Traditional and Atypical Presentations of Anxiety in Youth with Autism Spectrum Disorder

Abstract

We assessed anxiety consistent (i.e. “traditional”) and inconsistent (i.e. “atypical”) with diagnostic and statistical manual (DSM) definitions in autism spectrum disorder (ASD). Differential relationships between traditional anxiety, atypical anxiety, child characteristics, anxiety predictors and ASD-symptomology were explored. Fifty-nine participants (7–17 years, Mage=10.48 years; IQ>60) with ASD and parents completed semi-structured interviews, self- and parent-reports. Seventeen percent of youth presented with traditional anxiety, 15% with atypical anxiety, and 31% with both. Language ability, anxious cognitions and hypersensitivity predicted traditional anxiety, whereas traditional anxiety and ASD symptoms predicted atypical anxiety. Findings suggest youth with ASD express anxiety in ways similar and dissimilar to DSM definitions. Similarities support the presence of comorbid anxiety disorders in ASD. Whether dissimilarities are unique to ASD requires further examination.

Comorbid Social Anxiety Disorder in Adults with Autism Spectrum Disorder

“…For example, avoidance of social or performance situations solely due to general disinterest in social engagement, dislike of changing the routine, or sensory overarousal in a stimulating environment (e.g., bright lights, loud crowd) did not result in a diagnosis of SAD. This approach of distinguishing SAD is consistent with previous studies of youth with ASD and anxiety (Kerns et al 2014;Leyfer et al 2006).…”

“…ASD Autism spectrum disorder, SAD social anxiety disorder, early childhood kindergarten or earlier; only those participants who had reached the corresponding age were included in the proportion for each time period J Autism Dev Disord note, however, that several of the participants without SAD in the ASD group expressed a dislike of, or disinterest in, social situations, without endorsing fear of negative evaluation by others. These individuals could be conceptualized as displaying an atypical or DSM-inconsistent manifestation of social anxiety, which has been identified in youth with ASD (Kerns et al 2014). The possibility that SAD may manifest in both similar and dissimilar ways between people with and without ASD warrants future study.…”

“…In addition, diagnostic decisions are complicated by the potential unusual or atypical manifestation of social anxiety symptoms in ASD (Kerns and Kendall 2012;Kerns et al 2014). In a sample of 59 youth with ASD, Kerns et al (2014) found that 8.5 % exhibited active avoidance, somatic symptoms, or other behaviors indicative of distress (e.g., increased self-injury) in social settings, without an accompanying fear of negative evaluation. Although this manifestation does not meet DSM-5 diagnostic criteria for SAD (APA 2013), given the absence of social evaluation concerns, these symptoms were excessive and impairing.…”

Anxiety and social deficits have distinct relationships with amygdala function in autism spectrum disorder

“…a formal anxiety disorder). In particular, the inclusion of such a group will improve our ability to tease apart neural signatures of anxiety that are or are not ASD-specific (Kerns et al, 2014).…”

A Systematic Review of the Assessment and Treatment of Posttraumatic Stress Disorder in Individuals with Autism Spectrum Disorders

“…Anxiety in ASD presents an increased symptom burden over and above that associated with ASD, with the potential to exacerbate core ASD features and to increase social withdrawal and behavioural problems (for a review see Wood and Gadow 2010). Preliminary evidence suggests that anxiety in ASD presents itself in both Btraditional^and Batypical^forms (Kerns et al 2014). Models of anxiety development in ASD posit that cognitive, genetic and neurobiological features of ASD presentation, together with socio-environmental stressors, act to predispose individuals to the development of clinical anxiety.…”