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Research paper
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Autistic burnout
The content of this document is OFFICIAL.
Please note:
The research and literature reviews collated by our TAB Research Team are not to be shared
external to the Branch. These are for internal TAB use only and are intended to assist our
advisors with their reasonable and necessary decision-making.
Delegates have access to a wide variety of comprehensive guidance material. If Delegates
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advice.
The Research Team are unable to ensure that the information listed below provides an
accurate & up-to-date snapshot of these matters
Research questions:
What are the symptoms of autistic burnout? How long do symptoms typically last and how
are symptoms managed? What does recovery look like after autistic burnout?
What are the usual causes or triggers of autistic burnout?
How does autistic burnout differ from occupational burnout, stress, depression or anxiety in
autistic or non-autistic people?
Date: 12/3/2024
Requestor: Evan O’Grady
Endorsed by: Nicole Stacey
Researcher: Aaron Harrison
Cleared by: Stephanie Pritchard
Autistic burnout
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1. Contents
Autistic burnout .......................................................................................................................... 1
1.
Contents ....................................................................................................................... 2
2.
Summary ...................................................................................................................... 2
3.
Current state of research .............................................................................................. 3
4.
What is autistic burnout? ............................................................................................... 3
4.1
Definition .................................................................................................................... 3
4.2
Symptoms .................................................................................................................. 5
4.3
Triggers ..................................................................................................................... 6
4.4
Autistic burnout and other conditions ......................................................................... 6
5.
Management ................................................................................................................. 8
6.
References ................................................................................................................... 9
2. Summary
Autistic burnout is the experience of exhaustion brought on participating in activities or being in
environments that are not accessible for autistic people. It has long been recognised by the
autistic community as a feature of autistic people’s experience. However, the earliest formal
study sourced that focusses on autistic burnout was published in 2020.
Since then, a handful of preliminary studies have focussed mainly on defining the concept,
differentiating it from similar constructs, understanding how autistic burnout is experienced by
people with autism and establishing reliable outcome measures.
Symptoms described in the literature include fatigue, cognitive difficulties, loss of skills and
sensory intolerance. Triggers described in the literature include the effort of suppressing or
covering up autistic traits or behaviours, adopting neurotypical traits or behaviours, frequent
social interaction and sensory overstimulation. The duration of autistic burnout is unclear.
Episodes reported in the literature may be as short as a few hours or as long as a few years.
The relations between autistic burnout and other constructs are unclear. Autistic burnout
shares similarities with depression, anxiety, chronic stress and occupational burnout.
Researchers have observed that autistic burnout is described by those who experience it as
having features uniquely related to their autism, which often differentiates autistic burnout from
other more general conditions. More research is required to clarify the differences between
these concepts.
The only published study focussed on treatment or management approach is a single case
report describing successful use of stimulant medication to resolve symptoms of burnout in a
young adult with autism. Some management strategies are reported by people with lived
Autistic burnout
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experience of autistic burnout. These include withdrawing from social activities or inaccessible
environments, focussing on special interests and requesting reasonable accommodations to
make environments more accessible.
3. Current state of research
The earliest formal study sourced that focusses on autistic burnout was published in 2020
(Raymaker et al, 2020). Most research to date is qualitative, focussing on the burnout
experiences of autistic people or attempting to understand or define the concept of autistic
burnout. Current research examines symptoms, triggers and management strategies mostly
through survey or interview-based studies (Arnold et al, 2023a-b; Øverland et al, 2022;
Mantzalas et al, 2022a-b; Higgins et al, 2021; Raymaker et al, 2020). One quantitative
observational study examines the relationship between autistic burnout and escapist behaviour
(Pyszkowska et al, 2023).
At present, there are no validated measures of autistic burnout (Arnold et al, 2023b). Some
research exists describing occupational or professional burnout experiences for people with
autism, though this is intended to be a construct distinct from autistic burnout (Watanabe &
Akechi, 2023; Tomczak & Kulikowski, 2023; Cage & McManemy, 2022).
Only one study was found that proposes an underlying mechanism responsible for autistic
burnout (Mahony & Ryan, 2022). In this review paper, the authors suggest susceptibility to
autistic burnout may be a result of early life stress or chronic adolescent stress.
More research exists focussing on phenomena overlapping or contributing to autistic burnout,
such as depression, fatigue, masking, accessibility of social and occupational spaces. For
example, Zhuang et al (2023) review 58 studies linking camouflaging or masking by autistic
people with stress, depression, anxiety, and burnout. The literature on autistic burnout takes
masking or camouflaging as central to the definition of autistic burnout (Arnold et al 2023a;
Higgins et al, 2021; Raymaker et al, 2020).
4. What is autistic burnout?
The idea of autistic burnout originated from within the autistic community. It describes a
complex experience of exhaustion brought on by the effort of suppressing or covering up
autistic traits or behaviours, adopting neurotypical traits or behaviours, or frequenting
inaccessible places or places not designed for autistic people (Deweert, 2020). The concept is
intended to be distinct from, but analogous to, occupational burnout (Tomczak & Kulikowski,
2023; Cage & McManemy, 2022; for more on the relationship with occupational burnout, refer
to
4.4 Autistic burnout and other conditions).
4.1 Definition
There are two definitions of autistic burnout that are used in the research literature:
Autistic burnout
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Raymaker et al: Autistic burnout is a syndrome conceptualized as resulting from
chronic life stress and a mismatch of expectations and abilities without adequate
supports. It is characterized by pervasive, long-term (typically 3+ months) exhaustion,
loss of function, and reduced tolerance to stimulus (2020, p.133).
Higgins et al: Autistic Burnout is a severely debilitating condition with onset preceded
by fatigue from camouflaging or masking autistic traits, interpersonal interactions, an
overload of cognitive input*, a sensory environment unaccommodating to autistic
sensitivities and / or other additional stressors or changes. Onset and episodes of
autistic burnout may interact with co-occurring physical and / or mental health
conditions. The following criteria must be met:
- Significant mental and physical exhaustion
- Interpersonal withdrawal.
With one or more of the following:
- Significant reduction in social, occupational, educational, academic, behavioural, or
other important areas of functioning.
- Confusion, difficulties with executive function**, and/or dissociative states.
- Increased intensity of autistic traits and/or reduced capacity to camouflage/mask e.g.
increased sensory sensitivity, repetitive or stimming behaviour, difficulty engaging or
communication with others.”
The condition is not better explained by a psychiatric illness such as depression,
psychosis, personality disorder, trauma- and stressor-related disorders.
Extended or chronic episodes of autistic burnout may be preceded by brief or
intermittent episodes (2021, p.26).
Raymaker et al (2020) based their definition on 19 interviews with people who have
experienced autistic burnout as well as thematic analysis of 19 online sources, including blogs
and social media posts. Higgins et al (2021) base their definition on a Delphi consensus
process including 23 participants with lived expertise of autistic burnout.
There is overlap between these definitions and they may be compatible with one another.
Raymaker et al (2020) refer to “chronic life stress and a mismatch of expectations and
abilities”, whereas Higgins et al (2021) expand on this by specifying stressors or inaccessible
situations (masking, social situations, sensory or cognitive overload). The most significant
difference in definition relates to the timeframe. Raymaker et al (2020) reserve the diagnosis
for symptoms lasting longer than three months. In contrast, Higgins et al (2021) found people
who have experienced autistic burnout reported widely varied duration, from hours or days to
months or years. Arnold et al (2023b) argue that there is not currently sufficient information to
determine the typical duration of autistic burnout.
Autistic burnout
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Available research has not formed a consensus on the best definition. Mantzalas et al (2022b)
endorse the definition from Raymaker et al, though without considering the definition from
Higgins et al. An Australian study of 141 people who had experienced autistic burnout found
that most participants strongly endorsed the definition from Higgins et al (Arnold et al, 2023a).
Of note, the studies reported in Higgins et al (2021) and Arnold et al (2023a) were conducted
by the same team of researchers.
4.2 Symptoms
Studies agree on some core symptoms of autistic burnout including exhaustion, reduced
cognitive function, social withdrawal, and increase in autistic traits (Arnold et al, 2023b;
Mantzalas et al, 2022b; Higgins et al, 2021; Raymaker et al, 2020). Symptoms identified as
features of autistic burnout also include:
Physical symptoms: fatigue, exhaustion, sleep problems (Arnold et al, 2023a;
Mantzalas et al, 2022a; Higgins et al, 2021; Raymaker et al, 2020; Deweert, 2020)
Cognitive symptoms: confusion, dissociation, loss of executive function (Mantzalas et
al, 2022a; Higgins et al, 2021; Raymaker et al, 2020)
Emotional symptoms: difficulties with emotional regulation, short temper, depression,
anxiety, emotional numbness, suspicion or loss of trust in others (Mantzalas et al,
2022a; Higgins et al, 2021; Raymaker et al, 2020)
Other psychological symptoms: dissociation, suicidality, lower tolerance for sensory
stimulus (Mantzalas et al, 2022a; Higgins et al, 2021; Raymaker et al, 2020)
Behavioural symptoms: increased intensity or frequency of self-stimulating behaviour,
increased repetitive behaviours, avoiding social situations, escapist behaviour
(Pyszkowska et al, 2023; Mantzalas et al, 2022a; Higgins et al, 2021; Raymaker et al,
2020; Deweert, 2020)
Functional symptoms: loss of social skills, reduced capacity or desire for social
interaction, inability or reduced ability to speak or communicate, loss of daily living or
self-care skills, increased difficulty of work or school; reduced quality of life (Vinayagam
et al, 2023; Arnold et al, 2023a; Mantzalas et al, 2022a; Øverland et al, 2022; Higgins et
al, 2021; Raymaker et al, 2020)
There is some disagreement about whether certain symptoms are features of autistic burnout
or of co-occurring depression. For example, Raymaker et al (2020) note that sleep problems
and emotional numbness or inability to feel pleasure are features of depression that are
outliers in autistic burnout. In contrast, Higgins et al (2021) cites sleep problems and emotional
numbness as characteristic features of autistic burnout.
There is also some ambiguity around the behavioural symptoms associated with autistic
burnout. What are described as symptoms may also be coping mechanisms or management
strategies. Pyszkowska et al (2023) find that autistic burnout is associated with self-
Autistic burnout
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suppressing escapist behaviour in the form of time spent playing videogames. However, the
authors note that this observation is in line with some autistic people’s preferences for time
outside of social situations, special interests or hyperfocus. Researchers also note that
increase in self-stimulating behaviour and social withdrawal may be appropriate management
strategies to address the symptoms of autistic burnout (Mantzalas et al, 2022b; Higgins et al,
2021; Raymaker et al, 2020; for more detail refer t
o 5. Management).
4.3 Triggers
Researchers suggest that autistic burnout is a result of the accumulation of life stressors and
exacerbated by a lack of supports or reasonable accommodations. The stressors identified in
the literature generally relate to the added effort of actively engaging in inaccessible
environments. This is characterised as a lack of fit between the needs and preferences of an
autistic person and the environments that form the backdrop of everyday social and
occupational activities (Arnold et al, 2023a-b; Mantzalas et al, 2022a-b; Øverland et al, 2022;
Higgins et al, 2021; Raymaker et al, 2020; Deweert, 2020). Stressors that may precipitate an
episode of autistic burnout include:
Masking: suppressing autistic behaviours in order to function more easily in non-autistic
environments
Sensory overload: acting in environments that are not aligned to the autistic person’s
sensory needs
Interpersonal engagement: participating in activities that demand a high level of social
interaction
Task design: performing tasks at school, work or in social activities that are
inaccessible or not aligned with the autistic person’s cognitive or physical needs or
preferences.
4.4 Autistic burnout and other conditions
Researchers observe that characteristics of autistic burnout overlap with occupational burnout,
stress and depression. However, most researchers argue that autistic burnout is a distinct
construct with core features that differentiate it from these other conditions (Tomczak &
Kulikowski, 2023; Mantzalas et al, 2022a-b; Cage & McManemy, 2022; Mahony & Ryan, 2022;
Higgins et al, 2021; Raymaker et al, 2020). Autistic burnout has also been compared to other
experiences described by autistic people including autistic inertia, meltdowns and shutdowns.
Burnout, inertia, meltdown, shutdown
Phung et al (2021) proposes a distinction between four autistic experiences:
Burnout (feeling exhausted): extreme exhaustion after masking in inaccessible
environments
Inertia (feeling stuck): inability to initiate tasks, even personally desirable tasks
Autistic burnout
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Meltdown (feeling out of control): significant overwhelm accompanied by
externalising behaviours
Shutdown (feeling frozen): significant overwhelm accompanied by internalising
behaviours.
Phung et al found substantial overlap between inertia, meltdown and shutdown and Raymaker
et al’s definition of autistic burnout. The authors note that these experiences can occur
consecutively, with meltdowns preceding burnouts or happening at the start of burnouts.
Higgins et al (2021) suggest that meltdown can be distinguished from burnout as the latter is
more likely to involve emotional numbness, whereas the former is more likely to involve
inability to control emotions. As noted above
(4.1 Definition), the presence of emotional
numbness in autistic burnout is a point of disagreement between Higgins et al and Raymaker
et al.
More empirical work is required to differentiate between these categories (Arnold et al, 2023a;
Phung et al, 2021). Arnold et al (2023b) suggest a possible autistic exhaustion syndrome that
could encompass burnout, inertia and shutdown, though more research would be required to
substantiate this posit.
Occupational burnout
Occupational burnout is a response to chronic work stress that involves physical or emotional
exhaustion, cynicism or indifference to people associated with the job or to work related tasks
and reduced personal achievement at work (Edú-Valsania et al, 2022). The concept of burnout
was originally applied to care workers, then generalised for other workplace and professional
contexts. It has been expanded to include responses to non-professional contexts such as
education, and to systemic problems such as racism and sexism (Wolbring & Lillywhite, 2023;
Watanabe & Akechi, 2023).
Burnout is not included in the DSM-5 and is counted in the ICD-11 as an occupational
phenomenon, but not a distinct health condition (Higgins et al, 2021). There is a lack of
consensus in the literature on burnout regarding its definition, subtypes, causes, symptoms,
prevalence, and appropriate measurement tools (Tomczak & Kulikowski, 2023; Wolbring &
Lillywhite, 2023; Edú-Valsania et al, 2022; Higgins et al, 2021). Some studies suggest that the
difference between occupational burnout and depression is artificial (Higgins et al, 2021).
Autistic burnout was named by analogy with occupational burnout, though the constructs are
intended to be different (Tomczak & Kulikowski, 2023; Higgins et al, 2021; Raymaker et al,
2020). While acknowledging the similarities, Higgins et al (2021) differentiate autistic and non-
autistic burnout according to differences in triggers and symptoms. They note non-autistic
burnout is almost always employment related, whereas autistic burnout is generally
precipitated by masking, social interaction and inaccessible environments. Whereas non-
autistic burnout is characterised by cynicism towards the workplace or task, autistic burnout
may be characterised by indifference or antipathy to non-autistic people, social groups or
Autistic burnout
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environments. Autistic burnout may include more severe cognitive symptoms and skills loss
compared with non-autistic burnout.
Considering the lack of consensus in burnout research, it is not clear if the differences
described in Higgins et al are sufficient to differentiate two conditions, rather than broaden the
existing category of burnout. Cage & McManemy (2022) note that autistic traits, even in non-
autistic people, are correlated with increased risk of occupational burnout. They suggest that
autistic and occupational burnout may be two manifestations of a more general construct.
Stress
Stress is a core feature of all conceptions of autistic burnout. Researchers argue that autistic
burnout is a response to chronic stress, with unique triggers and symptoms. Mahony & Ryan
(2022) note the similarities between descriptions of autistic burnout and early life stress (ELS)
or chronic adolescent stress (CAS). Based on these similarities, they suggest that autistic
burnout is a specific type of CAS. However, further work is required to substantiate these
ideas.
Depression
There are apparent similarities between depression and autistic burnout, such as fatigue, lack
of emotional control, and social withdrawal. Risk of depression is increased for autistic people
even in the absence of burnout. Depression is also a commonly reported feature of autistic
burnout (Higgins et al, 2021; Raymaker et al, 2020). According to Mahony & Ryan (2022, p.4):
Both [Major Depressive Disorder (MDD)] and autistic burnout are associated with
chronic fatigue, cognitive incapacitation, and suicidal ideation; however, the anhedonia
and existential hopelessness that characterizes MDD is not always a defining feature of
autistic burnout. While depression is described as a lack of motivation to participate in
life, autistic burnout is experienced as a lack of capacity to do so. Nevertheless, autistic
burnout can lead to the subsequent development of MDD and vice versa.
A further reason for differentiation relates to appropriate treatment methods. What works for
depression may not work for autistic burnout. For example, whereas physical activity and
community or social participation are appropriate management strategies for depression, they
may exacerbate the underlying problems that lead to autistic burnout. In contrast, social
withdrawal and focus on individual special interests is a commonly recommended
management strategy.
5. Management
One treatment study was found, a conference abstract included in a supplement to the journal
Neurology, that investigates the management of autistic burnout (Hale & Sanders, 2023). The
authors present the case of a 24-year-old autistic student who presented with symptoms of
autistic burnout. They were prescribed dextroamphetamine, associated with treatment of
attention-deficit hyperactivity disorder, and reported positive outcomes.
Autistic burnout
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Several qualitative studies note strategies that those who experience autistic burnout have
used to recover. Examples include:
• Social support from the right people (which could include other autistic people)
• ‘Unmasking’, reducing masking behaviours or avoiding situations where they are
necessary
• Taking time to understand one’s own needs and preferences
• Taking time to focus on a special interest
• Request reasonable accommodations and appropriate supports from work or school
• Reduced activity, rest, regular breaks (Gabrielsen et al, 2023; Mantzalas et al,
2022a; Higgins et al, 2021; Raymaker et al, 2020).
6. References
Arnold, S. R., Higgins, J. M., Weise, J., Desai, A., Pellicano, E., & Trollor, J. N. (2023a).
Confirming the nature of autistic burnout.
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and practice,
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Arnold, S. R., Higgins, J. M., Weise, J., Desai, A., Pellicano, E., & Trollor, J. N. (2023b).
Towards the measurement of autistic burnout.
Autism: the international journal of
research and practice,
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Brouwers, E. P. M., Bergijk, M., van Weeghel, J., Detaille, S., & Dewinter, J. (2023). What is
the Meaning of Paid Employment for Well-Being? A Focus Group Study on Differences
and Similarities Between Autistic Adults With and Without Employment.
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Cage, E., & McManemy, E. (2022). Burnt Out and Dropping Out: A Comparison of the
Experiences of Autistic and Non-autistic Students During the COVID-19 Pandemic.
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. https://doi.org/10.3389/fpsyg.2021.792945
Edú-Valsania, S., Laguía, A., & Moriano, J. A. (2022). Burnout: A Review of Theory and
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Gabrielsen, T.P., Begay, K.K., Campbell, K., Hahn, K., Harrington, L.T. (2023). Autism
Diagnosis in Adult Females: Post-secondary Education, Careers, and Autistic Burnout.
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Assessment of Autism in Females and Nuanced Presentations. Springer, Cham.
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Hale, E., & Sanders, J. S. (2023). Autistic Burnout: A Report of Treatment Success [Abstract
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) https://doi.org/10.1212/WNL.0000000000202510
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Higgins, J. M., Arnold, S. R., Weise, J., Pellicano, E., & Trollor, J. N. (2021). Defining autistic
burnout through experts by lived experience: Grounded Delphi method investigating
#AutisticBurnout.
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Mahony, C., & O'Ryan, C. (2022). A molecular framework for autistic experiences:
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. https://doi.org/10.3389/fpsyt.2022.985713
Mantzalas, J., Richdale, A. L., & Dissanayake, C. (2023). Examining subjective
understandings of autistic burnout using Q methodology: A study protocol.
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Mantzalas, J., Richdale, A. L., & Dissanayake, C. (2022a). A conceptual model of risk and
protective factors for autistic burnout.
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Mantzalas, J., Richdale, A. L., Adikari, A., Lowe, J., & Dissanayake, C. (2022b). What Is
Autistic Burnout? A Thematic Analysis of Posts on Two Online Platforms.
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Øverland, E., Hauge, Å. L., Orm, S., Pellicano, E., Øie, M. G., Skogli, E. W., & Andersen, P. N.
(2022). Exploring life with autism: Quality of Life, daily functioning and compensatory
strategies from childhood to emerging adulthood: A qualitative study protocol.
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Phung, J., Penner, M., Pirlot, C., & Welch, C. (2021). What I Wish You Knew: Insights on
Burnout, Inertia, Meltdown, and Shutdown From Autistic Youth.
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12, 741421
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Pyszkowska, A., Gąsior, T., Stefanek, F., & Więzik, B. (2023). Determinants of escapism in
adult video gamers with autism spectrum conditions: The role of affect, autistic burnout,
and gaming motivation.
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https://doi.org/10.1016/j.chb.2022.107618
Raymaker, D. M., Teo, A. R., Steckler, N. A., Lentz, B., Scharer, M., Delos Santos, A., Kapp,
S. K., Hunter, M., Joyce, A., & Nicolaidis, C. (2020). "Having All of Your Internal
Resources Exhausted Beyond Measure and Being Left with No Clean-Up Crew":
Defining Autistic Burnout.
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143.
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Tomczak, M. T., & Kulikowski, K. (2023). Toward an understanding of occupational burnout
among employees with autism - the Job Demands-Resources theory perspective.
Current psychology (New Brunswick, N.J.), 1–13. Advance online publication.
https://doi.org/10.1007/s12144-023-04428-0
Autistic burnout
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Vinayagam, R., Tanner, C., Harley, D., Karatella, S., & Brooker, K. (2023). "My Autism is
Linked with Everything": at the Crossroads of Autism and Diabetes.
Journal of autism
and developmental disorders. Advance online publication.
https://doi.org/10.1007/s10803-023-06033-3
Watanabe, T., & Akechi, T. (2023). The mediating role of psychological flexibility in the
association of autistic-like traits with burnout and depression in medical students during
clinical clerkships in Japan: a university-based cross-sectional study.
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23(1), 302.
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Wolbring, G., & Lillywhite, A. (2023). Burnout through the Lenses of Equity/Equality, Diversity
and Inclusion and Disabled People: A Scoping Review.
Societies,
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https://doi.org/10.3390/soc13050131
Zhuang, S., Tan, D. W., Reddrop, S., Dean, L., Maybery, M., & Magiati, I. (2023). Psychosocial
factors associated with camouflaging in autistic people and its relationship with mental
health and well-being: A mixed methods systematic review.
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105, 102335
. https://doi.org/10.1016/j.cpr.2023.102335
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