The Presentation of Anxiety in Children with Pervasive Developmental Disorders

Divisions of Child and Adolescent Psychiatry, Department of Psychiatry and Behavioral Sciences, University Hospital at Stony Brook, NY 11974, USA.
Journal of Child and Adolescent Psychopharmacology (Impact Factor: 2.93). 06/2005; 15(3):477-96. DOI: 10.1089/cap.2005.15.477
Source: PubMed

ABSTRACT Although the Diagnostic and Statistical Manual of Mental Disorders, 4th ed. (DSM-IV) diagnostic criteria generally discourage the diagnosis of other Axis I disorders in children with pervasive developmental disorder (PDD), anxiety symptoms are often observed in this clinical population. Moreover, there are some albeit limited data that suggest an association between anxiety and psychotic symptoms in children. Because co-occurring psychiatric symptoms have important clinical implications, this study examined anxiety and psychotic symptoms in children with and without PDD.
Parents and teachers completed the Early Childhood Inventory-4 (ECI-4) or the Child Symptom Inventory (CSI-4) for children evaluated in a developmental disabilities clinic (PDD) or a child psychiatry outpatient clinic (non-PDD). Children were divided into four groups: 3-5- year-olds with (n = 182) and without (n = 135) PDD, and 6-12-year-olds with (n = 301) and without (n = 191) PDD. The 6-12-year-olds were further divided into high-anxious and low-anxious subgroups based on CSI-4 ratings and compared with regard to severity of psychotic symptoms.
Teachers rated preschoolers with PDD as exhibiting more severe anxiety symptoms than the non-PDD group; however, the converse was true for parent ratings. For 6-12- year-olds, both parents and teachers rated children with PDD as significantly more anxious than non-PDD clinic referrals. In general, the severity of anxiety symptoms varied by PDD subtype (Asperger's disorder > PDDNOS > Autistic disorder) and IQ (high > low). Furthermore, highly anxious 6-12-year-olds with PDD received significantly higher parent and teacher ratings of psychotic symptom severity (strange behaviors, hearing voices, illogical thinking, inappropriate affect, and odd thoughts) than our low-anxious group, even when controlling for PDD symptom severity. Moreover, the relation between anxiety level and psychotic symptom severity was similar for both PDD and non-PDD children. Parent and teachers differed in their perceptions of the severity of specific anxiety symptoms. In addition, parent- versus teacher-defined anxiety level groups varied with regard to the differential severity of psychotic symptoms. This finding highlights the importance of continued investigation of source-specific syndromes in children with PDD. Two case vignettes are presented.
Anxiety appears to be a clinically important concern in many children with PDD. Similarities in anxiety symptom presentation and their association with psychotic symptoms in both children with and without PDD support the possibility of: (1) psychiatric comorbidity in the former; (2) at least some overlap in causal mechanisms for anxiety and psychotic symptoms in both PDD and non-PDD children; and (3) a unique diagnostic entity comprised of PDD, anxiety, and psychotic symptoms. Lastly, clinicians should seriously consider dual diagnoses in children with PDD.

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    • "It was expected that children with PDD-NOS display more 'emotional and related symptoms' than children with AD (Pearson, et al., 2006) (Snow & Lecavalier, 2011) (Weisbrot, et al., 2005). In the current study children this finding was also confirmed. "
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    ABSTRACT: The objective of this study was to identify differences between and determine predictors for Autistic Disorder (AD) and Pervasive developmental disorder not otherwise specified (PDD-NOS). The motivation behind this is that the criteria for PDD-NOS stated in the Diagnostic and Statistical Manual of Mental Disorders - fourth edition (DSM-4) are ambiguous and need clarification in order to formulate more precise and validated criteria. Differences and predictors were derived from the Health of the Nation Outcome Scales for Children and Adolescents (HoNOSCA), a questionnaire which is conducted as part of Routine Outcome Monitoring in mental health institutions. Participants originated from a pool of individuals who were assessed at the child- and adolescent psychiatric department of the University Medical Centre Utrecht (The Netherlands). Seventy-two children and adolescents with AD (mean age 9.5 years, SD= 4.2) and 75 with PDD-NOS (mean age 9.6 years, SD= 4.2) were included and analyzed with on 15 items of the HoNOSCA. Independent sample T-test showed that the AD subgroup displayed significantly more problems on the items ‘overactivity, attention or concentration’, ‘scholastic or language skills’ and ‘self-care and independence’ whereas the PDD-NOS subgroup displayed significantly more problems regarding ‘emotional and related symptoms’. Binary logistic regression revealed that more problems on ‘overactivity, attention or concentration’, ‘self-care and independence’ and ‘disruptive, antisocial or aggressive behavior’ are predictive for AD rather than PDD-NOS with respectively OR of 2.06 (95%C.I. 1.34-3.18), 1.75 (95%C.I. 1.30-2.36) and 1.32 (95%C.I. 1.00-1.75). More ‘emotional and related symptoms’ predicted PDD-NOS rather than AD with an OR 1.79 (95%C.I. 1.28-2.49). The HoNOSCA could serve as a rapid and cost-effective instrument to help identify cases of AD and PDD-NOS. Emotional and related symptoms may be useful to formulate new and more precise criteria for PDD-NOS.
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    • "was written specifically for DSM-IV-TR-based assessment of children and adolescents from 6 to 18 years and was developed from the Child Symptom Inventory-4th revision (Gadow and Sprafkin 2010)) and the Youth's Inventory (Gadow et al. 2002). The CASI was used in a study of 103 children with an ASD (Gadow et al. 2005) and another sample of 67 children with an ASD (Weisbrot et al. 2005). Normative data for the entire CASI and for the subscales on samples of children with an ASD are described in the CASI Test Manual and elsewhere (Gadow and Sprafkin 2010; Gadow et al. 2002). "
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    ABSTRACT: To determine any variation that might occur due to the type of assessment and source used to assess them, the prevalence of 7 anxiety disorders were investigated in a sample of 140 boys with an Autism spectrum disorder (ASD) and 50 non-ASD (NASD) boys via the Child and Adolescent Symptom Inventory and the KIDSCID Clinical Interview. Boys with an ASD were significantly more anxious than their NASD peers. Data collected from the boys with an ASD themselves showed differences in the severity and diagnostic criterion of anxiety disorders to data collected from the boys’ parents. There were age-related variations to the pattern of anxiety disorder differences across reports from the boys with an ASD and reports from their parents.
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    • ") was written specifically for DSM-IV-TR-based assessment of children and adolescents and was developed from the Child Symptom Inventory, fourth revision (Gadow & Sprafkin, 2010) and the Youth's Inventory (Gadow et al., 2002). The CASI was used in a study of 103 children with an ASD (Gadow, Devincent, Pomeroy, & Azizian, 2005) and another sample of 67 children with an ASD (Weisbrot et al., 2005). Normative data for the entire CASI and for the subscales on samples of children with an ASD are described in the CASI Test Manual and elsewhere (Gadow & Sprafkin, 2010; Gadow et al., 2002). "
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    ABSTRACT: The effect of psychological resilience as a buffer against anxiety was investigated in a sample of 39 boys with high-functioning autism spectrum disorder (ASD) via individual online questionnaire responses to standardised inventories for assessing anxiety and psychological resilience. Ability to handle problems, make good decisions, think before acting and help others were the most powerful buffers against Generalised Anxiety Disorder, while thinking before acting significantly buffered social phobia. Believing that they were able to handle problems was significantly associated with less emotional anxiety about school, work or social activities, being irritable, unable to relax and fatigue. As well as describing the pathways between the components of psychological resilience and anxiety, these findings also suggest several specific directions for training programmes aimed at equipping boys with an ASD with skills to cope more effectively with anxiety.
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