Date Presented 03/31/2022

This quantitative survey study measured stress, engagement in meaningful activities, self-efficacy, quality of life, and coping among women with and without autism spectrum disorder (ASD) during the time of coronavirus disease 2019 (COVID-19). Statistical analysis revealed significant differences on all measures except engagement. These findings suggest a potential need for specialized OT support for women with ASD that may be especially desired when adapting to changes during and after COVID-19.

Primary Author and Speaker: Yan-hua Huang

Additional Authors and Speakers: Annika Lin, Teresa Lam, Alexandra Krizek, Jaclyn Ingram

PURPOSE: A paucity of literature exists on the experiences of adult females with autism spectrum disorder (ASD) and how they differ from adult females without ASD (Bargiela et al., 2016). As a result, the adult female ASD population may experience insufficient occupational therapy (OT) support. This study investigated how measures of stress, engagement in meaningful leisure activities, self-efficacy, quality of life (QoL), and coping during COVID-19 differ between females with and without ASD. The researchers hypothesized that females with ASD will have experienced higher levels of perceived stress and avoidant coping strategies and lower levels of engagement, self- efficacy, and QoL during the pandemic.

DESIGN: This quantitative study utilized a survey design to collect data from two participant groups, females with ASD and females without ASD. Participants with ASD may be formally, informally, or self-diagnosed. All participants were assigned female at birth, are at least 18 years old, and are working or a student at least part time. Flyers were posted on various social media platforms for participant recruitment.

METHOD: This study utilized the The Stress, Engagement, Self-Efficacy, QoL, and Coping survey (SESQoLC), which consisted of five standardized measures: Perceived Stress Scale, Engagement in Meaningful Activities Survey, Generalized Self-Efficacy Scale, WHOQOL-BREF, and Brief-COPE. Data collected from a total of 256 participants (ASD group n = 185, non-ASD group n = 71) was analyzed using SPSS 27 through descriptive statistics, frequency analysis, Pearson’s product moment correlation coefficient, and independent t-test.

RESULTS: Statistically significant differences were found between the ASD and non-ASD groups for all measures except engagement (p < .01). Self-efficacy and QoL scores were significantly lower and perceived stress and avoidant coping strategy scores were significantly higher among the ASD group. Level of engagement scores was found to be lower in the ASD group, however did not reach significance. Significant correlation between measures within both groups was also found (p < .01).

DISCUSSION: This study is innovative because it is the first to compare adult females with ASD and without ASD during COVID-19. Similar to previous findings, adult females with ASD have lower self-efficacy and QoL and experience more stress and avoidant coping than those without ASD during major adaptation periods (Bishop-Fitzpatrick et al., 2017; Gernert et al., 2020). This study’s results add to the currently lacking body of literature pertaining to adult females with ASD, especially during COVID-19, highlighting these statistically significant differences between the two groups. No significant differences were found for engagement scores between the ASD and non-ASD groups. However, they were lower than previously found normative data, suggesting COVID-19 impacted general access to meaningful occupations (Eakman, 2011).

CONCLUSION: Results of this study have implications for occupational therapy (OT) by highlighting the needs females with ASD have. Informing the field of how this population’s needs differ from the needs of females without ASD is critical in tailoring better individualized support for this population, especially in adapting to changes during and after COVID-19 times.


Bargiela, S., Steward, R., & Mandy, W. (2016). The experiences of late-diagnosed women with autism spectrum conditions: An investigation of the female autism phenotype. Journal of Autism and Developmental Disorders, 46(10), 3281–3294.

Gernert, C., Falkai, P., & Falter-Wagner, C. M. (2020). The generalized adaptation account of autism. Frontiers in Neuroscience, 14, 534218-534218.

Bishop-Fitzpatrick, L., Smith, L. E., Greenberg, J. S., & Mailick, M. R. (2017). Participation in recreational activities buffers the impact of perceived stress on quality of life in adults with autism spectrum disorder. Autism Research, 10(5), 973-982.

Eakman, A. M. (2011). Convergent validity of the Engagement in Meaningful Activities Survey in a college sample. OTJR: Occupation, Participation and Health, 31(1), 23-32.