Chancellor, Amelia Ann; (2024) Trajectories of self-esteem development in autistic adolescents and their associated risk factors. Doctoral thesis (D.Clin.Psy), UCL (University College London).

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Abstract

Background: Autistic individuals are more likely to experience mental health difficulties, and there is a call for research to better understand individual and environmental factors related to this high prevalence. Self-esteem (SE) is a well-established research area, with low SE associated with various mental health difficulties. However, few studies have explored SE development in autistic young people, and no studies have modelled the trajectories of SE development in this population. Aims: This study aimed to (1) describe multiple trajectories of SE development for autistic young people between ages 11 and 17 years using Growth Mixture Modelling (GMM), and (2) explore the association between risk factors (sex, ethnicity, socio-economic status, ADHD diagnosis, parental closeness, peer relationships, peer victimization, and school environment) and likelihood of belonging to a trajectory class. Method: The sample was drawn from the Millennium Cohort Study (MCS), a longitudinal population-representative birth cohort study in the UK. GMM was used to estimate SE trajectories in a sample of 471 autistic children. A multinomial logistic regression was used to investigate the associations between trajectory class membership and potential risk factors. Results: The GMM which best represented the data showed three distinct trajectories of SE development: a ‘slow increasing (worsening SE)’ class (91.42% of the sample), a ‘fast increasing (worsening SE)’ class (6.37%), and a ‘fast decreasing (improving SE)’ class (2.55%). Lower levels of peer victimisation were associated with a decreased likelihood of membership to the ‘fast decreasing (improving SE)’ class. All members of the ‘fast decreasing (improving SE)’ class were White British. Females were more likely to be members of the ‘fast increasing (worsening SE)’ class. Conclusions: The majority of autistic adolescents experienced worsening SE over time. This highlights adolescence as an important developmental period to consider for intervention and support around SE. Risk factors have begun to be explored, with more research is needed to robustly explore risk factors associated with SE trajectories, to aid targeted intervention. Future work could use these trajectories to explore distal outcomes for autistic young people including mental health outcomes.

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