Repetitive Behavior Severity as an Early Indicator of Risk for Elevated Anxiety Symptoms in Autism Spectrum Disorder

Baribeau, Danielle A.; Vigod, Simone N.; Pullenayegum, Eleanor; Kerns, Connor M.; Mirenda, Pat; Smith, Isabel M.; Vaillancourt, Tracy; Volden, Joanne; Waddell, Charlotte; Zwaigenbaum, Lonnie; Bennett, Teresa; Duku, Eric; Elsabbagh, Mayada; Georgiades, Stelios; Ungar, Wendy J.; Zaidman‐Zait, Anat; Szatmári, Péter

doi:10.1016/j.jaac.2019.08.478

Cited by 70 publications

(63 citation statements)

References 43 publications

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“…With regard to future directions, assessing a broader range of anxiety problems in ASD with greater accuracy may shed light on how anxiety relates to the phenotype and developmental trajectory (Baribeau et al, 2019) and outcomes of children with ASD Lecavalier et al, 2017;Pellecchia et al, 2016;van Steensel et al, 2012) and aid in the identification of anxiety biomarkers, such as physiological (Hollocks, Howlin, Papadopoulos, Khondoker, & Simonoff, 2014) and amygdala responses (Herrington et al, 2017), in ASD. Accurate assessment is also critical to ensure that the full range of children suffering from anxiety problems are identified and given access to appropriate interventions.…”

Section: Clinical Implications and Future Directionsmentioning

confidence: 99%

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

Kerns

Winder-Patel

Iosif

et al. 2020

Journal of Clinical Child & Adolescent Psychology

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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"

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Section: Clinical Implications and Future Directionsmentioning

confidence: 99%

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

Kerns

Winder-Patel

Iosif

et al. 2020

Journal of Clinical Child & Adolescent Psychology

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“…The strong and consistent associations found across studies suggests the RRBs and anxiety are interrelated; that this relationship is speci c to children with ASD (14); and that the presence of RRB's proceeds the onset of anxiety (11,15,16). Subsequently, RRBs have been conceptualised as an early manifestation of anxiety (11,15) or a maladaptive response to negative affect which subsequently increases one's risk of anxiety over time (10,11,17). Although engaging in RRBs may temporarily reduce anxiety symptoms, their continued use may impede one's ability to adopt more adaptative coping mechanisms, reduce their ability to engage in their environment, and therefore ultimately perpetuate feelings of anxiety (10,11,17).…”

Section: Rrbs and Anxietymentioning

confidence: 80%

“…There is a body of evidence highlighting the association between RRBs and anxiety symptoms in individuals with ASD (11). Speci cally, cross-sectional studies have found moderate to large correlations between the two constructs (r = .41 -.69) with individuals experiencing higher anxiety engaging in more RRBs (12)(13)(14).…”

Section: Rrbs and Anxietymentioning

confidence: 99%

“…Speci cally, cross-sectional studies have found moderate to large correlations between the two constructs (r = .41 -.69) with individuals experiencing higher anxiety engaging in more RRBs (12)(13)(14). Several longitudinal studies exploring the nature of this relationship have found that the severity of RRBs predicts later anxiety, suggesting that a unidirectional relationship exists between the two constructs (p < .001 -p = 0.026) (11,15,16). The strong and consistent associations found across studies suggests the RRBs and anxiety are interrelated; that this relationship is speci c to children with ASD (14); and that the presence of RRB's proceeds the onset of anxiety (11,15,16).…”

Section: Rrbs and Anxietymentioning

confidence: 99%

“…Several longitudinal studies exploring the nature of this relationship have found that the severity of RRBs predicts later anxiety, suggesting that a unidirectional relationship exists between the two constructs (p < .001 -p = 0.026) (11,15,16). The strong and consistent associations found across studies suggests the RRBs and anxiety are interrelated; that this relationship is speci c to children with ASD (14); and that the presence of RRB's proceeds the onset of anxiety (11,15,16). Subsequently, RRBs have been conceptualised as an early manifestation of anxiety (11,15) or a maladaptive response to negative affect which subsequently increases one's risk of anxiety over time (10,11,17).…”

Section: Rrbs and Anxietymentioning

confidence: 99%

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Repetitive and Restricted Behaviours and Anxiety in Autism Spectrum Disorder: Protocol for a Systematic Review and Meta-Analysis

Sellick

Ure

Williams

2020

Preprint

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BackgroundAutism Spectrum Disorder (ASD) is a neurodevelopmental disorder defined by persistent deficits in social functioning and the presence of restricted and repetitive behaviours (RRBs). RRBs refer to four subtypes of behaviour including repetitive movements, speech or use of objects; insistence on sameness; restricted interests; and sensory processing abnormalities. Many individuals with ASD also experience anxiety, which compounds ASD related difficulties and inhibits daily functioning. RRBs have been found to be positively associated with anxiety, however our understanding of the interplay between RRB subtypes and anxiety remains unclear. Thus, the current review aims to systematically review and meta-analyse the association between RRBs and anxiety. Methods This review will collate studies which analyse the association between RRBs and anxiety in individuals with ASD. We will search five databases: CINAHL Plus, Cochrane Central Register of Controlled Trials, Ovid MEDLINE, PsycINFO, and Scopus. Articles included in the review will have their titles, abstracts and full texts reviewed by two independent authors and their risk of bias assessed via the modified Newcastle-Ottawa Scale. DiscussionThis will be the first review to examine the association between anxiety and the four subtypes of RRBs in individuals with ASD. Understanding this relationship, and the factors associated with this, may help clinicians understand the different underpinnings and presentations of anxiety within this population with potential implications for assessment and treatment.Systematic Review Registration PROSPERO CRD42020185434

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Overall prognosis of preschool autism spectrum disorder diagnoses

Brignell

Harwood

May

et al. 2022

Cochrane Database of Systematic Reviews

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Repetitive Behavior Severity as an Early Indicator of Risk for Elevated Anxiety Symptoms in Autism Spectrum Disorder

Cited by 70 publications

References 43 publications

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

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

Repetitive and Restricted Behaviours and Anxiety in Autism Spectrum Disorder: Protocol for a Systematic Review and Meta-Analysis

Overall prognosis of preschool autism spectrum disorder diagnoses

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