Anxiety as a Moderator Between Autistic/ADHD Traits and Quality of Life in Autistic Children and Adolescents.

PURPOSE: Anxiety is associated with lower well-being in autistic children, yet little is known about how anxiety symptoms moderate the relationship between neurodivergent traits and Quality of Life (QoL). METHODS: The present study analyzed data from 316 clinician-diagnosed autistic children aged 7-17 from the Province of Ontario Neurodevelopmental Disorders Network. QoL, depression (as a control variable), anxiety, autistic traits, and ADHD traits were assessed. We expected anxiety to interact with autistic and ADHD traits in their associations with QoL domains. RESULTS: Regression analyses revealed that after controlling for depression, greater anxiety was associated with reduced school QoL. Additionally, greater ADHD hyperactive-impulsive (ADHD-HI) traits were associated with lower family QoL, while greater ADHD inattentive (ADHD-I) traits were associated with lower self-esteem QoL. Autistic traits were associated with lower friendship QoL but higher school QoL. There were interactions between ADHD-HI traits and anxiety. At high levels of anxiety, ADHD-HI traits were associated with higher school and self-esteem QoL. At low levels of anxiety, ADHD-HI traits were associated with lower friendship QoL. No significant associations were found for the interaction between ADHD-I traits and anxiety, or for the interaction between autistic traits and anxiety. CONCLUSIONS: These results introduce novel insights into how autistic traits, ADHD traits and anxiety interact in their associations with QoL in autistic children. Given that no corrections were made for multiple comparisons, this study should be considered exploratory and hypothesis-generating, intended to inspire future research that adopts a trait-based approach in studying the QoL of neurodiverse children.