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We examined social anxiety and internalizing symptoms using the Social Phobia and Anxiety Inventory for Children (SPAI-C), the Social Anxiety Scale for Children -Revised (SASC-R), and the Child Behavior Checklist (CBCL) in a sample of fifty-four high-functioning subjects with autism or Asperger syndrome (HFA/AS) (M = 11.2 +/- 1.7 years) and 305 com...
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Context 1
... significant differences were found between older HFA/AS and control groups in the rate of participants exceeding the clinical cut-off scores for the SASC-R and SPAI-C, reflecting clinically significant social anxiety (See Table 3). More than half of the older participants with HFA/ AS exceeded the clinical cut-off on both the SPAI-C and the SASC-R whereas fewer than 17% exceeded these cut-points Fig. 1 The interaction between age and diagnostic group on SPAI-C Note: SPAI-C Total = SPAI-C Total score; Soc Assert = Social Assertiveness; Fear Gen = Fear of General Conversation; PC Anx = Physical and Cognitive Anxiety Symptoms; B Avoid = Behavioural Avoidance; Fear PP = Fear of Public Performance; R-SPAI-C = revised SPAI-C Total score; R-B Avoid = revised Behavioural Avoidance; SASC-R Total = SASC- R Total score; FNE = Fear of Negative Evaluation; SAD-New = Social Avoidance, Behavioural Inhibition and Social Discomfort; SAD-G = Generalized Social Avoidance, Behavioural Inhibition and Social Discomfort; R-SASC-R total = revised SASC-R Total score; R-SAD-G = revised Generalized Social Avoidance, Behavioural Inhibition and Social Discomfort; Internalizing = Total Internalizing Symptoms scale; Withdrawn = Withdrawn; Somatic = Somatic Complaint, Anx/Dep = Anxious/Depressed; R-Internalizing = revised Internalizing Symptoms scale; R-Withdrawn = revised Withdrawn; R-Anx/Dep = revised Anxious/Depressed in the older control group. ...
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Background
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Citations
... Regarding the correlations between age and behavioral and emotional symptoms, the present results showed an increase in all CBCL scores with increasing age in boys, whereas girls only showed greater anxiety symptoms at older ages. Some studies showed an increase in anxiety symptoms, including social avoidance, negative appraisal, and inhibition with older age (Gadow et al., 2004(Gadow et al., , 2005Kuusikko et al., 2008), particularly in girls, with a greater increase in symptoms during adolescence (Gotham et al., 2015;Napolitano et al., 2022). A recent review (Napolitano et al., 2022) reported sex differences in the age trajectory of psychopathological comorbidities: in early adolescence, results from parent-report questionnaires showed greater depressive symptoms in girls with ASD than in boys. ...
Introduction
Autism Spectrum Disorder (ASD) is a neurodevelopmental disorder characterized by a higher prevalence in male than in female participants. Recent studies have hypothesized the presence of different phenotypes in male and female participants with ASD. The present study aims to assess possible sex differences in cognitive and adaptive functioning, symptomatology of ASD, and psychopathological comorbidities in a large sample of children and adolescents with ASD.
Methods
The study included a total of 2,146 children and adolescents diagnosed with ASD, comprising 1785 boys (mean age 7.12 ± 3.69 years) and 361 girls (mean age 6.25 ± 3.30 years). The age of the participants ranged from 1.35 to 19.05 years (mean age 9.98 ± 3.64). The study sought to include all children and adolescents diagnosed with Autism or ASD.
Results
Present results showed that girls with ASD had lower IQs than boys but similar adaptive functioning. The severity of symptoms of ASD was greater in boys than in girls, as were scores on psychopathological measures. With increasing age, boys with ASD showed greater impairment in social communication skills than girls and increased psychopathological comorbidities. Older girls showed fewer restricted and repetitive behaviors.
Discussion
Exploring phenotypic differences in children and adolescents with ASD fosters an understanding of subtle diagnostic facets that may go unrecognized, allowing for increasingly individualized and tailored interventions.
... Prior research has shown autistic adolescents are impacted across a range of different environments and the effects of this upon their participation and well-being. Studies show that autistic adolescents participate 25% less in cooperative interactions in mainstream schooling and it being a complex and demanding environment for autistic students (Bailey & Baker, 2020;Giarelli et al., 2013;Horgan et al., 2023;Humphrey & Symes, 2011;Paraskevi, 2021;Skafle et al., 2020), and that autistic adolescents are regularly bullied (Eroglu & Kilic, 2020;Horgan et al., 2023;Sreckovic et al., 2014;Zeedyk et al., 2014), experience social anxiety (Jackson et al., 2022;Kuusikko et al., 2008) and breakdowns (Shah, 2019) and score highly on scales of loneliness (Locke et al., 2010). ...
This study aimed to investigate the impact of external factors on the experiences and family relationships of autistic adolescents and their families. A qualitative approach was used, with in-depth interviews conducted with 30 participants, including autistic adolescents, siblings and parents from within families with an autistic adolescent family member. The findings suggest that external factors significantly influence the well-being of autistic adolescents and their families. The school environment was identified as a significant factor, with sensory overload, bullying and adverse interactions with teachers having a negative impact on the mental health and quality of family relationships for participants. In addition, the study highlighted that isolation and stigma were major concerns for families, suggesting a need for public efforts to raise awareness and understanding of autism. The lack of appropriate support and services was also identified as a significant challenge that families face. The study highlights the need for person-centred approaches to service provision, which involves including autistic adolescents and their families in the design and delivery of support and services. The study recommends collaboration among schools, service providers, and families, as well as efforts to promote autism-friendly environments in schools and the broader community.
Lay abstract
The influence of the environment on different groups of people with disabilities has rarely been studied in the context of neurodevelopmental disabilities, such as autism, in adolescence. This study explored how external responses to autism affect the experiences, outcomes and family relationships of autistic adolescents and their family members, including siblings and parents. This study adds to the knowledge of factors that contribute to the social disadvantage and exclusion autistic adolescents and their families face in their communities. Interviews with 30 participants from families with an autistic adolescent show that external factors greatly impact the well-being of autistic adolescents and their families. The school environment, including sensory overload, bullying and negative interactions with teachers, was found to be a key factor that negatively influenced mental health and family relationships. The study also revealed that isolation and stigma are major concerns for families, indicating the importance of public awareness campaigns to increase understanding of autism. In addition, the lack of adequate support and services presented significant challenges for families. The study emphasises the importance of person-centred approaches to providing services, which involve including autistic individuals and their families in designing and delivering support.
... Cochrane's Q B test was then used to examine the association between anxiety prevalence and gender. Initial plans to analyse differences between parent and child ratings did not proceed due to the underrepresentation of child informants (Bellini, 2004;Kuusikko et al., 2008). ...
... was identified (Avni & Zachor, 2018;Baribeau et al., 2020;Bellini, 2004;Ben-Itzchak et al., 2020;Boulter et al., 2014;Cholemkery et al., 2014;Dubin et al., 2015;Factor et al., 2017;Guerrera et al., 2022;Kerns et al., 2021;Kim et al., 2000;Kuusikko et al., 2008;Niditch et al., 2012;Simonoff et al., 2008;van Steensel et al., 2012;see Fig. 1). ...
... Not surprisingly, our estimates were characterised by substantial between-study variation-a finding that reflects not only the hallmark heterogeneity associated with ASD (Masi et al., 2017;Mottron & Bzdok, 2020) but also the complexities of measuring mental health as a construct (Migliavaca et al., 2020). Only the SCAS-C and Kinder-DIPS produced narrow confidence intervals (Cholemkery et al., 2014;Kuusikko et al., 2008). In comparison, the SCARED included a confidence interval as low as 13% to as high as 46% (Ben-Itzchak et al., 2020). ...
Research on the prevalence of anxiety in children and adolescents with autism remains fragmented due to a reliance on help-seeking populations and differences in anxiety assessment. We present the pooled findings from 15 community studies (N = 4459) sourced from the Embase, PubMed, and PsycINFO databases (1970–2023). Equally high rates of anxiety symptoms and disorders were identified via self-report (33%, CI = 25 to 40%) and diagnostic interview (19%, CI = 7 to 40%). Higher IQ and male gender were identified as significant covariates, although these results may reflect sampling biases. The findings highlight the need for routine screening, with multiple informants, and improved sampling methods. Protocol was registered on Open Science Framework (https://osf.io/7mtca/).
... The onset of ADHD is in childhood and is defined by a persistent pattern of inattention and/or hyperactivity-impulsivity and may interfere with functioning, development, and eating behaviors [28][29][30][31]. Interestingly, 25-50% of 8-12-year-old children with high-functioning ASD have comorbid ADHD [22,32], which may account for some shared symptoms between children with ASD and ADHD. Further, children with ND also commonly share comorbidities, such as anxiety disorders [12,[33][34][35], with research showing that children with moderate and severe fussy eating later show increased signs of generalized anxiety disorder, social anxiety, and depression [16]. ...
Despite the surge in studies on fussy eating in recent years, anxiety as an associated factor is generally not considered, even though children with fussy eating and those with neurodevelopmental disorders, including Autism Spectrum Disorder or Attention Deficit/Hyperactivity Disorder (ADHD) often have higher levels of anxiety than typically developing children. The current study investigated changes in anxiety scores during a Taste Education intervention, a seven-week school-based intervention for 71 children with fussy eating. Comparisons were made based on neurodevelopmental status (between children with (n = 30) and without (n = 41) neurodevelopmental disorders). Participants were paired based on age, sex, and neurodevelopmental disorder. The Multidimensional Anxiety Scale for Children (MASC) was administered at delayed intervention (for those waiting 7 weeks before starting the intervention), pre-intervention, post-intervention, and at six-month follow-up. Results did not indicate elevated anxiety based on mean MASC T-scores. MASC Total T-scores ranged from slightly elevated to average, decreasing significantly between pre-intervention and post-intervention, plateauing at six-month follow-up. Significant reductions between measurement points were seen for the physical symptoms, social anxiety, and separation anxiety subscales, but not for harm avoidance. Repeated measures analysis of variance with neurodevelopmental disorders as between-subjects factors did not reveal a significant interaction effect between neurodevelopmental disorders and changes in MASC Total score or subscales. The results indicated that our food-based intervention did not elevate MASC scores in fussy eating children, with or without neurodevelopmental disorders.
... Moreover, the correlation between ASD and SAD highlighted in our research is in line with the current literature that explored the relationship between the two disorders both in clinical and non-clinical samples [66,67]. To date, many studies have demonstrated that the symptoms of ASD and SAD significantly overlap in various areas, resulting not only in an increased difficulty in distinguishing between the two disorders [25,26], but also in recognizing the underlying presence of subthreshold autism spectrum traits or even a high functioning ASD among subjects showing social anxiety symptoms. ...
Social anxiety disorder (SAD) has been frequently reported by subjects with Autism Spectrum Disorder (ASD). However, interestingly, the overlap between social anxiety and autistic traits may sometimes impede ASD diagnosis in subjects without intellectual or language impairment. The aim of the present work was to evaluate the presence and correlates of social phobic features among subjects with ASD, with a specific focus on evaluating which social anxiety symptoms may be statistically predictive of an ASD diagnosis. With this purpose, 48 subjects with ASD and 48 gender- and age- matched healthy controls (HCs) were recruited and assessed with the SHY-SV and the AdAS Spectrum questionnaires. Results highlighted higher scores in all SHY-SV Spectrum domains and total scores for the ASD group. Moreover, AdAS Spectrum scores were significantly correlated with all SHY-SV domain and total scores. A logistic regression analysis highlighted the SHY-SV Interpersonal sensitivity and Substance Abuse domains scores as significant positive predictors of an ASD diagnosis. These results confirm the link between ASD and SAD. Because of this association, particular attention should be paid to subjects with high interpersonal sensitivity traits and substance abuse problems.
... The CASI-4R ETSD subscale was administered to the autistic children and to their parents, separately, by the research-reliable clinicians. Autistic children can self-evaluate their own emotions [38], including loneliness [39], anxiety [40], and depression [41]. ...
There is some evidence that autistic children experience more traumatic events than non-autistic children, but little research attention has been given to sex differences on this issue. This study investigated the presence of sex-based differences in the occurrence and severity of trauma-related events and resultant stress in autistic youth, and tested the null hypothesis of no sex differences. A sample of 32 autistic males and 32 autistic females (6 yr to 18 yr), plus one of their parents, participated in a survey study of (a) the presence of a traumatic event and ongoing stress regarding that event, and (b) recurrent memories or dreams of that event. Although the autistic children rated their experience of trauma, plus their recurrent memories or dreams of that event, as more severe than their parents did, neither of these sources of information showed any significant sex differences in the total score or diagnostic frequency for trauma-related stress. There were no significant correlations between age, IQ, or autism severity and trauma-related stress scores for the autistic males or females. These results challenge the generalizability of the prevalence of sex differences in trauma-related stress that has been reported in the wider community, arguing that equal attention should be given to male and female autistic youth for this possible comorbidity.
... Research reveals that students with ASD experience more difficulties than typically developing students (TD). They tend to achieve poorer learning outcomes (Bullen et al., 2020;Gilmour et al., 2019;Keen et al., 2016;Mayes et al., 2020), experiencing more school absenteeism (Adams, 2021;Adams et al., 2022;Black & Zablotsky, 2018;Mattson et al., 2022;Munkhaugen et al., 2017;Ochi et al., 2020;Totsika et al., 2020), more bullying Adams et al., 2014;Ashburner et al., 2019;Hwang et al., 2018;Rowley et al., 2012;Sreckovic et al., 2014), more social isolation (Bauminger et al., 2003;Bauminger & Kasari, 2000;Humphrey & Symes, 2011), more behavioral problems (Boonen et al., 2014;Hastings et al., 2020;Konst et al., 2013;Kurzius-Spencer et al., 2018;Matson et al., 2010) and more emotional problems (Green et al., 2000;Kuusikko et al., 2008;Shtayermman, 2009). Because of these difficulties, it is important to study which variables can positively influence the educational experience of ASD students. ...
The teacher-student relationship (TSR) is an important factor for promoting academic success. Even though students with autism spectrum disorder (ASD) experience more educational difficulties, the TSR in ASD students has been understudied, and there is a significant empirical gap in the perception that ASD adolescent students themselves have of their relationships with their teachers. The present study followed a non-experimental, correlational, cross-sectional and comparative design to analyze the TSR in ASD adolescents in comparison to the TSR of their typically developing (TD) peers. Sixty-four students (33 females, 31 males) who were in their first year of secondary school ( participated in the study. 32 of them had ASD and 32 had TD. The TSR subscale of the SEI was applied (Appleton et al., 2006). The results show significant interaction effects between student condition and gender, where female ASD students reported a worse relationship than their male ASD peers. These findings differ from existing research indicating that ASD students experience worse TSR and that female students experience better relationships than male students. The important role of the existing school integration program in Chilean schools, and guidelines for future research to explain the gender differences found in this study are discussed.
... While intellectually able individuals may have better social functioning than those with intellectual disabilities, autistic adolescents predominantly engage in solitary/parallel activities (Bauminger et al., 2008;Shattuck et al., 2011). Furthermore, increased social anxiety may lead to avoidance of social situations with unfamiliar people (Kuusikko et al., 2008;Muller et al., 2008;Pickard et al., 2017). Nonetheless, many researchers (Barendse et al., 2018;Chen et al., 2015;Deckers et al., 2014;Jaswal & Akhtar, 2019;Muller et al., 2008) have found that autistic people desire social interactions. ...
... Specifically, intellectually able autistic adolescents aware of their social limitations may be concerned about negative evaluations from others (Anderson et al., 2011;Capps et al., 1995;Vickerstaff et al., 2007). In comparing themselves to peers, they become anxious in the context of social engagement (Johnston & Iarocci, 2017;Kuusikko et al., 2008;Stichter et al., 2010;Verhoeven et al., 2012). For these and other reasons, many autistic individuals attempt to conceal their autism by "masking" (Cook et al., 2021), with the result that they may encounter elevated mental health challenges and a decreased sense of identity (Cook et al., 2021). ...
Individuals who cope well with challenges may engage in social situations more successfully. We examined the association between coping behaviors, self-perceived competence, and social anxiety in everyday social situations. A total of 133 participants between the ages of 10 and 16 years (82 autistic, 51 neurotypical) carried a mobile device that prompted them seven times each day for 7 days to record what they were doing and their perceived competence and social anxiety in that situation. We used the Coping Inventory to measure overall coping abilities (i.e. coping with the self and the environment). Multilevel analyses found that autistic adolescents were more likely than neurotypical peers to experience social anxiety while engaged in maintenance or productive activities with adults. While their ability to cope with the self was positively associated with perceived social competence, it was negatively associated with the ability to cope with environmental challenges. Furthermore, autistic adolescents with poor ability to cope with environmental challenges were more likely than those who coped well to be socially anxious when engaged in leisure activities with peers. Findings from this study can guide evaluation and intervention to improve the social experiences of autistic adolescents by helping them increase coping skills.
Lay abstract
Individuals who cope well with challenges may engage in social situations more successfully. We examined how well autistic adolescents coped, depending on how competent they felt and how much anxiety they experienced during social activities. We included 133 individuals (82 autistic, 51 neurotypical) between the ages of 10 and 16 years. Participants carried a mobile device that prompted them seven times a day for 7 days to record what they were doing, how competent they felt and how much anxiety they experienced. We used the Coping Inventory to understand how well participants coped with environmental challenges and met their needs for growth. Autistic adolescents were more likely than neurotypical peers to feel anxious while doing activities with adults. Autistic adolescents who had more difficulty coping with challenges were more likely to feel anxious when doing leisure activities with peers. Interestingly, autistic adolescents who coped better with challenges tended to feel less competent in social situations. However, those better able to meet their needs for growth tended to perceive their social competence positively. These findings can help practitioners develop strategies and programs to reduce the negative social experiences of autistic adolescents by helping them cope better.
... Children with ASD have high levels of social anxiety disorder 39,45 . Children with ASD have sensory hypersensitivity, difficulties taking perspective, and limited socializing ability 3 . ...
The Anxiety Disorder diagnosis is a common comorbidity of Children with Autism Spectrum Disorder (ASD). The early detection of Anxiety is essential to increase the quality of life of children, especially in kindergarten children. Thus, the study aimed to investigate the differences between parents and teachers in reports of Anxiety in autistic children 3–5 years old. We used the Screen for Child Anxiety-Related Disorders (SCARED) parent version for parents and teachers of Ecuadorian children with ASD. The statistical analyses were performed on two evaluations of the same children. The sample size was 34 parents and 34 teachers. The binomial logistic regression model for the SCARED rating to the responses of teachers was statistically significant for age (odds [OR], 0.16; 95% confidence interval [CI] 0.31-0.82) for 5-year-olds (p<0.028). The SCARED subscale for Panic Disorder, Generalized Anxiety Disorder, Separation Anxiety Disorder, and Social Anxiety Disorder is correlated with the anxiety disorder. The data are statistically significant based on teachers' responses (p <0.05). According to parents' responses, the SCARED rating did not find any relationship between the study variables and the anxiety disorder. Most children were classified with anxiety disorder when evaluated by teachers but not by parents. Identifying Anxiety in children with ASD in kindergarten can help adequately treat the disease and contribute to neurodevelopment and quality of life in childhood. Keywords: Anxiety Disorder; Children; Autism; Kindergarten; Ecuador
... Autism spectrum disorder (hereafter autism) is a neurodevelopmental condition characterised by social communication difficulties, restricted and repetitive behaviour and sensory anomalies (American Psychiatric Association, 2013) that affects 1 in 54 children (Centers for Disease Control and Prevention, 2019). Between 29% and 57% of autistic children and adolescents have co-occurring Social Anxiety Disorder (SAD; Bellini, 2006;Hollocks et al., 2022;Kuusikko et al., 2008;Simonoff et al., 2008). Common aetiological factors underlying SAD (e.g. ...
Background:
Social camouflaging (hereafter camouflaging) in autism includes factors such as masking and compensating for one's neurodevelopmental differences, and to assimilate or 'fit in' with non-autistic peers. Efforts to hide one's authentic self and autism traits (masking) resemble impression management (IM) in safety behaviours identified in Clark and Wells' (1995) cognitive model of social anxiety (SA). This study explores the relationship between camouflaging in autism and safety behaviours in SA among autistic and non-autistic adolescents.
Methods:
One hundred fifteen adolescents (14-19 years) with (n = 61; 36 female) and without (n = 54; 37 female) a clinical diagnosis of autism matched on age and SA symptom severity were recruited from clinics, schools and online. Adolescents completed online measures including autism traits, SA symptoms, camouflaging behaviours, SA-related safety behaviours and SA-related negative cognitions. Partial and bivariate Pearson's correlations and structural equation modelling were used to understand the relationship between camouflaging, safety behaviours, autism traits and SA in both groups. Exploratory factor analysis assessed item-level factor cross-loadings between camouflaging and safety behaviours.
Results:
Across both groups, masking and IM were significantly associated with SA symptom severity, not autism traits, via SA-related social cognitions. Exploratory factor analysis indicated construct overlap across masking, assimilation, IM and avoidance behaviours and identified factors analogous to self-focused attention, social avoidance and mental rehearsal identified in the Clark and Wells' (1995) model of SA.
Conclusions:
This is the first study using group-matched design to identify that masking (factor in social camouflaging) and IM both relate to SA in autistic and non-autistic adolescents. Assessment and formulation of construct overlap between masking and IM may inform psychoeducation and adaptation of SA treatment for autistic adolescents.
