The presentation of anxiety in children with pervasive developmental disorders.
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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ABSTRACT: The prevalence, severity and symptom profiles for major depressive disorder (MDD) were compared in samples of boys and adolescents with and without an autism spectrum disorder (ASD). Self-reports were obtained on the Depression subscale of the Child and Adolescent Symptoms Inventory (CASI-D) with 70 ASD and 50 non-ASD male participants between the ages of 8 and 18 from Queensland, Australia who were matched for age and IQ. Results indicated that the ASD participants had significantly higher total CASI-D scores, a greater proportion of participants who qualified for a diagnosis of MDD, and over 50% higher scores for 8 of the 10 CASI-D symptoms than non-ASD participants. The MDD profiles for the ASD participants were dominated by anhedonia. Issues for assessment and diagnosis of comorbid MDD in young males with an ASD, plus targeted treatment planning that directly addresses their MDD profile, are discussed.International Journal of Disability Development and Education 03/2015; 62(2):158-167. DOI:10.1080/1034912X.2014.998179 · 0.59 Impact Factor
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ABSTRACT: The ‘parent distortion’ hypothesis regarding assessment of a child’s anxiety state was examined in the mothers of 128 boys with an autism spectrum disorder. Mothers’ own Generalised anxiety disorder (GAD) and their ratings of their sons’ GAD were compared with the boys’ self-ratings and the ratings of the boys given by a clinician. Boys’ cortisol concentrations were also explored for their association with these three sources of GAD ratings. Results indicated that mothers’ GAD was significantly and directly correlated with the ratings they gave for their sons’ but that only mothers who were above-minimally anxious gave ratings of their sons’ anxiety that significantly agreed with those from the clinicians. Minimally-anxious mothers appeared to underestimate their sons’ anxiety, and these effects generalised to their sons’ self-ratings of anxiety. Associations between the boys’ cortisol concentrations suggested an interaction between the presence of the diurnal fluctuation in boys’ cortisol concentrations and mothers’ anxiety states.Research in Autism Spectrum Disorders 07/2015; 15-16:42-52. DOI:10.1016/j.rasd.2015.03.002 · 2.96 Impact Factor
Clinical Case Studies 12/2013; 13(1):22-36. DOI:10.1177/1534650113504488