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COMMENTARY
A conceptual model of risk and protective factors for autistic
burnout
Jane Mantzalas | Amanda L. Richdale | Cheryl Dissanayake
Olga Tennison Autism Research Centre, La
Trobe University, Bundoora, Victoria,
Australia
Correspondence
Amanda L. Richdale, OTARC, School of
Psychology and Public Health, La Trobe
University, Kingsbury Drive, Bundoora, VIC
3086, Australia.
Email: a.richdale@latrobe.edu.au
Abstract
Early qualitative research indicates that autistic burnout is commonly experienced
by autistic people and is associated with significant, negative consequences for
their mental health, wellbeing, and quality of life, including suicidality. Findings
to date suggest that factors associated with being autistic and the widespread lack
of autism awareness and acceptance within society contribute to the onset and
recurrence of autistic burnout. Based on autistic adults’descriptions of their lived
experiences, a Conceptual Model of Autistic Burnout (CMAB) is proposed, which
describes a series of hypothesized relationships between identified risk and protec-
tive factors that may contribute to, or buffer against, autistic burnout. The theo-
retical framework for the CMAB is based on the Social-Relational model of
disability and neurodiversity paradigm, and the Job Demands-Resources model
of burnout, and Conservation of Resources theory. The CMAB offers a holistic
perspective for understanding individual, social, and environmental factors that
can influence autistic burnout via various direct and indirect pathways. Autistic
burnout research is in its infancy and the CMAB provides a foundation for future
investigations about this condition.
Lay Summary
Although many autistic people describe experiencing autistic burnout, there has
been little research on this topic. Based on descriptions of autistic peoples’lived
experiences, we developed a conceptual model to explore how various risk and
protective factors may interact to contribute to, or prevent, autistic burnout.
KEYWORDS
autism, autistic burnout, burnout, conservation of resources theory, job demands-resources model,
neurodiversity, social-relational model
INTRODUCTION
“Burnout”occurs when an individual’s coping capacity
has been exceeded, with the term originally used to
describe a loss of motivation and fatigue in employees
within people-centered professions (Schaufeli &
Greenglass, 2001). It has since been expanded to explore
these symptoms in other populations including athletes
and parents (Gustafsson et al., 2011; Mikolajczak &
Roskam, 2018). According to the dominant theory, the
core characteristics of burnout are exhaustion, deperson-
alization and reduced personal accomplishment
(Maslach & Jackson, 1981).
The term “autistic burnout”has long been used by
members of the autistic community to describe the
negative consequences of living in a predominately non-
autistic world. Despite myriad anecdotal accounts online,
research into autistic burnout is relatively new. To date,
only a few qualitative studies have sought to define autis-
tic burnout and understand its core features by examining
the lived experiences of autistic adults (Higgins
et al., 2021; Mantzalas et al., 2021; Raymaker
et al., 2020). Their findings validate first-person reports
and characterize autistic burnout as long-term mental,
physical, and emotional exhaustion that builds over time,
often recurring after stressful life events or transitions.
Common features of autistic burnout include impaired
cognitive function, the loss of previously acquired skills
(e.g., self-care or speech), social and sensory withdrawal,
and a marked increase in observable autistic traits
Received: 2 November 2021 Accepted: 22 March 2022
DOI: 10.1002/aur.2722
© 2022 International Society for Autism Research and Wiley Periodicals LLC.
976 Autism Research. 2022;15:976–987.
wileyonlinelibrary.com/journal/aur
(Higgins et al., 2021; Mantzalas et al., 2021; Raymaker
et al., 2020). Factors including “masking”autistic traits,
stressful life events, and alexithymia contribute to autistic
burnout, as do stigma and discrimination against autistic
people. In contrast, energy management, social support,
stimming, and good self-awareness can be protective
(Higgins et al., 2021; Mantzalas et al., 2021; Raymaker
et al., 2020). Findings suggest that autistic burnout can
severely impact the mental health, quality of life and
wellbeing of autistic people. Thus, it is vital to learn more
about potential risk and protective factors. Based on the
current literature, we propose a conceptual model to bet-
ter understand the factors underlying autistic burnout.
THEORETICAL FRAMEWORK
The theoretical framework proposed for the model is
based on two disability theories: the Social-Relational
Model of disability ([S-RM]; Simpson et al., 2013;
Thomas, 2004), and the neurodiversity paradigm
(Kapp, 2020), and two theories of burnout and stress: the
Job Demands-Resources model ([JD-R]; Bakker
et al., 2004; Demerouti et al., 2001) and Conservation of
Resources theory ([COR]; Hobfoll, 1989).
MODELS OF DISABILITY
Within the medical model of disability, autism is viewed
through a deficit-based lens. Diagnostic criteria for
autism (e.g., restricted and repetitive behaviors; Ameri-
can Psychiatric Association, APA, 2013) are patholo-
gized and treatments often aim to reduce or extinguish
“undesirable”or observable autistic traits. The social
model of disability, on the other hand, posits that disabil-
ity arises from external factors that limit people’s partici-
pation in society (Oliver, 2013). The S-RM bridges these
perspectives, conceptualizing disability as a form of social
oppression dependent on the relationship between an
individual’s“impairments”and social and environmental
influences (Simpson et al., 2013). While aspects of a per-
son’s condition may restrict their activity, disability is
socially imposed. Disability may be “structural”or “psy-
cho-emotional”and affect an individual’s activity and
psychological or emotional wellbeing (Simpson
et al., 2013; Thomas, 2004). Whereas structural disablism
is caused by exclusionary factors in the environment
(e.g., access to employment or information, and physical
access to buildings), psycho-emotional disablism is an
internal form of oppression that can indirectly or directly
contribute to exclusion (Reeve, 2014).
Exclusion by indirect psycho-emotional disablism
stems from structural reminders that individuals with dis-
abilities are different, leading to embarrassment and
preventing them from using services or facilities
(e.g., accessing a building via a hidden entrance or a
supermarket’s designated “quiet hour”). On the other
hand, direct psycho-emotional disablism comes from an
individual’s relationships with their families, friends, pro-
fessionals, strangers, and themselves. Being stared at,
called names, infantilized, ignored, and narratives about
curing disabilities can lead to lower self-esteem and self-
worth, and subsequent social withdrawal (Reeve, 2014).
These experiences can contribute to internalized oppres-
sion where individuals try to pass as “normal”or overcom-
pensate to achieve above expectations, both of which can
be physically and emotionally exhausting. Individuals who
internalize negative messages about disability may subcon-
sciously exclude themselves from normative life experi-
ences (e.g., marriage or having children; Reeve, 2014).
Autism is a heterogeneous condition with a wide
range of traits and support needs, some of which are chal-
lenging and can limit social participation. For example,
sensory and social-communication differences may limit
social connectedness. Furthermore, autistic people often
report co-occurring conditions such as sleep problems
(Jovevska et al., 2020), epilepsy (Lukmanji et al., 2019)
and psychiatric conditions (APA, 2013) which can further
limit social participation. Existing social, medical, cul-
tural, and economic barriers can compound these diffi-
culties and contribute to disability. Examples of
structural disablement include a lack of low-sensory
spaces in workplaces or shopping centers, which may pre-
vent autistic individuals retaining employment or pur-
chasing essential items. Similarly, noisy, or brightly lit
waiting rooms may prevent autistic people seeking
healthcare. Autistic people are a minority group who
experience marginalization, negative stereotyping and
poor awareness about the diversity of autism characteris-
tics (Botha & Frost, 2020; Cage et al., 2019;
Sarrett, 2016), which can contribute to internalized
stigma and psycho-emotional disablement. For example,
if autistic people feel like a burden, or unworthy of rea-
sonable accommodations, this can restrict their participa-
tion in work, study, or social interactions.
Challenging the medical model’s focus on cure and
societal stigma about people with neurodiverse conditions
(e.g., autism, attention deficit hyperactivity disorder, Tour-
ette’s syndrome), the neurodiversity paradigm adopts a
strengths-based lens with acknowledgment that aspects of
these conditions can be challenging and disabling (Kapp
et al., 2012; Silberman, 2015), particularly when needs are
not supported. Neurodiversity is an advocacy movement
that supports the inclusion and acceptance of
neurodivergent people and views autism as a natural form
of human variation with inherent strengths rather than a
collection of deficits that should be eliminated (den
Houting, 2019; Kapp et al., 2012). Positive representation
of neurodivergent conditions can help combat the direct
and indirect psycho-emotional disablement experienced by
autistic people by reframing stereotypical views about
autism and emphasizing participation, self-acceptance,
self-advocacy, and inclusion.
COMMENTARY 977
THEORIES OF BURNOUT AND STRESS
The JD-R is a theory of workplace stress that classifies
work attributes as either demands or resources. Job
demands require physical or cognitive effort that may
lead to physical or psychological costs over time, whereas
job resources can offset the costs associated with job
demands and are experienced as fulfilling or rewarding.
According to the JD-R, exhaustion and burnout can
occur if job demands consistently exceed job resources
(Bakker et al., 2004; Xanthopoulou et al., 2007). A core
assumption of the JD-R is that resources act as a buffer
between demands and exhaustion; however, COR theory
posits that this relationship is not always straightforward.
Fundamentally, COR theory is a motivation model
based on the premise that individuals strive to acquire, pro-
tect, and replenish resources. Stress and burnout may occur
if an individual’s investment in resources (e.g., time) does
not produce expected returns (Hobfoll, 1989;Hobfoll&
Freedy, 2017). Resources are objects, conditions, personal
qualities, and energies that are intrinsically valued, or which
facilitate the acquisition of other valued resources
(e.g., education, money, self-esteem). Resource loss can trig-
ger “loss spirals”that lead to further resource losses. For
example, depleted energy (resource) may prevent an autistic
individual engaging with their special interests (resource)
which could, in turn, reduce their mental wellbeing
(resource). Additionally, the effort associated with acquiring
and maintaining some resources can outweigh their protec-
tive, buffering effect (Hobfoll & Freedy, 2017).
THE CONCEPTUAL MODEL
Guided by the disability and stress models, we developed
the Conceptual Model of Autistic Burnout ([CMAB];
Figure 1) to explore the direct and indirect relationships
among categories of measurable variables including
demands and resources, mental strain and wellbeing, demo-
graphics, and social and environmental factors, and their
Autistic
Burnout
Personal
Demands
Personal
Resources
Mental
Strain
Wellbeing
Social,
Environmental,
Demographic
Exhaustion
Masking or
camouflaging
Stimming
Depression
Satisfaction
with life
Stigma
Social
withdrawal
Sensory
sensitivities
Special
interests
Anxiety
Community
Discrimination
Autistic traits
Self-
awareness
Stress
Gender
Age
Social
support
AUTISTIC
BURNOUT
MENTAL STRAIN
WELLBEING
PERSONAL
DEMANDS
PERSONAL
RESOURCES
-
+
-
+
-
-
-
+
+
+-
Social, Environmental &
Demographic factors
FIGURE 1 The conceptual model of
risk and protective factors for autistic
burnout. Solid lines between variables
depict direct hypothesized relationships,
and dashed lines represent indirect
hypothesized relationships
978 COMMENTARY
potential influence on autistic burnout. The selection of
model variables was informed by the current literature
about autistic burnout (Higgins et al., 2021; Mantzalas
et al., 2021;Raymakeretal.,2020) and the mental health
and wellbeing of autistic adults (Lai et al., 2019).
Further, an Advisory Group of four autistic adults with
lived experience of autistic burnout reviewed the model and
endorsed the relevance of the chosen variables and hypothe-
sized relationships. This group comprised three autistic
females and one autistic male, over 18 years, who had all
received a late autism diagnosis. The CMAB incorporates
demands and resources that may influence the onset of autis-
tic burnout directly, or indirectly via the intermediate factors
of mental health and wellbeing. The CMAB also integrates
the impact of loss spirals described in COR theory.
Based on the CMAB, 14 positive and negative rela-
tionships are hypothesized (Table 1). The rationale for
the inclusion of the variables in the CMAB is discussed in
the next section.
RISK AND PROTECTIVE FACTORS FOR
AUTISTIC BURNOUT
Personal demands
Autistic traits
Autism is a heterogeneous condition where, in the
absence of robust biological markers, diagnosis is based
on observable behavioral traits including social-
communication difficulties, repetitive and restricted
behaviors, and sensory issues (APA, 2013). Research sug-
gests that elevated autistic traits are associated with nega-
tive social and mental health outcomes including a
greater risk of bullying among autistic children (Rai
et al., 2018), and a higher incidence of abuse and trauma
throughout the lifespan (Roberts et al., 2015). Among
autistic adults, autistic traits may contribute to suicidality
(Pelton & Cassidy, 2017), depression (Hedley et al., 2018;
Rai et al., 2018) and dissatisfaction with social support
(Hedley et al., 2018). Conversely, fewer autistic traits are
associated with fewer negative life events (Griffiths
et al., 2019). During periods of autistic burnout, adults
report feeling “more autistic”and commonly experience
the loss of previously acquired skills (e.g., self-care and
speech), greater sensory sensitivities and increased social
communication difficulties (Higgins et al., 2021;
Mantzalas et al., 2021; Raymaker et al., 2020).
Studies examining the influence of autistic traits on
mental health often report total scores on validated mea-
sures (e.g., the Autism Spectrum Quotient; Baron-Cohen
et al., 2001). It has been suggested, however, that examin-
ing subscale scores could identify nuances in the relation-
ship between individual autistic traits and mental
wellbeing (Stimpson et al., 2021). Using the Broad
Autism Phenotype Questionnaire (Hurley et al., 2007),
which measures sub-clinical autistic traits and produces
both a total and three subscale scores, Stimpson
et al. (2021) found that “aloofness”was the only signifi-
cant predictor of mental wellbeing among adults in a
non-clinical sample. Similarly, the core autism traits of
social communication difficulties and insistence on same-
ness have been associated with depression and suicidal
ideation (Hedley et al., 2021). Thus, the CMAB includes
the broad category “autistic traits,”to assess their general
impact on mental strain, wellbeing, and autistic burnout,
but also considers the impact of individual traits such as
sensory sensitivities and special interests, which may
influence the development of autistic burnout, positively
or negatively.
Masking/camouflaging
According to autistic adults, the effort of masking
(or camouflaging) their autistic traits is exhausting and is
a prominent risk factor for autistic burnout (Higgins
et al., 2021; Mantzalas et al., 2021; Miller et al., 2021;
Raymaker et al., 2020). Masking can be understood as
the “conscious or unconscious suppression of natural
responses and adoption of alternatives across a range of
domains including social interaction, sensory experience,
cognition, movement, and behavior”(Pearson &
Rose, 2021, p. 53). Although the terms are often used
interchangeably, Hull et al. (2017) differentiate between
three types of camouflaging strategies: “compensation”
(e.g., pretending to make eye contact), “masking”
TABLE 1 Hypothesized relationships among variables in the
conceptual model of autistic burnout
CMAB facet Hypothesis
Personal
demands
•Will directly increase the risk of autistic
burnout.
•Will indirectly increase the risk of autistic
burnout by increasing mental strain.
•May either increase or decrease personal
resources.
•Will decrease wellbeing.
Personal
resources
•Will directly decrease the risk of autistic
burnout.
•May either increase or decrease personal
demands.
•Will indirectly decrease the risk of autistic
burnout by increasing wellbeing.
•Will decrease mental strain.
Mental strain •Will increase the risk of autistic burnout.
•Will decrease wellbeing.
Wellbeing •Will decrease the risk of autistic burnout.
•Will decrease mental strain.
Additional
variables
•Gender and age may influence the risk of
autistic burnout.
•Social and environmental factors will influence
the risk of autistic burnout.
COMMENTARY 979
(e.g., using pre-prepared scripts during conversations),
and “assimilation”(e.g., trying to blend in with a social
group). (Hereafter, we use “masking”to describe the suite
of strategies used to disguise autistic traits). Masking is
used to facilitate social communication between autistic
and non-autistic people, which can be stressful and con-
fusing (Hull et al., 2017). Unsuccessful social interactions
are commonly attributed to autistic people’s social-
communication difficulties and poor understanding
about the motivations, mental and emotional states of
others (“theory of mind”; Baron-Cohen et al., 1985).
These perceptions likely motivate autistic people to mask.
However, autistic people report fewer social-
communication difficulties during interactions with other
autistic people (Gernsbacher et al., 2017), suggesting that
autistic and non-autistic people have difficulties under-
standing each other (Edey et al., 2016; see also “the dou-
ble empathy”problem; Milton, 2012).
Pearson and Rose (2021) suggest that masking
extends beyond behavioral strategies and could be a
trauma response that develops from experiences of
stigma. It is well established that autistic people mask to
avoid discrimination, stigma, and victimization (Cage &
Troxell-Whitman, 2019; Hull et al., 2017), and to gain
access to employment and social inclusion. Indeed, autis-
tic adolescents mask to avoid being perceived as mentally
deficient and less competent by others (Bernardin
et al., 2021).
These cost–benefit characteristics describe why the
CMAB categorizes masking as both a demand and a
means of resource gain. However, despite its potential
benefits, long-term masking can harm the mental health
of autistic adults and may contribute to suicidality
(Bargiela et al., 2016; Cage & Troxell-Whitman, 2019;
Livingston et al., 2019). Masking can also conceal sup-
port needs (Baldwin & Costley, 2016) and contribute to
the misdiagnosis and under-diagnosis of autism, particu-
larly among women (Livingston et al., 2019; Milner
et al., 2019). Masking can contribute to psycho-
emotional disablement through feelings of guilt and isola-
tion (Hull et al., 2017; Livingston et al., 2019), with-
drawal to avoid social rejection (Hull et al., 2017), and
identity confusion (Pearson & Rose, 2021). However,
while “taking the mask off”can assist with recovery from
autistic burnout (Mantzalas et al., 2021; Raymaker
et al., 2020), unmasking is complex and may contribute
to burnout through trauma associated with resultant bul-
lying, discrimination, and stigma (Mantzalas et al., 2021;
Miller et al., 2021; Pearson & Rose, 2021).
Sensory sensitivities
Sensory sensitivities are common among autistic people
of all ages and can significantly impact their mental
health and wellbeing (Halim et al., 2018; Milner
et al., 2019). Compared to the general population,
autistic people are more likely to report over- or under-
responsivity to sensory stimuli which continues across the
lifespan (Ben-Sasson et al., 2009; Crane et al., 2009;
Lane, 2020). Indeed, a study comparing sensory over-
responsivity among autistic and non-autistic adults found
that autistic participants self-reported increased over-
responsiveness in all sensory categories (sight, smell,
hearing, touch, taste, and proprioception) compared to a
control group (Tavassoli et al., 2014). Autistic females
have identified sensory sensitivities as one of the most
challenging aspects of autism that can reduce quality of
life and contribute to meltdowns (externalized aggression,
crying, distress) or shutdowns (internalizing behaviors
including emotional and cognitive dissociation, or appe-
aring “frozen”; Halim et al., 2018; Milner et al., 2019;
Phung et al., 2021). Sensory overload is a prime risk fac-
tor for autistic burnout, with reduced tolerance to sensory
stimuli commonly reported during burnout episodes.
Conversely, sensory withdrawal and avoidance can be
beneficial for prevention and recovery (Higgins
et al., 2021; Mantzalas et al., 2021; Raymaker
et al., 2020).
Personal resources
Self-stimulatory behaviors
Repetitive, self-stimulatory behaviors (“stimming”) are a
core diagnostic feature of autism (APA, 2013) and can be
physical (e.g., fidgeting, rocking), vocal (e.g., humming,
repeating phrases), visual (e.g., staring at a lava lamp),
tactile (e.g., rubbing fabric), or olfactory (e.g., sniffing
things; Steward, 2015). Stimming is an important form of
sensory and emotional self-regulation that facilitates cop-
ing during overwhelming and stressful situations, (Kapp
et al., 2019; Manor-Binyamini & Schreiber-Divon, 2019),
and is a vital part of many autistic people’s identity
(Steward, 2015). Despite this, the use of noticeable stims
by adults is stigmatizing and generally socially unaccept-
able (Kapp et al., 2019). Some autism interventions focus
on eliminating stims, which can be harmful for mental
health (Halim et al., 2018; Kapp et al., 2019). Findings
from two qualitative studies (Higgins et al., 2021;
Mantzalas et al., 2021) that examined autistic adults’
lived experiences of autistic burnout (N=23 and
N=612, respectively) suggest that stimming to regulate
emotions helps offset the accumulation of stress that con-
tributes to burnout. However, the stigma surrounding
stimming can become internalized (Kapp et al., 2019),
thus contributing to psycho-emotional disability.
Special interests
Another diagnostic criterion of autism is restricted inter-
ests or activities (APA, 2013). “Special interests”are
980 COMMENTARY
topics about which autistic individuals are highly knowl-
edgeable and competent, and provide enormous pleasure,
familiarity, and calm during times of stress
(McDonnell & Milton, 2014). These interests can facili-
tate identity formation (Jordan & Caldwell-Harris, 2012)
and emotional self-regulation, as well as improve self-
esteem and self-efficacy (McDonnell & Milton, 2014).
While intense interests are usually called hobbies or pas-
sions among non-autistic people, they are often perceived
as unusual and unhealthy obsessions among autistic peo-
ple (McDonnell & Milton, 2014). A possible reason for
these negative perceptions is that autistic people can per-
severate or “hyperfocus”on their beloved activities to the
exclusion of other things (Ashinoff & Abu-Akel, 2019).
Intense focus, also called “monotropism,”(Murray
et al., 2005) may partly explain attention and social-
communication differences in autism. Absorption in a
preferred activity can make it difficult for autistic people
to switch focus and engage in social interaction if they
are interrupted (Milton, 2017). Deep immersion in an
enjoyable activity is also called “flow”(Ullén
et al., 2012), which can mitigate depression and emo-
tional exhaustion associated with workplace burnout
among non-autistic people (Mosing et al., 2018).
As time with special interests can assist during recovery
from autistic burnout (Higgins et al., 2021), they have been
categorized as a personal resource in the CMAB. However,
the overwhelming exhaustion that defines autistic burnout
could offset the positive benefits of special interests if indi-
viduals lack the energy to engage with them. Additionally,
hyperfocus may offset their protective qualities if it interferes
with self-care (e.g., rest and eating regularly; Mantzalas
et al., 2021); therefore, it is hypothesized that special inter-
ests may also increase personal demands.
Self-awareness
Autistic burnout occurs after demands build up over time;
therefore, recognizing early signs of physical and mental
overwhelm is vital. It is estimated, however, that approxi-
mately 50% of autistic people experience alexithymia—
difficulties identifying and describing one’sfeelingsand
emotions—compared to 5% of the general population
(Berthoz & Hill, 2005; Kinnaird et al., 2019). Individuals
with alexithymia are more likely to experience emotion reg-
ulation and mental health difficulties (Kinnaird et al., 2019),
and it has been suggested that alexithymia could be a risk
factor for workplace burnout (Riethof et al., 2020).
Alexithymia is also a prominent marker for impaired
interoception (Shah et al., 2016). Interoception refers to
the ability to perceive bodily states including pain,
hunger, and tension (Shah et al., 2016) and is vital for
socio-emotional function (Murphy et al., 2017). Atypical
interoception is common among autistic adults (DuBois
et al., 2017) and can contribute to poor self-regulation,
poor physical and mental health (Shah et al., 2016),
sensory symptoms (Murphy et al., 2017) and autistic
burnout (Mantzalas et al., 2021; Pearson & Rose, 2021).
Interoception difficulties occur throughout the lifespan,
often spiking during adolescence and older-adulthood
alongside developmental changes (e.g., puberty and men-
opause; Murphy et al., 2017). This is similar to the pat-
tern observed for autistic burnout, suggesting that
autistic individuals with alexithymia and/or interoception
difficulties may be more vulnerable to autistic burnout.
Extant research suggests that self-awareness can improve
after autistic burnout (compared to individuals’pre-burnout
levels) as people learn to recognize triggers, develop and
implement protective coping strategies, including self-care,
planning, energy management, and boundary setting to pre-
vent recurrence (Higgins et al., 2021; Mantzalas et al., 2021;
Raymaker et al., 2020).
Social support
Social support is defined as “an exchange of resources
between at least two individuals perceived by the provider
or the recipient to be intended to enhance the wellbeing of
the recipient”(Shumaker & Brownell, 1984,p.13).Social
support is provided by a network of family, friends, or
others who individuals can turn to during times of stress or
crisis. Good social support can have a positive impact on
the self-esteem, independence, mental health, and wellbeing
of autistic adults (Baldwin & Costley, 2016; Zener, 2019).
Examples include understanding autistic peoples’traits and
sensitivities and accommodating for communication, sen-
sory and social needs at home, school, or work (Hayward
et al., 2019; Zener, 2019). Research shows a link between
poor social support and both depression and suicidal idea-
tion in autistic adults (Hedley et al., 2018). A lack of appro-
priate support and barriers to support have been identified
as risk factors for autistic burnout (Higgins et al., 2021;
Raymaker et al., 2020).
Consistent with COR theory, the proposed CMAB rec-
ognizes that, while social support is a protective resource, it
can also contribute to personal demands. For example, sup-
port networks may get tired of helping and become unwill-
ing to help during chronic stress (Hobfoll & Freedy, 2017).
Well-meaning support that is incompatible with the needs
of autistic adults can also prolong or worsen episodes of
autistic burnout (Higgins et al., 2021). Furthermore, if autis-
tic individuals cannot offer reciprocal support due to over-
load, relationships may become strained, narrowing future
sources of support.
Mental strain
Depression, anxiety, and stress
Studies show that approximately 70% of autistic people
experience a co-occurring mental health condition such
COMMENTARY 981
as depression or anxiety throughout the lifespan
(APA, 2013; Au-Yeung et al., 2019; Hofvander
et al., 2009), with heightened risk during key develop-
mental milestones (e.g., adolescence; Lai et al., 2019).
Indeed, autistic adults often report that their first experi-
ence of autistic burnout occurred during the transition to
high school or adulthood. Early findings indicate that co-
occurring conditions may represent a risk factor for autis-
tic burnout and exacerbate existing conditions
(Mantzalas et al., 2021; Raymaker et al., 2020). In addi-
tion, stressful life events such as bullying, victimization
(Streckovic et al., 2014), unemployment, and discrimina-
tion (Milovanov et al., 2013) contribute to mental strain
among autistic people during childhood and adulthood
(Berg et al., 2016; Fuld, 2018; Milovanov et al., 2013).
Stressful life events can also contribute to autistic burn-
out, with heightened risk when individuals cannot relieve
stress, or when requests for support are dismissed or dis-
believed (Raymaker et al., 2020).
Similarities between (workplace) burnout and depres-
sion have fueled debate about whether the two are dis-
tinct constructs, or different points along a depression
“spectrum.”Bianchi et al. (2014,2015) posit that com-
mon symptoms (e.g., exhaustion, difficulties concentrat-
ing) and methodological flaws in the structure and
measurement of burnout support the argument that burn-
out is a form of atypical depression. However, a later sys-
tematic review and meta-analysis which examined the
relationship between burnout, depression and anxiety
concluded that the three conditions are distinct and
robust constructs (Koutsimani et al., 2019). In a qualita-
tive investigation, participants with lived experience of
both burnout and depression described clear differences
between the two, such as more debilitating exhaustion
during burnout than depression, and the ability to enjoy
non-work activities during burnout while they were
unable to enjoy anything while depressed (Tavella &
Parker, 2020). Similarly, autistic adults differentiate
between depression and autistic burnout, and report that
it is possible to engage in their special interests during
periods of burnout (Higgins et al., 2021; Mantzalas
et al., 2021; Raymaker et al., 2020).
Wellbeing
Satisfaction with life
Satisfaction with life (SWL) is a component of subjective
wellbeing that can impact an individual’s mental health
outcomes. While heritable factors and temperament may
contribute to SWL, environmental factors play a key role
(Pavot & Diener, 2008). Research among autistic adults
shows that social support and connectedness, social inclu-
sion and community positively influence SWL
(Casagrande et al., 2020), whereas victimization, negative
life events and unemployment have a negative impact
(Griffiths et al., 2019). SWL may also offset mental strain
and buffer against autistic burnout, particularly for indi-
viduals who make positive life changes after experiencing
burnout (e.g., career change, setting boundaries; Higgins
et al., 2021; Mantzalas et al., 2021).
Community
Distinct from social support, a “community”is a group of
people who share common characteristics, interests, atti-
tudes, and identity. Connection to people with shared lived
experiences can have a positive impact on wellbeing and
improve self-advocacy (Haney & Cullen, 2017;
Kapp, 2020). The disability rights and self-advocacy move-
ments and widespread access to the internet have contrib-
uted to the formation of autistic communities
(Bagatell, 2010), whose members connect through social
media (e.g., the #ActuallyAutistic hashtag), gaming plat-
forms, blogs, discussion forums and advocacy groups.
Autistic communities (e.g., autistic parents, autistic people
of color, gender-diverse autistic individuals) are a valuable
source of acceptance and pride for autistic people who often
face discrimination and stigma elsewhere (Bagatell, 2010).
Members of autistic communities offer and receive autism-
related information and advice, understanding and valida-
tion about shared lived experiences (Mantzalas et al., 2021;
Raymaker et al., 2020). Positive interactions with autistic
peers and role models may lessen internalized oppression
associated with psycho-emotional disablism (Reeve, 2014).
Thus, according to the CMAB, belonging to a supportive
community could help mitigate the onset and impact of
autistic burnout.
Autistic burnout
Exhaustion
Consistent with the broader burnout literature, exhaus-
tion is a core feature and consequence of autistic burnout.
Autistic adults have described a debilitating state of phys-
ical, mental, and emotional exhaustion that significantly
impacts their ability to function. Aspects of functioning
affected during autistic burnout include reduced execu-
tive functioning (e.g., planning, organization), loss of
focus and concentration, difficulties producing and
processing speech, and the loss of previously acquired
skills, including self-care abilities (Higgins et al., 2021;
Mantzalas et al., 2021; Raymaker et al., 2020).
Social withdrawal
The deleterious impact of autistic burnout on energy levels
can lead to withdrawal from daily activities including work,
study, and socializing (Higgins et al., 2021; Mantzalas
et al., 2021; Raymaker et al., 2020). While avoidance
coping is generally perceived to be maladaptive, or only
982 COMMENTARY
beneficial in the short-term (Suls & Fletcher, 1985), early
findings suggest its utility may differ for autistic people
experiencing burnout (Mantzalas et al., 2021). Indeed,
autistic adults commonly use social, sensory, and interper-
sonal withdrawal to prevent autistic burnout and facilitate
recovery (Higgins et al., 2021; Mantzalas et al., 2021;
Raymaker et al., 2020).Asacopingmechanism,with-
drawal from stressful situations may allow the individual
time to rest and recover, thereby limiting resource losses
(Hobfoll & Freedy, 2017).
Additional factors
Gender
In the CMAB, it is hypothesized that gender could influ-
ence the onset of autistic burnout, possibly through the
motivations for masking, which as previously discussed,
is a key risk factor. Some studies suggest that autistic
males are less socially motivated to mask than autistic
females and feel less pressure to fit in (Milner et al., 2019;
Sedgewick et al., 2016). Males also report more positive
feelings associated with camouflaging compared to
females (Hull et al., 2017). Societal expectations associ-
ated with the female gender role may increase the burden
on autistic females through a perceived need to maintain
a façade, especially if they do not enjoy stereotypical
aspects of femininity such as wearing makeup and a
desire for motherhood (Bargiela et al., 2016; Cage &
Troxell-Whitman, 2019; Kanfiszer et al., 2017).
Hobfoll (1989) acknowledges that women (in general)
may be more vulnerable to stress and face more barriers to
resource acquisition than men. Indeed, being autistic and
female is associated with an increased risk for anxiety and
depression (Uljarevi
c et al., 2019). Unique factors associated
with being female such as menstruation, menopause
(Moseley et al., 2020;Stewardetal.,2018), and pregnancy
and childbirth (Samuel et al., 2021) may contribute to a
greater risk of autistic burnout among females as these expe-
riences are often associated with heightened sensory difficul-
ties and anxiety, poorer executive functioning, and a
reduced capacity for emotion regulation. Additionally, peo-
ple on the autism spectrum are more likely to experience
gender dysphoria (e.g., identify as transgender, non-binary;
Cooper et al., 2021; George & Stokes, 2018); thus, it is pos-
sible that the stress of claiming or masking multiple margin-
alized identities (e.g., transgender, disabled) could increase
the risk of autistic burnout.
Age
Age may influence vulnerability to autistic burnout at
various stages throughout the lifespan. While extensive
research has focused on autism in childhood, autistic
advocates and researchers have highlighted the urgency
of studying autism in later life (Howlin & Taylor, 2015;
Michael, 2016), particularly as autistic adults have a
shorter life expectancy than adults in the general popula-
tion (Hirvikoski et al., 2016). Adult milestones including
post-secondary education, marriage, and parenthood can
increase the mental health burden for autistic adults
(Mason et al., 2019; Raymaker et al., 2020; Sterling
et al., 2007). Research suggests that changes associated
with developmental transitions (e.g., adolescence, early
adulthood) could increase vulnerability to autistic burn-
out because they place additional strain on coping
resources (Mantzalas et al., 2021; Phung et al., 2021;
Raymaker et al., 2020). Advancing age can also bring a
variety of challenges including cognitive changes,
bereavement, loss of social support, serious or chronic ill-
ness, and retirement. For example, emotional changes
during menopause can significantly overtax the
established coping resources of autistic women (Moseley
et al., 2020). While such life events are universal, they
may be additionally burdensome for autistic people due
to changes in established routines, extra strain on coping
resources, additional sensory demands, and the potential
loss of support networks.
Social and environmental factors
While autistic burnout appears to be common among
autistic people, it is not experienced by all, and should
not be accepted as an inherent part of being autistic.
Research suggests that social and environmental factors
contribute significantly to the onset and recurrence of
autistic burnout (Higgins et al., 2021; Mantzalas
et al., 2021; Raymaker et al., 2020), and was described by
one autistic adult as the consequence of “being in a world
that is not your world”(Higgins et al., 2021, p. 6). Envi-
ronmental influences can include harmful sensory envi-
ronments and a lack of family or workplace support. At
a societal level, the widespread lack of autism awareness
and acceptance can impact accurate and timely autism
diagnosis, access to supports, underlie motivations for
masking and contribute to internalized stigma (Higgins
et al., 2021; Mantzalas et al., 2021; Raymaker
et al., 2020). While various protective strategies have
been proposed here, most are person-centered. Societal
change to reduce stigma, discrimination and inhospitable
environments for autistic people is vital for long-term
and sustained prevention and recovery from autistic
burnout.
CONCLUSION
The proposed CMAB identifies risk and protective fac-
tors for autistic burnout using a theoretical framework
informed by the JD-R, COR theory, S-RM, and neu-
rodiversity paradigm, and includes measurable variables
COMMENTARY 983
from extant literature classified as personal demands,
personal resources, mental strain, and wellbeing. In so
doing, direct and indirect, testable relationships are pro-
posed that may influence the risk of autistic burnout.
While anecdotal reports and the few existing qualitative
studies indicate that burnout is common among autistic
people, it is not experienced by all. It is therefore impor-
tant to examine risk and protective factors to identify rea-
sons why some autistic individuals may be more
vulnerable to burnout. Identifying protective and vulner-
ability factors forms a basis for the prevention or amelio-
ration of autistic burnout.
Todate,researchhasfocusedontheexperiencesof
autistic adults who have indicated that autistic burnout
often first occurs early in life and recurs across the
lifespan, supporting the need to adopt a developmental
approach in future research. This approach will be
important to identify unique risk factors and preven-
tive strategies that may help to interrupt the harmful
cycle of burnout which can impede achievement and
independence. The CMAB proposes the underlying
mechanisms of autistic burnout, but can be adapted to
investigate burnout among different groups whose
demands and resources may vary greatly (e.g., autistic
people with high support needs; autistic children; or
older autistic women).
Having proposed the CMAB, it is important to
empirically test the model to examine the hypothesized
relationships. As research in the field of autistic burnout
develops, the research findings will further inform the
CMAB and lead to the incorporation of other relevant
variables. It is anticipated that this body of research will
lead to the future development of resources and supports
to prevent the onset of autistic burnout and to assist
autistic individuals through recovery.
ETHICS STATEMENT
Approval for this research was obtained from the La
Trobe University Human Research Ethics Committee
(HEC21009).
ACKNOWLEDGMENTS
Our warmest thanks to Regine Theodore, Kieran Rose,
Lauren Sargeant, and Sarah McFarlane for their time
and insightful feedback.
DATA AVAILABILITY STATEMENT
Data sharing not applicable to this article as no datasets
were generated or analysed during the current study.
ORCID
Jane Mantzalas https://orcid.org/0000-0002-9202-8961
Amanda L. Richdale https://orcid.org/0000-0003-4911-
7181
Cheryl Dissanayake https://orcid.org/0000-0002-8771-
4027
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