COVID-19 health distress among autistic adults: Does psychological flexibility explain effects of health distress on mental health concerns?
Teaching autistic adults to act on personal values cuts the mental-health punch of COVID-19 health worries.
01Research in Context
What this study did
The team asked 281 autistic adults to fill out three online surveys. One survey measured how much COVID-19 health worries bothered them. Another tracked mental-health red flags like anxiety and depression. The third looked at psychological flexibility: how well people move toward personal values even when stress shows up.
Using a stats test called mediation, the authors checked if values progress (moving toward what matters) and values obstruction (getting stuck) carried the effect from health distress to mental-health problems.
What they found
Higher health distress predicted worse mental health, but not equally for everyone. Adults who kept making small moves toward their values showed milder mental-health fallout. Those who felt blocked by values reported sharper spikes in anxiety and depression.
Both paths were partial mediators, meaning values work softened about one-third of the distress impact.
How this fits with other research
Sutton et al. (2022) extends these results. Their one-year follow-up of Italian autistic adults shows that losing in-person services caused large, lasting drops in daily-living skills. Together the papers paint a two-part picture: pandemic stress hurts mental health right away, and service loss erodes functioning over time.
Koç et al. (2026) flips the lens to parents. In parents of autistic kids, low psychological flexibility feeds emotional reactivity, which then fuels burnout. The same flexibility skill matters across generations, just with different fallout.
Romero et al. (2024) adds a child angle. Kids with weak executive function before the pandemic later showed more anxiety. The adult study mirrors this: flexible thinking and acting now can buffer future distress.
Why it matters
You can’t erase a client’s health worries, but you can weave values work into your sessions. Try a five-minute values card sort, then help the client pick one tiny action tied to that value before your next visit. Over a month these micro-moves can shave points off anxiety or depression scales, giving clients a practical shield against pandemic stress or any new crisis that hits.
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02At a glance
03Original abstract
The COVID-19 pandemic caused significant health distress among autistic adults in the United States. While there is considerable evidence that autistic adults' COVID-19 health distress was related to increases in mental health concerns (e.g. depression, anxiety, and stress), there is a less clear understanding of the possible mechanisms by which this process occurs. Accordingly, our participatory action research team assessed whether psychological flexibility, a strengths-based mechanism from acceptance and commitment therapy, mediated the association between COVID-19-related health distress and mental health concerns (e.g. depression, anxiety, and stress). We found that among 281 autistic adults the positive relationship between COVID-19 health distress and mental health concerns was partially mediated by values progress (a component of psychological flexibility) and values obstruction (a component of psychological inflexibility). Results provide preliminary support that the strengths-based mechanism of psychological flexibility might be a salient therapeutic target to improve mental health among autistic adults experiencing health distress.Lay AbstractWhat is already known?In the United States, the COVID-19 Pandemic caused many autistic adults to be fearful and worried about their health. There is a lot of research that says that when autistic adults experience health distress it can worsen their mental health. We do not know, however, what might explain how experiencing health distress negatively affects mental health. Because of this, our participatory action research team wanted to understand if there are strengths-based processes that help us understand the relationship between health distress and mental health concerns.What does this paper add?We examined among 281 autistic adults how a strengths-based construct from acceptance and commitment therapy called psychological flexibility might explain the relationship between health distress and mental health concerns. We found that for adults that had more values progress, doing the things that mattered to them, was associated with better mental health even while experiencing health distress. We also found that values obstruction, getting stuck on uncomfortable thoughts and feelings and trying to avoid them, explained worse mental health for autistic adults experiencing health distress.Implications for research and practice?The findings of this study provide initial support that psychological flexibility can explain the relationship between health distress and mental health concerns among autistic adults. Interventions that seek to improve psychological flexibility, like acceptance and commitment therapy, might be useful in improving autistic adults' mental health while they are experiencing health distress.
Autism : the international journal of research and practice, 2025 · doi:10.1177/13623613241313403