex and remain poorly understood. Cognitive flexibility, social camouflaging, and perceived stress provide useful indices of the interacting neurocognitive, behavioral, and environmental factors that have been associated with anxiety and depression in autistic individuals. Here, we test if cognitive flexibility, as the factor most closely related to individual differences in thinking styles, mediates the relationships between social camouflaging, perceived stress, and anxiety/depression. This study included 806 autistic individuals aged between 18 and 83 years (Mean age = 40.2), recruited through the Research Match service of the Simons Powering Autism Research (SPARK) participant registry. Participants completed an online battery of questionnaires measuring cognitive and social flexibility, social camouflaging, perceived stress, anxiety, and depression. Parallel mediation analyses were used to test the mediating effect of cognitive and social flexibility. Across separate parallel mediation analyses, cognitive flexibility was found to significantly mediate the relationships between both social camouflaging and perceived stress with anxiety and depression. This was contrasted with social flexibility, which showed a lower magnitude mediating effect for perceived stress and no mediating effect of social camouflaging. Cognitive flexibility plays an important mediating role between the impact of both perceived stress and social camouflaging on greater symptoms of both anxiety and depression in autistic adults.