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

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Vella, Lydia 
Ring, Howard A 
Aitken, Mike Rf 
Watson, Peter C 
Presland, Alexander 


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 ( nASD = 29 and nneurotypical = 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.



Cambridge Gamble Task, Information Sampling Task, Iowa Gambling Task, autism spectrum, decision-making, Adolescent, Adult, Attention, Autism Spectrum Disorder, Case-Control Studies, Decision Making, Female, Humans, Male, Middle Aged, Neuropsychological Tests, Self Report, Task Performance and Analysis, Young Adult

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SAGE Publications
Medical Research Council (MC_UU_00005/14)
Medical Research Council (MC_UU_00005/6)
The research reported here was carried out by the first author (Lydia Vella, née Luke) as part of her PhD in the Department of Psychiatry, University of Cambridge, and was supported by a Pinsent Darwin Studentship in Mental Health; University of Cambridge Domestic Research Studentship; the Charles Slater Fund; and the Marmaduke Sheild Fund. IC was supported during the preparation of this paper by the National Institute of Health Research (NIHR) Collaboration for Applied Health Research and Care (CLAHRC) East of England at Cambridgeshire & Peterborough NHS Foundation Trust. We are grateful to all our funders for their support. The paper describes independent research and the views expressed are those of the authors and not necessarily those of the NHS, the NIHR, or the Department of Health.