Autism and Self-Esteem: A Systematic Review Quantifying Differences Between Autistic and Non-Autistic Adolescents and...

Autistic individuals are at increased risk of developing mental health difficulties. Self-esteem has been found to be a significant indicator of mental health in the general population yet remains underexplored in autistic adolescents. This review aimed to explore rates of low self-esteem in autistic versus non-autistic adolescents (10-19 years of age) and examine the relationship between self-esteem and mental health symptomatology. A comprehensive literature search was conducted across four databases to identify relevant studies published until March 2025. The systematic review included 30 studies of self-esteem in autistic adolescents, including 15 studies with a non-autistic comparison group, and 16 studies with measures of both self-esteem and mental health. Autistic adolescents reported significantly lower levels of self-esteem compared with non-autistic adolescents, with a moderate weighted pooled effect size (g = -0.47). Group differences were maintained when considering measure variance in self-esteem tools but observed to be greater when using the Self-Perception Profile (g = -0.55) in contrast to the Rosenberg Self-Esteem Scale (g = -0.33). Lower self-esteem was associated with greater depressive symptomatology in autistic adolescents, with large effect (r = -.59). These findings highlight the need for targeted self-esteem interventions in autistic adolescents as a potential means to address co-occurring mental health difficulties.Lay AbstractAutistic adolescents are more likely to experience mental health difficulties than their non-autistic peers. One factor that may influence mental health is self-esteem, which refers to how positively or negatively a person views themselves. This review looked at how self-esteem differs between autistic and non-autistic adolescents, and whether low self-esteem is linked to mental health problems such as depression and anxiety. The review included 30 studies, some of which compared self-esteem levels between autistic and non-autistic adolescents and others explored how self-esteem relates to mental health symptoms. The findings showed that autistic adolescents tend to have lower self-esteem than non-autistic adolescents. In addition, lower self-esteem was linked to higher levels of depression in autistic adolescents. These results suggest that supporting self-esteem in autistic adolescents may be an important way to help improve mental health difficulties. The studies in this review included mainly male participants and used different ways to measure self-esteem and mental health, so more research is needed to better understand these relationships and how best to support a diverse range of autistic adolescents.