Clinically Significant Anxiety in Children with Autism Spectrum Disorder and Varied Intellectual Functioning

Abstract

Objective: To evaluate how distinct presentations of anxiety symptoms and intellectual impairment influence the measurement and estimated rate of clinically significant anxiety in autism spectrum disorder (ASD). Method: The sample included 75 children (ages 9-13 years) with ASD and varied IQ and 52 typically developing (TD) controls and parents. Parents completed anxiety symptom scales and a diagnostic interview, designed to (1) differentiate anxiety and ASD and (2) examine DSMspecified and unspecified ("distinct") anxiety presentations in each child, including fears of change, special interests, idiosyncratic stimuli and social confusion rather than evaluation. Children completed standard intellectual and ASD diagnostic assessments. Results: 69% of those with ASD had clinically-significant anxiety, including 21% DSM-specified anxiety disorders, 17% distinct anxiety, and 31% both. Only 8% of TD children had clinicallysignificant anxiety, all DSM-specified. DSM-specified anxiety disorders in children with ASD and intellectual impairment (IQ<70) were predominantly specific phobias. DSM-specified anxiety other than specific phobia was significantly less common in children with, versus without, intellectual impairment; this was not the case for distinct anxiety. The sensitivities of anxiety scales were moderate to poor, particularly in cases with intellectual impairment. Conclusions: ASD is associated with more frequent and varied presentations of clinical anxiety, which may align with and differ from the specified anxiety disorders of the DSM. Standard parent report anxiety scales have reduced sensitivity to detect clinical anxiety in ASD, particularly in children with intellectual impairment. "This summer [1937] we brought him to a playground slide and on the first afternoon when the other children were sliding on it he would not get about it, and when we put him up to slide down it he seemed horrorstruck. The next morning when nobody was present, however, he walked out, climbed the ladder, and slid down and he has slid on it frequently since, but slides only when no other child is present to join him in sliding." Case 1, "Donald" "He frets when the bread is put in the oven to be made into toast, and is afraid it will get burned and be hurt. He is upset when the sun sets. He is upset because the moon does not always appear in the sky at night." Case 8, "Alfred"

Trajectories of co-occurring psychopathology symptoms in autism from late childhood to adulthood

“…Internalizing symptoms in children and adults who are minimally verbal can be difficult to assess using instruments normed for the general populations. In a recent study, individuals with cognitive impairments were most commonly diagnosed with specific phobias and separation anxiety, whereas a much wider range of anxiety disorders were found in individuals with IQs over 70 (Kerns et al, 2020). Thus, the ASEBA measures may not have been sensitive to detect the quality of anxiety in individuals with ASD and lower cognitive capacity.…”

Case study: identification of anxiety and subsequent intervention in an adolescent male with autism, severe intellectual disability and self-injurious behaviour

“…Kerns et al (2020) also noted that the sensitivities of anxiety scales were moderate to poor, particularly so for children with ID. While some findings indicate that prevalence of anxiety disorder may be associated with either lower (van Steensel et al 2011) or higher (Sukhodolsky et al 2008) levels of intellectual functioning, others have concluded that intellectual ability may have bigger effects on the presentation of anxiety disorder rather than its prevalence in individuals with ASD (Kerns et al 2020, Kerns et al 2012.…”

A Scoping Review of Anxiety in Young Children with Autism Spectrum Disorder

“…Another reason for these limited findings may be that cognitive functioning levels are associated with specific phenotypes of anxiety. For example, higher cognitive functioning may be more strongly associated with traditional, DSM disorders that require verbal reasoning skills for full symptom presentation such as generalized anxiety disorder [Kerns et al, 2020]. Notably, mixed results regarding the association between nonverbal communication and anxiety may reflect the need for investigating associations between IQ, communication, and anxiety subgroups.…”

“…Anxiety is an internal experience of thoughts, emotions, and physiological processes that may be particularly difficult to capture amidst a landscape of emerging ASD symptoms in young children. Hence, it is essential that new measures include questions to correctly differentiate anxiety and ASD symptoms, assess anxiety in nonverbal children, and capture distinct presentations of anxiety that may emerge in this age group [Kerns et al, 2014[Kerns et al, , 2020Rodgers et al, 2016;Vasa, Mazurek, Mahajan, et al, 2016]. Developing screening measures that can be administered by professionals working with young children with ASD (e.g., primary care physicians, speech pathologists, and behavioral therapists) will increase the likelihood of early detection and treatment of anxiety.…”