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The relationship between autism spectrum disorders and anxiety: The moderating effect of communication

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Abstract

Communication skills have been shown to have differing effects on levels of anxiety depending on whether or not a child has an autism spectrum disorder (ASD) or is typically developing. This article examined whether or not communication deficits differentially affect children with ASD compared to those without ASD. Ninety-nine children with autistic disorder (n=33), Pervasive Developmental Disorder – Not Otherwise Specified (PDD-NOS; n=33), and no diagnosis (n=33) were examined using the Autism Spectrum Disorders Diagnostic for Children and Comorbidity for Children scales to determine their level of anxiety and degree of communication deficits. Results indicated that anxiety decreased as communication deficits increased for those with autistic disorder compared to those with PDD-NOS or no diagnosis; however, for those with PDD-NOS anxiety increased as communication deficits increased compared to those with no diagnosis. The importance and differential impact of communication deficits on anxiety for different groups is highlighted.

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... Indeed, on one hand, anxiety is positively correlated with deficit in communicative skills in typically developing children. On the other hand, communicative deficits are associated to less anxious symptoms in children with ASD (Davis III et al., 2011). This finding is unexpected and provides two different assumptions: 1) severe communication deficits in ASD children don't permit them to express anxiety; 2) ASD children could have different ways to express anxiety who are difficult to detect by classical tools (Davis III et al., 2011). ...
... On the other hand, communicative deficits are associated to less anxious symptoms in children with ASD (Davis III et al., 2011). This finding is unexpected and provides two different assumptions: 1) severe communication deficits in ASD children don't permit them to express anxiety; 2) ASD children could have different ways to express anxiety who are difficult to detect by classical tools (Davis III et al., 2011). On the other hand, considering RRBs, one can find different pathologic conditions such as sensory overresponsivity (SOR), restricted interests (RI), repetitive movements of body and echolalia (APA, 2013). ...
... Furthermore, Spiker and colleagues (2012) concluded that restricted interests might be a maladaptive response which is adopted by ASD children for avoiding anxious situations. Moreover, anxiety for unpredictable situations and social relationships could lead more several restricted interests and behaviours in high functioning ASD children (Davis III et al., 2011). However, more studies comparing communication skills and RRBs in both typically developing children and ASD children are required (Spiker et al., 2012). ...
Thesis
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Autism Spectrum Disorder (ASD) is one of the most common neurodevelopmental disorders across the world. Early diagnosis and intervention showed to be essential in order to improve life conditions in this population. Therefore, early markers for ASD diagnosis are needed. In particular, infants with an older sibling with ASD diagnosis are at elevated likelihood (EL-sibs) for developing ASD themselves as compared to infants who have an older sibling with typical development (TL- sibs). Therefore, this study compared the development of EL-sibs (n = 47) and TL-sibs (n = 33). This study provided a literature review on ASD and methods for studying developmental pathways in both EL-and TL- sibs. In addition, we focused on the role of Response to Name (RtN) in both EL-and TL- sibs. In the experimental section, the current study aimed to investigate whether RtN is a suitable tool in order to predict 36-month-ASD diagnosis as early as by 14-24 months of age. Furthermore, the relationship between RtN and receptive language functioning has been investigated. Results demonstrate that EL-sibs show more failures to RtN task as compared to TL- sibs by 14 months of age. Yet, this difference is not present at the following timepoints. Notably, ASD children also show more failures to RtN task as compared to both BAP/DD and typically developing children by 14 months of age. Moreover, 36-month- receptive language outcome is not linked to RtN ability at 14-24 months. Finally, RtN show to be an unsensitive tool for ASD diagnosis but its specificity is high. In the last chapter research outcomes are discussed and implications for clinical practice and future studies are provided.
... firstly, those with more severe communication issues have a more impaired level of general functioning, so are less able to experience anxiety. Secondly, those with more severe communication difficulties are unable to express feelings of anxiety that are readily noticed by others and therefore it goes unrecognised (Davis et al., 2011). ...
... However the same study also concluded that anxiety in people with ASD and LD could be recognised in the same way as individuals without these diagnoses, contradicting Davis et al. (2011). ...
... The theory suggested by Davis et al. (2011) that an increase in communication deficits was associated with a decrease in anxiety was not supported within the themes found in the present study. 'Communication' was a prominent theme throughout the interviews, in both frequency and importance. ...
Poster
Between 42-79% of adults with autism spectrum disorder (ASD) are said to suffer from an anxiety disorder, and 40% are said to have a co-occurring learning disability (LD). Although a considerable amount of research over the past 20 years has examined the causes of anxiety in people with ASD, few of the studies consider the nature of anxiety in adults with both ASD and LD. All available research focused on adults with ASD only, or young children diagnosed with both, as viewed by parents and caregivers. Semi-structured interviews were conducted with 7 experienced Band 2 and 3 NHS support workers who work for an NHS trust, in Social Care Homes for adults with ASD and LD, with a focus on anxiety. This was with the aim of gaining a deeper understanding into what causes anxiety, how it presents, and how staff can best support the people they are working with. A Thematic Analysis was conducted which identified 4 main themes: ‘(Un) Familiarity’, ‘Communication’, ‘Knowledge’ and ‘Lack of Confidence in Other Staff’. These themes did align with the existing theories of anxiety in adults and children with ASD, which are currently focused on intolerance of uncertainty, ability to cope with change, emotion regulation, alexithymia, sensory processing and communication deficits. The findings also highlighted themes and concepts not found within the existing literature, such as the importance of rapport building, of a person-centred approach, and working proactively not reactively. The researcher was then able to make a number of recommendations in how best to manage and hopefully reduce anxiety in adults with ASD, LD specifically those with marked difficulties in verbal communication.
... In children with ASD, on the other hand, the reverse pattern has been found. In a sample of children with ASD or TD, ages two through 14 years old, children with ASD who had higher verbal communication abilities experienced more anxiety, whereas the opposite trend was observed in TD children (Davis et al. 2011). The association between higher language ability and increased levels of anxiety has also been found in very young children with ASD. ...
... Based on prior research, we expected that structural language would relate positively to anxiety levels in young children with ASD (e.g. Davis et al. 2011). We also expected that pragmatic language would be inversely related to child anxiety. ...
... We also observed that initial levels of structural language were positively related to later levels of child anxiety, such that children who had higher structural language abilities experienced more anxiety, and children with poorer structural language abilities experienced less anxiety. This is in line with prior research, which has also found an association between higher language ability and increased anxiety symptomatology in individuals with ASD (Davis et al. 2011(Davis et al. , 2012. These findings suggest that perhaps children who have higher structural language ability are adept in comprehending negative social information, which may translate into anxiety. ...
Article
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Children with autism spectrum disorder (ASD) are at heightened risk for developing comorbid psychological disorders, including anxiety disorders, which may be further exacerbated by the presence of externalizing behaviors. Here, we examined how structural language and pragmatic language predicted anxiety and externalizing behaviors. Participants were 159 young children (4–7 years old) with ASD and their mothers. Utilizing structural equation modeling we examined associations among structural language, pragmatic language, anxiety symptoms, and externalizing behaviors. Pragmatic language, was inversely related to child anxiety and co-occurring externalizing behaviors. Structural language skills positively predicted child anxiety. These findings suggest that children with ASD may be at heightened risk for anxiety and externalizing disorders due to their pragmatic language deficits.
... Anxiety has been shown to be higher in the AD group (83,85,89) or in the PDD-NOS group (90). A study investigated the interaction between diagnosis (AD or PDD-NOS) and communication deficits (91). Children with AD experienced less anxiety as communication deficits increased while children with PDD-NOS experience more anxiety as communication deficits increased highlighting distinct type of interaction (91). ...
... A study investigated the interaction between diagnosis (AD or PDD-NOS) and communication deficits (91). Children with AD experienced less anxiety as communication deficits increased while children with PDD-NOS experience more anxiety as communication deficits increased highlighting distinct type of interaction (91). Chien et al. showed that children with PDD-NOS had a higher risk for developing Schizophrenia Spectrum Disorder, Bipolar Disorder, Major Depressive Disorder than those with AD (92). ...
Article
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Introduction Autism Spectrum Disorder (ASD) diagnosis is relatively consensual in typical forms. The margins of the spectrum and their degree of extension, however, are controversial. This has far-reaching implications, which extend beyond theoretical considerations: first, peripheral forms of autism are more prevalent than central forms; second, we do not know how relevant typical-targeted recommendations are for atypical forms. In DSM-IV-TR, these margins of autism were studied within the category of Pervasive Developmental Disorder – Not Otherwise Specified (PDD-NOS). In spite of its low reliability, this former diagnosis was of particular interest to shed light on the gray area of margins. The aim of this systematic is therefore to investigate the clinical characteristics of PDD-NOS in comparison with Autistic Disorder. Method A stepwise systematic PRISMA literature review was conducted by searching PubMed and Web Of Science databases to select corresponding studies. Results The systematic review included 81 studies comprising 6,644 children with PDD-NOS. Cross-sectional and longitudinal studies comparing PDD-NOS and AD showed that PDD-NOS corresponds to milder form of autism with less impact and less associated disorder, with the exception of schizophrenia and mood disorder. Discussion Our review challenges initial views of PDD-NOS, and shows the clinical relevance of this diagnosis when dealing with the margins of autism, and the de facto diversity included in the spectrum. However, in view of the many limitations of PDD-NOS (low reliability, instability through time, low acceptability), we suggest taxonomic changes in DSM-5: we introduce a new category based on three main dimensions related to socialization impairment, emotional lability and psychotic symptoms. Conclusion Our review argues for a distinction between AD and PDD-NOS on clinical characteristics and thus highlights the need to study the margins of autism. While the limitations of the PDD-NOS category made it irrelevant to investigate these margins from a research perspective, we believe that a multidimensional approach for mental health professionals taping socialization, emotion lability and psychotic symptoms would be interesting. Our review therefore encourage future studies to test relevant criteria for a new category and possibly identify developmental trajectories, specific interventions and treatments.
... Anxiety is an emotional state characterized by feelings of tension, intrusive or worried thoughts, and in some cases physical changes (tachycardia, hypertension). While anxiety is experienced fairly ubiquitously at some level, it can also exist in a more debilitating and chronic form as an anxiety spectrum disorder (including generalized anxiety disorder, obsessive-compulsive disorder, panic disorder, post-traumatic stress disorder, social anxiety disorder, and specific phobias) [56]. As many as 33.7% of the population may be affected by an anxiety spectrum disorder during their lifetime, making these conditions a significant source of morbidity in the population [56,57]. ...
... While anxiety is experienced fairly ubiquitously at some level, it can also exist in a more debilitating and chronic form as an anxiety spectrum disorder (including generalized anxiety disorder, obsessive-compulsive disorder, panic disorder, post-traumatic stress disorder, social anxiety disorder, and specific phobias) [56]. As many as 33.7% of the population may be affected by an anxiety spectrum disorder during their lifetime, making these conditions a significant source of morbidity in the population [56,57]. Post-traumatic stress disorder, which occurs after experiencing a traumatic situation (such as a natural disaster, serious accident, violence, amongst others) leading to intense intrusive thoughts related to that experience that can last long after its resolution, is one such condition that has been linked to DED frequency and severity [58]. ...
Article
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The Tear Film & Ocular Surface Society (TFOS) Workshop entitled 'A Lifestyle Epidemic: Ocular Surface Disease' was a global initiative undertaken to establish the direct and indirect impacts of everyday lifestyle choices and challenges on ocular surface health. This article presents an Executive Summary of the evidence-based conclusions and recommendations of the 10-chapter TFOS Lifestyle Workshop report. Lifestyle factors described within the report include contact lenses, cosmetics, digital environment, elective medications and procedures, environmental conditions, lifestyle challenges, nutrition, and societal challenges. Each topic area chapter comprises a narrative-style review of the current literature and seeks to answer a key topic-specific question using systematic review methodology. The TFOS Lifestyle Workshop report was published in its entirety in the April 2023 and July 2023 issues of The Ocular Surface. Links to downloadable versions of the document and supplementary material, including report translations, are available on the TFOS website: www.TearFilm.org.
... Another observational study showed that preschool children with ASD, unlike other children, showed fewer coy smiles when seeing themselves in the mirror, suggesting reduced shyness and altered interpersonal self . Also, a parent-report study found that 2-to 14-year-old children with ASD showed more avoidant symptoms than typically developing children (Davis et al., 2011). Together, these empirical findings confirm that older children with ASD have disturbed self-conscious emotional expressions. ...
... Children with more autistic traits show more shamelike avoidance. This is consistent with earlier work (Davis et al., 2011;Muris et al., 2016). As shame-like avoidance inhibits a prosocial response after making a social transgression (Barrett, 2005), elevated levels of shame-like avoidance may cause problems in the repairing and maintenance of social relationships. ...
Article
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Self-conscious emotions arise from evaluating the self through the eyes of others. Given that children with autistic traits may experience difficulties with understanding others' minds, they might show less attuned self-conscious emotions. Two-to-five-year-old children's (N = 98, Mage = 48.54 months, 50% girls, 92% White) self-conscious emotions (guilt, embarrassment, and shame-like avoidance) were observed after children "broke" the experimenter's favorite toy. Data were collected from March 2018 till June 2019. Children with more autistic traits showed less theory of mind (ToM), and more shame-like avoidance, but associations were not mediated by ToM. This provides initial evidence that children with more autistic traits may show disturbances in some but not all self-conscious emotions, which could hinder their social functioning.
... That is, by reducing anxiety, even children with ASD establish better social relationships and, on the other hand, by establishing friendly relationships, and increasing these relationships, we can help reduce the anxiety of these children. This is in line with the results of the previous study [50]. According to Green et al. anxiety arises from sensory processing patterns [28]. ...
... Communication skills have different effects on anxiety levels. In some people with ASD, anxiety decreases with an increase in communication deficits, and in some of these children, anxiety increases with increasing communication deficits [50]. Kring et al. suggested that ASD adolescents and adults with co-morbid psychiatric disorders (such as anxiety disorder) are more prone to engage in asocial activities [52]. ...
Article
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Background Despite the high prevalence of communicational differences, anxiety, and sensory processing difficulties in children with autism spectrum disorder (ASD), little is known about the nature of their experiences. Thus, the present study aimed to explore the correlation between communication skills, sensory difficulties, and anxiety in children with ASD. Fifty-three children with ASD (M age = 8.51, SD = 2.51; males = 42) were recruited. The Persian version of the Short Sensory Profile (SSP), the Children’s Communication Checklist (CCC), and the Spence Children’s Anxiety Scale (SCAS) was used to assess the variables. Results The overall sensory score of children with ASD was significantly and positively correlated with most of the communication skills ( P < 0.05). The overall sensory score of children with ASD was significantly and negatively correlated with all anxiety subsets of these children ( P < 0.05). The social relationships score of children with ASD had a significant and negative correlation with all subsets of anxiety and a significant and positive correlation with all sensory subsets ( P < 0.05). The total score of communication was significantly and negatively related to all subsets of anxiety except separation anxiety ( P < 0.05). Conclusions Sensory processing difficulties in ASD children appear to be significantly associated with communication skills and anxiety acts as a mediator between the two.
... De acuerdo con Bellini (2004Bellini ( , 2006 y como consecuencias de este mal ajuste, las personas con TEA pueden desarrollar ansiedad social, que puede llegar a fobia social y, como medida de evitación, el aislamiento social. Algunos resultados empíricos, además, apuntan en la dirección de que son las personas con TEA de alto funcionamiento las que presentan, con mayor frecuencia e intensidad, trastornos de ansiedad (Davis et al., 2011). La investigación demuestra que a los estudiantes con TEA les cuesta un mayor esfuerzo alcanzar el grado que a sus compañeros neurotípicos, presentando a su vez un alto nivel de soledad, ansiedad y depresión, con una alta tasa de abandono antes de alcanzar la graduación (Jackson et al. et al., 2018). ...
... Los trastornos de ansiedad en las personas con TEA no siguen los patrones psicosociales de la manifestación de la ansiedad en personas neurotípicas, relacionándose con los síntomas nucleares de los TEA (Wood y Gadow, 2010). Entre las personas con TEA, las de alto funcionamiento son las que tienen mayor riesgo de presentar o desarrollar este trastorno (Davis et al., 2011;Van Steensel y Heeman, 2017). Fernández-Rodríguez y colaboradores (2019) realizan un estudio sobre una muestra de setecientos estudiantes universitarios de la Universidad de Oviedo en el que se midieron diferentes variables psicológicas. ...
Article
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En los últimos 10 años hemos visto incrementar el número de publicaciones relacionadas con la inclusión en las aulas universitarias de estudiantes con Trastornos del Espectro del Autismo, síndrome de Asperger o Autismo de alto funcionamiento. En este artículo, se resume la literatura sobre la presencia de estudiantes con Trastornos del Espectro del Autismo en la Universidad y se reflexiona sobre la necesidad de desarrollar programas específicos para su atención en el marco de los servicios de apoyo a los estudiantes con discapacidad u otras estructuras de servicios similares. Entre las medidas específicas, hemos encontrado experiencias sobre programas de sensibilización a profesores y estudiantes con la finalidad de generar una cultura sobre “el autismo”, programas para tratar la ansiedad, programas de prevención de salud mental, etc. En definitiva, medidas que, aunque están dirigidas a un colectivo en particular, pueden beneficiar a toda la comunidad universitaria.
... The second, alternative explanation is that a higher IQ may provide individuals with greater means to report their emotional difficulties, over those with a lower IQ (Caamaño et al. 2013). Moreover, in less intelligent individuals who cannot express their problems, anxiety symptoms may be mistaken for communication deficits and resultantly underestimated (Davis et al. 2011). The ability to report symptoms may therefore confound the relationship between IQ and internalising symptoms. ...
... By contrast, anxious parents have been shown to over-report anxiety in children (Bernstein et al. 2005). Furthermore, caregivers may overestimate or under-report anxiety by confusing symptoms with ASD traits, such as communication deficits and social avoidance (Davis et al. 2011;Kuusikko et al. 2008). Also, parents of individuals with poorer abilities to communicate feelings may struggle to accurately report anxiety symptoms, particularly if external signs do not accompany them. ...
Article
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Intelligence quotient (IQ), has been found to relate to the presence of internalising symptoms in autism spectrum disorder (ASD). This meta-analysis sought to clarify the direction of the relationship between IQ and two prevalent internalising symptoms, anxiety and depression, in adolescents with ASD. Secondly, this study aimed to highlight methodological factors contributing to inconsistent findings in existing research. Self-reported anxiety was found to be significantly higher in youth with a lower IQ, while depression was positively associated with IQ. Consequently, parents, schools and clinicians should be cautious of underestimating anxiety in youth with a lower IQ. However, care should also be taken to ensure adolescents with ASD without intellectual disabilities are not overlooked with regards to social and emotional support.
... In line with this finding, there is some evidence that ASD children with lower nonverbal and higher verbal skills show more anxiety and mood problems, which would mean that a low PIQ and high VIQ are related to more anxiety in children with ASD (15). However, other research showed that children with PDDNOS had higher anxiety levels as communication deficits increased (29). ...
... The finding that ASD children with a higher PIQ and lower VIQ had more childrated specific phobia symptoms is incon sistent with research showing that deficits in both receptive and expressive communication skills are related to less anxiety symptoms in children with ASD (28), but is consistent with the finding that children with PDDNOS had higher anxi ety levels as communication deficits increased (29). There is some evidence that specific fears related to particular people, animals, or situations could be reduced by verbalization of feel ings (62), which may prevent the development of this kind of anxiety into a full specific phobia. ...
Article
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Anxiety is highly prevalent in children with an autism spectrum disorder (ASD). However, there is inconsistency in studies investigating the prevalence and risk factors of anxiety in children with ASD. Therefore, the first aim of this study was to give an overview of the prevalence of anxiety symptoms in a clinical Dutch sample of children with ASD. The second aim was to investigate age, gender, ASD subtype, and IQ as potential risk factors for anxiety in this sample. In total, 172 children with ASD (age, 8–15 years) and their parents participated in this study. Specialized services in which children with ASD were recruited were two mental health institutes and one secondary special education school. The findings showed that more than 60% of the participating children with ASD had at least subclinical anxiety symptoms according to children. More than 80% of the children with ASD had at least subclinical anxiety symptoms according to parents. It was found that younger children and girls with ASD had more anxiety symptoms than older children and boys with ASD. Moreover, it was found that children with a higher performance (non-verbal) IQ and lower verbal IQ had more specific phobia symptoms. The findings suggest that in a clinical context, children with ASD have a high risk to have co-occurring anxiety symptoms, especially girls and younger children with ASD. Therefore, early prevention and treatment of anxiety in children with ASD who are most at risk is important.
... Greater social and communication deficits in children with ASD may be associated with increased anxiety (Chang et al. 2012;Eussen et al. 2013), but some studies report that associations were significant only in individuals with ASD without intellectual disabilities (e.g., Bellini 2006;Niditch et al. 2012;Sukhodolsky et al. 2008;Wood and Gadow 2010). In individuals with ASD with co-occurring intellectual disabilities, greater communication deficits have been postulated to potentially buffer against anxiety (Davis et al. 2011b;Mazurek and Kanne 2010). Yet other studies have found no relationship between ASD social/communication symptom severity and anxiety (Hollocks et al. 2014;Rieske et al. 2012). ...
... In the present study, T1 DBC S/C was not a significant predictor of later anxiety, consistent with some crosssectional studies reporting no association between social/ communication impairments and anxiety in ASD (Hollocks et al. 2014;Rieske et al. 2012), but contrasting others reporting either positive or negative associations (e.g. Chang et al. 2012;Davis et al. 2011b;Eussen et al. 2013). Table 7 Summary of hierarchical regression analyses for Time 1 variables predicting Time 2 DBC-P-S/C scores SIB-R Total scales of independent behavior-revised, total standard scores; DBC-P-R/S developmental behavior checklist-parent version-repetitive speech/stereotyped behavior symptom scores; DBC-P-S/C developmental behavior checklist-parent version-social/communication symptom scores; SCAS-P Total Spence children's anxiety scale-parent report, total raw scores *p < .05; ...
Article
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Little is known about continuity, change and predictors of anxiety in ASD. This follow-up study investigated changes in caregiver-reported anxiety in 54 non-referred youth with ASD after 10–19 months. Earlier child predictors of later anxiety were also examined. Anxiety scores were generally stable. Time 1 ASD repetitive behavior symptoms, but not social/communication symptoms, predicted Time 2 total anxiety scores, over and above child age, gender and adaptive functioning scores, but this predictive relationship was fully mitigated by Time 1 anxiety scores when these were included as a covariate in the regression model. Exploring bi-directionality between autism and anxiety symptomatology, Time 1 anxiety scores did not predict Time 2 ASD symptoms. Preliminary clinical implications and possible future directions are discussed.
... Evidence of that association comes from White et al. (2009), who reviewed 40 studies which identified several aspects of the ASD symptomatology that were significantly linked to anxiety, including social skills deficits (Bellini, 2004) and sensory defensiveness (Pfeiffer, Kinnealey, Reed, & Herzberg, 2005). Other studies have found associations between communication deficits and anxiety in children with ASD (Davis et al., 2011). In their meta-analysis of 31 studies involving 2121 young people with ASD, van Steensel et al. (2011) noted that studies which included older participants found a higher prevalence of anxiety, and that studies with a lower mean IQ also reported higher anxiety rates. ...
... Similarly, although Pfeiffer et al. (2005) measured sensory defensiveness via the Sensory Profile (Brown & Dunn, 2006) which has been widely used with ASD samples, they performed their analysis with data from the total score from that scale, preventing identification of the specific aspects of sensory features that were associated with anxiety in their sample of adolescents with ASD. Although Davis et al. (2011) measured communication deficits with the verbal communication subscale score from the Autism Spectrum Disorders-Diagnostic for Children (Matson, González, & Wilkins, 2009), they also measured anxiety by "combining the subscale scores for the worry/depressed, and avoidant behavior subscales" (p. 326) from the Autism Spectrum Disorders-Comorbidity for Children scale (Matson & Wilkins, 2008) rather than a formal definition of GAD. ...
Article
Background: The relationship between symptoms of Autism Spectrum Disorder (ASD) and Generalised Anxiety Disorder (GAD) is complex and sometimes confounding. However, exploration of that relationship has significant potential to assist in treatment or avoidance of GAD by identifying ASD-related behaviours as 'targets' for intervention with anxious children as well as for preventative treatments that could be implemented into daily routines before children become anxious. To further understanding of this relationship, the association between parent-ratings of their sons' ASD symptoms and GAD symptoms was investigated in two samples of boys with high-functioning ASD. Methods: Parents of a sample of 90 pre-adolescent (M age=8.8yr) and 60 adolescent males (M age=14.6yr) completed the Social Responsiveness Scale (SRS) and the GAD subscale of the Child and Adolescent Symptom Inventory (CASI-4 GAD) about their sons. Results: Pre-adolescents had significantly higher SRS scale scores than adolescents. For pre-adolescents, high levels of tension in social situations were associated with 3.5-times greater likelihood of having GAD; for adolescents, experiencing difficulty in changes in routine was associated with a 10-fold increase in risk of GAD. Conclusions: In addition to focussing upon GAD itself, preventative and treatment options aimed at reducing GAD or its risk might profitably recognise and focus upon these two aspects of ASD that are different across the two age groups but each of which was significantly associated with GAD severity and prevalence in this study.
... In this context, the demand for children to conform to certain socially accepted and expected behavior standards for their age could increase the frequency of negative emotional responses as a result of their lack of social repertoire to deal with such situations. On the other hand, some symptoms of anxiety may be mistaken for deficits in social communication in ASD (Davis et al., 2011), suggesting that parents might misinterpret these deficits. ...
Article
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This study aimed to evaluate changes in the treatment of children with Autism Spectrum Disorder (ASD) during the COVID-19 pandemic, assess and correlate educational social skills (ESS), the mental health of parents/caregivers, children’s social skills (SS) and behavioral problems (BP), and compare ESS between parents with and without mental health indicators. Reports from 69 participants were analyzed using the IHSE-parents, DASS-21 and SSRS version-parents instruments. Results indicated a decrease in consultation frequency. While ESS values were average, the children’s repertoire was deficient. There was a positive correlation between ESS and SS and internalizing BP, as well as between parental mental health and SS. A negative correlation was observed between parental mental health and BP. Parents with anxiety and depression displayed a worse ESS repertoire. These findings underscore the importance of parental mental health and ESS in supporting ASD development.
... For instance, an inverse relationship exists between anxiety and communication deficits in individuals with ASD diagnoses (T. E. Davis et al., 2011), the implications of which are not well understood. Future studies should thus explore the relationship between anxiety and other behavioral phenotypes that are associated with MIA and NDDs. ...
Thesis
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Exposure to maternal immune activation (MIA) during pregnancy is associated with an increased risk for offspring to be diagnosed with neurodevelopmental disorders (NDDs). The maternal and fetal immune response to infection is thought to disrupt important developmental processes in offspring that can have long-lasting effects on their neuroimmune function and behavior. NDDs – such as autism, schizophrenia, and general learning disabilities – are more common in males than females. This suggests there are sex differences in neurodevelopment that may be differently affected by MIA to contribute to the symptoms of such disorders. The goal of this dissertation is to investigate how MIA affects rat offspring by evaluating their reflex development as neonates (Aim 1), their adult anxiety, learning, and memory behaviors (Aim 2), and their neuroimmune state both at basal levels across the lifespan (Aims 1 and 3) and in response to a secondary immune challenge in adulthood (Aim 3). We hypothesized that MIA would produce a neuroinflammatory state in offspring that would negatively impact these behavioral processes, and that males would be more affected by MIA than females. The experiments of this dissertation utilized a model of MIA that exposed female Sprague-Dawley rats to lipopolysaccharide during gestation to mimic an immune response to bacterial infection. We found that MIA enhanced the development of neonatal reflexes in both male and female offspring and did not affect maternal arched-back nursing nor licking and grooming toward pups (Aim 1). In adulthood, MIA offspring displayed reduced anxiety in the elevated-plus maze and improved performance of novel object location memory (Aim 2). Additionally, MIA induced latent inhibition in female offspring that were pre-exposed to the innocuous tone during conditioned fear training and prevented latent inhibition of tone memory in male offspring (Aim 2). Finally, in the offspring medial prefrontal cortex, MIA upregulated IL-1β at P7 and downregulated IL-6 at P21 in both sexes, and decreased BDNF in the dorsal hippocampus of males at P21 (Aim 1). In adulthood (Aim 3), MIA did not affect the inflammatory immune response to adult LPS exposure but did downregulate basal gene expression in the dorsal hippocampus (IL-6, CD11b, BDNF) and amygdala (IL-1β) of male and female offspring. These findings suggest that the relationship between MIA and the etiology and manifestation of NDD-related symptoms in offspring is more complex than the literature suggests. Our data revealed that MIA elevated IL-1β expression at P7, reduced BDNF expression at P21 (in males) and in adulthood, and impacted latent inhibition learning in adult offspring, which are outcomes characteristic of human NDDs. On the other hand, MIA also downregulated neuroinflammatory gene expression in the brains of juvenile and adult offspring, reduced adult anxiety behaviors, and improved neonatal reflex development and adult novelty learning, which are phenotypes not typically associated with NDDs. Nonetheless, the results of this dissertation support that MIA can produce profound and long-lasting effects on offspring neuroimmune and behavioral processes.
... The observed preference for written communication modalities, such as emails and messaging apps, by participants with ASD is in line with their proposed function to reduce social anxiety and enhance self-expression 5,8,9 . This interpretation is also supported by the consistently reduced verbal communication which was previously linked to increased social anxiety in ASD 19 . Considering that we did not collect any information on anxiety this issue should be evaluated in a future study with a specific focus on social anxiety. ...
Preprint
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Adults with high-functioning autism (HFA) may compensate for their social difficulties by resorting to more sequential forms of communication. Here, we study communication preferences in individuals with HFA and neurotypical controls by monitoring smartphone-based communication for verbal, written and mixed app categories over a period of four months. We find HFA participants to prefer written over verbal communication, underscoring the importance of considering these preferences to facilitate social integration
... As this may have a fundamental effect on the classroom behaviour, academic progress, and friendships of autistic children (Hogan et al., 2014;Menting et al., 2011), it is surprising that this outcome has not gained more attention in the literature to date. Although receptive communication differences have been implicated in the development of anxiety in autistic children (Davis et al., 2011), the extent to which anxiety may impact listening has not been explored. It is possible that, despite the removal of language differences from the DSM criteria for autism (American Psychiatric Association, 2013), parents and professionals view receptive language difficulties as characteristic of autism rather than an additional impact of anxiety. ...
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Anxiety is a common co-occurring condition for autistic students; however, little is known about how anxiety may affect their social or academic outcomes in an educational setting. Furthermore, the perspectives of students themselves have rarely been included in the literature. Using Q-sort method, 45 autistic participants aged 7 to 17 years identified the outcomes they perceived were most impacted by their anxiety in the educational setting. The three outcomes most highly rated as being impacted by anxiety overall were academic outcomes. Using by-person factor analysis, six distinct factors, or ‘viewpoints’, were identified. These viewpoints reflect different combinations of outcomes affected by anxiety, including missing school or activities, reduced interactions with friends, reduced classroom communication and finding it harder to complete schoolwork. This study adds to the literature by using Q-sort method to enable autistic children and adolescents to report the impacts of their anxiety. Anxiety has additional impacts on the social and academic outcomes of autistic students, highlighting the need for increased awareness and training for parents and professionals, an individualised approach to student support and further research regarding the relationship between anxiety and academic outcomes. Lay abstract Many autistic students experience anxiety, but there is little research that explores how anxiety might affect autistic students in the school environment. In this study, 45 autistic students, aged 7 to 17 years, completed an online sorting activity to tell us how anxiety impacts them at school. The students were given 21 statements about possible social and academic effects of anxiety (for example, ‘When I’m worried it’s hard to start my schoolwork’ or ‘When I’m worried I talk less to my friends or other students’), and sorted them based on how much they agreed each statement was true for them. The three statements most highly rated as being impacted by anxiety were difficulties related to schoolwork. By comparing the information provided by students, six smaller groups of students were identified who sorted the statements in a similar order. These groups show that anxiety affects different autistic students in different ways, including missing school or activities, communicating less with friends and teachers and finding it harder to complete schoolwork. This online sorting activity enabled autistic students themselves to report how anxiety affects them at school. The results suggest that it is important to provide individualised support for autistic students who experience anxiety at school, to reduce the impact of their anxiety on their participation, communication and interactions, and schoolwork. Further research about the effects of anxiety on the academic outcomes of autistic students is also needed.
... Lim et al. (2021) also found that parents' emotional distress in response to the stigma associated with having a disability may heighten anxiety in autistic adolescents when interacting with their parents. Another possible explanation is that, although intellectually able, these autistic adolescents may have experienced communication difficulties, contributing to heightened anxiety (Davis et al., 2011). ...
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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.
... Although we focus on the field of cognitivecommunication rehabilitation here as our area of expertise and a section of the field that urgently needs to implement new approaches for increased precision and progress, these principles apply to science and treatment across many communication disorders and have in fact gained traction in other heterogeneous clinical populations such as autism (Contaldo et al., 2020;Davis et al., 2011;Lombardo et al., 2019;Sievers et al., 2018). We hope that increased implementation of these analytic approaches, combined with team science to increase sample size and other advanced statistical and experimental approaches, will lead to faster advances in treatment design and improved outcomes for patients with cognitive-communication disorders. ...
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Purpose The dual goals of this tutorial are (a) to increase awareness and use of mediation and moderation models in cognitive-communication rehabilitation research by describing options, benefits, and attainable analytic approaches for researchers with limited resources and sample sizes and (b) to describe how these findings may be interpreted for clinicians consuming research to inform clinical care. Method We highlight key insights from the social sciences literature pointing to the risks of common approaches to linear modeling, which may slow progress in clinical–translational research and reduce the clinical utility of our work. We discuss the potential of mediation and moderation analyses to reduce the research-to-practice gap and describe how researchers may begin to implement these models, even in smaller sample sizes. We discuss how these preliminary analyses can help focus resources for larger trials to fully encapsulate the heterogeneity of individuals with cognitive-communication disorders. Results In rehabilitation research, we study groups, but we use the findings from those studies to treat individuals. The most functional clinical research is about more than establishing only whether a given effect exists for an “average person” in the group of interest. It is critical to understand the active ingredients and mechanisms of action by which a given treatment works (mediation) and to know which circumstances, contexts, or individual characteristics might make that treatment most beneficial (moderation). Conclusions Increased adoption of mediation and moderation approaches, executed in appropriate steps, could accelerate progress in cognitive-communication rehabilitation research and lead to the development of targeted treatments that work for more clients. In a field that has made limited progress in developing successful interventions for the last several decades, it is critical that we harness new approaches to advance clinical–translational research results for complex, heterogeneous groups with cognitive-communication disorders.
... According to data obtained, children with Autism Spectrum Disorder (ASD) is the biggest group among the SSN preschoolers which has been included under IE Programme (Ministry of Education, 2020). ASD is a one of learning disability that involves social and communication deficit, repetitive or restricted behaviour and lacking in understanding emotion (Davis et al., 2011). Those with ASD could be diagnosed through clinical test as early as two years old. ...
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Most children begin emotional development at birth with expressing emotions, reading facial expressions and continue to develop skills of empathy and relationship building as they grow. However, children with Autism Spectrum Disorder (ASD) have a harder time with this development which includes having a difficult time understanding their own emotions. As in self-appearance domain stated in the framework of Kurikulum Standard Prasekolah Kebangsaan (KSPK), Social Emotional Learning (SEL) has been emphasised. It can help children with ASD to develop an awareness of emotions and build social relationships. Therefore, myriad of initiative on SEL are needed in inclusive classrooms to ensure an equal learning opportunities among the children especially those with ASD. Research has shown the positive effects of using visual supports to guide emotional development. This is because children with ASD respond better visually than they do by just listening. By using visual supports teachers can communicate better with them about their feelings and emotions. Over the decades, Augmented Reality (AR) is widely used in many fields such as education especially in helping Students with Special Needs (SSN). AR is a new technology that merges virtual objects with the real world. Fundamentally, it gives the real image of the world virtually and interactively. By adapting AR during teaching and learning process, children with ASD could learn to recognise, understand and express their feelings cum emotions more effectively. In the nutshell, AR is an evidence based learning tools in promoting SEL among children with ASD and applicable in Malaysian inclusive preschool classrooms.
... They were also over five times more likely to have experienced poor mental health. These findings closely align with high rates of anxiety and depression previously reported in adults with ASD (Davis et al., 2011;Gray et al., 2012;Lever & Geurts, 2016;Uljarević et al., 2019;Rai et al., 2018;Wigham et al., 2017), particularly in those who have at least age-expected cognitive ability (Sterling et al., 2008). Interestingly, the presence of this stronger association coupled with largely absent group differences in the sleep parameters (with the exception of weak evidence for lower sleep efficiency in the ASD group) suggests a more sensitive relationship between mood and sleep in ASD. ...
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This study examined sleep and its cognitive and affective correlates in adults with and without autism spectrum disorder (ASD), utilizing UK Biobank data. There were no group differences in subjective sleep duration [n = 220 ASD; n = 2200 general population (GP)]. Accelerometer measures of sleep duration or nighttime activity did not differ by group, but sleep efficiency was marginally lower in ASD (n = 83 ASD; n = 824 GP). Sleep efficiency was associated with wellbeing and mental health, and pathways between accelerometer sleep measures and wellbeing and mental health were significantly stronger for adults with ASD (who also reported substantially poorer wellbeing and > 5 × likelihood of experiencing mental distress). These findings highlight the need to monitor sleep to maintain good mental health in adult ASD.
... Thus, the need to adhere to routines, and difficulty with transitions may then lead to challenging healthcare interactions Zanotti, 2018). Cooperation with healthcare providers may also be difficult due to a limited ability to communicate and understand what is occurring (Davis et al. 2011;Johnson et al. 2014a, b). ...
Article
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Individuals with an autism spectrum disorder (ASD) have a greater number of healthcare provider interactions than individuals without ASD. The obstacles to patient-centered care for this population, which include inflexibility of hospital environments, limited resources, and inadequate training, has been documented. However, there is little knowledge on efforts to address such concerns. A scoping review was conducted and the systematic search of the literature resulted in 23 relevant studies. The predominant themes include the use of data collection instruments, application of evidence-based practices and resources, and training of providers. The results of this review have implications for practitioners and future research to adapt and improve upon the provision of medical care for individuals with ASD across the lifespan.
... Additionally, given that many anxiety symptoms are associated with increased verbal ability, the absence of an ID and associated increase in verbal skills may play a key role in the ability to communicate anxiety symptoms. This is consistent with studies in children and adolescents where the presence of functional language use has been associated with an increase in anxiety symptoms in children with ASD (Sukhodolsky et al. 2008), and has been shown to have an opposite pattern to children without ASD, where language deficits were associated with increased anxiety symptoms, suggesting a unique relationship between ASD, language and anxiety (Davis et al. 2011). ...
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Anxiety is common in children with ASD; however, the burden of specific anxiety disorders for adults with ASD is under-researched. Using the Stockholm Youth Cohort, we compared anxiety disorder diagnoses among autistic adults (n = 4049), with or without intellectual disability, and population controls (n = 217,645). We conducted additional sibling analyses. Anxiety disorders were diagnosed in 20.1% of adults with ASD compared with 8.7% of controls (RR = 2.62 [95% CI 2.47–2.79]), with greatest risk for autistic people without intellectual disability. Rates of almost all individual anxiety disorders were raised, notably obsessive–compulsive disorder and phobic anxiety disorders. Anxiety disorders were more common in full siblings and half-siblings of people with ASD. The implications of this are explored.
... Consistent with the elevated prevalence of anxiety disorders in youth with ASD, parents rate anxiety as the second most common problem [17,18]. Further, symptoms of anxiety often motivate parents of youth with ASD to seek treatment [8,[12][13][14][15][16]. Anxiety can exacerbate core features of ASD, such as over-responsivity to sensory stimuli [19][20][21][22] and contribute to heightened social deficits [23], depressive symptoms [24], and family/peer relationship difficulties [25]. The presence of an anxiety disorder results in functional impairment over and above that related to ASD alone, affecting multiple domains including quality of life, employment, and educational attainment [17,24,[26][27][28]. ...
Article
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Anxiety is a common and impairing condition in youth with autism spectrum disorders (ASD). Evidence supports the use of cognitive behavioral therapy for treating anxiety in this population; however, available treatment protocols may be difficult to implement outside of research settings. The present study examined the efficacy of family-based exposure-focused treatment (FET) compared to a treatment as usual (TAU) control in 32 youth aged 6–17 years with ASD and co-occurring anxiety. Fourteen youth were randomized to FET, which included 12 face-to-face weekly therapy sessions lasing 45–55 min, while 18 youth completed the TAU control where engagement in psychotherapy or pharmacotherapy was at the discretion of the families. Results strongly supported FET with a 79% (versus 0% in TAU) response rate, 86% (versus 0% in TAU) remission in primary anxiety diagnosis, and large between-group effects on clinician-rated anxiety severity and most parent-rated domains of anxiety-related impairment. Among treatment responders, 2-month follow-up supported maintenance of gains. Overall, the study supported FET as a relatively brief intervention for the treatment of anxiety in youth with ASD, although further research is needed to replicate these findings and compare FET outcomes to more comprehensive interventions.
... Nonetheless, our findings align with those of Park et al. (2012) who, in a sample of pre-schoolers, similarly did not find any association between expressive language and emotional and behavioural difficulties but reported higher self-absorbed and social-relating problems for lower receptive skills. In school-age children with ASD, at lower levels of ASD severity lower expressive skills are related to higher levels of anxiety, while the opposite pattern is found at higher levels of ASD severity (Davis et al. 2011(Davis et al. , 2012. This conflicting evidence points to the role that age and severity of ASD symptoms might have in the relationship between EC and emotional and behavioural difficulties. ...
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We investigated the mechanism of impact of poor communication skills and emotional and behavioural problems in children with ASD (22–61 months) on parental psychological distress. Participants were dyads enrolled in two pilot intervention studies; the dataset includes cross-sectional data at baseline (N = 82). We postulated an indirect effect of child expressive and receptive communication on parent psychological distress, through child emotional and behavioural problems. The effect of receptive skills on parent psychological distress was fully mediated by child emotional problems: lower receptive skills were associated with higher levels of emotional symptoms, which in turn predicted higher parent psychological distress. Expressive skills did not show either direct or indirect effects. Findings are discussed in light of children’s marked ‘receptive disadvantage’ communication profile.
... However, in comparisons between the minimally verbal and verbal groups, the verbal group had higher symptom severity, and a higher percentage of participants exceeded clinical cut-offs for depression, general anxiety disorder and oppositional defiant disorder. These results were consistent with other reports in the literature that have suggested that better functional communication was associated with higher levels of anxiety in individuals with ASD (31)(32)(33)(34), although these other studies did not specifically enroll or investigate minimally verbal individuals with ASD as a group. In contrast to the profile of psychiatric comorbidities reported for verbal individuals with ASD, the MV participants assessed by Lerner et al. (29) were more likely to meet the clinical cutoff for ADHD-Hyperactivity/Impulsivity type relative to the verbal participants (50% compared to 37%), when controlling for non-verbal IQ, age, and ADOS calibrated symptom severity scores. ...
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Despite many studies documenting the prevalence of various co-occurring psychiatric symptoms in children and adults with ASD, less is known about how these symptoms relate to subtypes defined by particular phenotypic features within the ASD population. We examined the severity and prevalence of comorbid symptoms of psychopathology, emotion dysregulation, and maladaptive behaviors, as well as adaptive functioning, in a group of 65 minimally verbal children (n = 33) and adolescents (n = 32) with ASD. On the Child and Adolescent Symptom Inventory (CASI-5), for all the symptom classifications except oppositional defiant disorder and conduct disorder, more participants in our sample showed elevated or clinically concerning severity scores relative to the general population. On the Emotion Dysregulation Inventory (EDI), the mean scores for Reactivity and Dysphoria factors in our sample were lower than in the autism calibration sample, which included a large number of inpatient youth with ASD. Overall, few differences were found between the children and adolescents within this severely impaired group of ASD individuals based on clinical cutoff scores on the CASI-5 and EDI factor scores. Psychiatric comorbidities and emotion dysregulation measures were not correlated with autism symptom severity or with measures of adaptive functioning, and were largely unrelated to IQ in our sample. The number of clinically significant psychiatric symptoms on the CASI-5 emerged as the main predictor of maladaptive behaviors. Findings suggest a wide range of co-occurring psychopathology and high degree of maladaptive behavior among minimally verbal children and adolescents with ASD, which are not directly attributable to autism symptom severity, intellectual disability or limitations in adaptive functioning.
... Adults with ASD may have to deal with many challenges in their daily lives and it is now recognized that psychiatric morbidity is higher in ASD than in the general population (Croen et al., 2015). However, estimated rates of comorbid psychiatric problems vary widely (see reviews by Davis et al., 2011;Levy & Perry, 2011;Mannion & Leader, 2013;Mazzone et al., 2012), with figures for major psychiatric disorder ranging from 20% to 25% (Hutton et al., 2008) to over 75% (Joshi et al., 2013). Thus, Hutton et al. (2008) found that rates of adult-onset psychiatric disorders were comparable with population norms, while Brugha et al. (2011) found no evidence of increased use of mental health services among adults with autism. ...
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Cambridge Core - Psychiatry - Autism and Pervasive Developmental Disorders - edited by Fred R. Volkmar
... Adults with ASD may have to deal with many challenges in their daily lives and it is now recognized that psychiatric morbidity is higher in ASD than in the general population (Croen et al., 2015). However, estimated rates of comorbid psychiatric problems vary widely (see reviews by Davis et al., 2011;Levy & Perry, 2011;Mannion & Leader, 2013;Mazzone et al., 2012), with figures for major psychiatric disorder ranging from 20% to 25% (Hutton et al., 2008) to over 75% (Joshi et al., 2013). Thus, Hutton et al. (2008) found that rates of adult-onset psychiatric disorders were comparable with population norms, while Brugha et al. (2011) found no evidence of increased use of mental health services among adults with autism. ...
Chapter
Autism and Pervasive Developmental Disorders - edited by Fred R. Volkmar January 2019
... Parents reported that their children experienced difficulty with expressing their anxiety verbally, which led to behavioural means being utilised instead. Davis et al. (2011) different communication styles. Moreover, he reported that the experience of interacting with healthcare professionals was much more positive, and beneficial, when his communication preferences (e.g. ...
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Background A high proportion of individuals with Autism Spectrum Disorder (ASD) also meet criteria for anxiety disorders. Few studies have explored the experience and impact of anxiety in autistic adults using qualitative methods. Methods Seventeen semi-structured interviews with either autistic adults (n = 10) or the supporters of adults with a diagnosis of ASD (n = 7) were conducted. The data were analysed using thematic analysis. Results Three main themes were identified: ‘contributing and mitigating factors to anxiety’, ‘consequences of anxiety’, and ‘management of anxiety’. Discussion Findings highlighted the role that uncertainty plays in anxiety in autism, supporting existing theoretical accounts. Implications for clinical practice were discussed. These included ensuring that communication differences are minimised, and highlighting the importance of meaningfully including autistic people throughout the development and evaluation process of interventions for mental health.
... The limited body of research that has considered the potential role of verbal ability in psychiatric symptom presentation in ASD has predominantly focused on anxiety, indicating that better functional communication is associated with higher levels of anxiety (Davis et al. 2011;Kerns et al. 2015;Sukhodolsky et al. 2008;Witwer and Lecavalier 2010). For the most part, the higher rates in more verbal youth were attributed to certain symptoms emphasizing verbal responses (e.g., Witwer and Lecavalier 2010), though it is also possible that being more verbal exposes one to situations that might lead to anxiety (e.g., trying to start a conversation with an unfamiliar peer; Kerns et al. 2015). ...
Article
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Youth with autism spectrum disorder (ASD) experience high rates of psychiatric symptoms, but the relation between verbal ability and psychiatric symptoms is unknown. This study utilized a large sample of clinically referred inpatient and outpatient youth with ASD to compare psychiatric comorbidity between verbal and minimally-verbal youth, adjusting for nonverbal IQ, age, and ASD symptom severity. Results indicated that verbal youth were more likely to present with and meet clinical cutoffs for depression and oppositional defiant disorder symptoms, with greater impairment associated with depression. Youth in inpatient settings had greater symptom severity and impairment across almost all psychiatric comorbidities. These results present the most direct estimate to date of the association between verbal ability and psychiatric comorbidity in ASD.
... Our finding with the Social Communication subscale was consistent with some previous findings, though not with all literature on this topic regarding anxiety symptoms. Specifically, we found the presence of clinical anxiety symptoms was linked to poorer social communication, while some previous research has suggested the opposite relationship (i.e., Davis et al. 2011). Reviewing literature that is consistent with our findings, the relationship we found in the present study may be due to the fact that higher anxiety symptoms may impair the ability to communicate social needs as well as reciprocal social communication. ...
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Children with autism spectrum disorder (ASD) experience internalizing and externalizing problems at higher rates than typically developing children, which could worsen social impairment. The present study compared impairment scores (social responsiveness scale, 2nd edition; SRS-2 scores) in 57 children (3–17 years, 82.5% male) with ASD, either with or without heightened levels of anxiety or ADHD symptoms, all per parent report. Children with heightened anxiety problems showed higher scores on four SRS-2 subscales (Social Cognition, Social Communication, Social Motivation, and Restricted Interests and Repetitive Behavior). Children with heightened ADHD traits showed higher scores on two subscales (Social Communication and Social Awareness). These findings suggest similarities and differences in how social deficits in ASD may worsen with anxiety or ADHD symptoms.
... Anxiety and depression are prevalent in children with ASD. Current research suggests that up to 84% of people with autism will experience problems with anxiety (Davis 2011, White 2009) and 50% will suffer depression (Teirney 2004). Furthermore, 45% will meet the criteria for ADHD (Skokauskas 2012) and 10% will meet the criteria for obsessive compulsive disorder (OCD) (Gjevik 2010). ...
... Although research on anxiety in non-ASD populations has consistently shown a link between impairments in language and communication and levels of anxiety (Beitchman et al. 2001 ;Bornstein et al. 2013 ), only a handful of studies have examined the relationship between the social communication impairments and anxiety in ASD, consistently reporting that anxiety symptoms are more common in children with stronger communication abilities (Davis III et al. 2011bSukhodolsky et al. 2008 ;Kerns et al. 2015 ). However, several authors (e.g., Strang et al. 2012 ;Sukhodolsky et al. 2008 ;Tsai 1996 ) have suggested that lower levels of anxiety in minimally verbal children with ASD might be a consequence of diffi culties in communicating anxious symptoms rather than a true refl ection of lower levels of anxiety in this subgroup. ...
Chapter
Schizophrenia spectrum disorders (SSD) and autism spectrum disorder (ASD) are currently conceptualised as separate illnesses; however, this has not always been the case. The disorders share multiple phenotypic similarities and risk factors and have been reported to co-occur at elevated rates. In this chapter, we examine the level of comorbidity found between the disorders and the overlap between ASD and SSD at a clinical and trait level and discuss difficulties in the diagnosis and evaluation of the disorders. We then discuss genetic and neurobiological evidence, highlighting similarities and areas of distinction. Finally, we present treatment options, including non-medical and novel treatment strategies as well as pharmacological interventions.
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Many factors in the domains of mental, physical, and social health have been associated with various ocular surface diseases, with most of the focus centered on aspects of dry eye disease (DED). Regarding mental health factors, several cross-sectional studies have noted associations between depression and anxiety, and medications used to treat these disorders, and DED symptoms. Sleep disorders (both involving quality and quantity of sleep) have also been associated with DED symptoms. Under the domain of physical health, several factors have been linked to Meibomian gland abnormalities, including obesity and face mask wear. Cross-sectional studies have also linked chronic pain conditions, specifically migraine, chronic pain syndrome and fibromyalgia, to DED, principally focusing on DED symptoms. A systematic review and meta-analysis reviewed available data and concluded that various chronic pain conditions increased the risk of DED (variably defined), with odds ratios ranging from 1.60 to 2.16. However, heterogeneity was noted, highlighting the need for additional studies examining the impact of chronic pain on DED signs and subtype (evaporative versus aqueous deficient). With respect to societal factors, tobacco use has been most closely linked to tear instability, cocaine to decreased corneal sensitivity, and alcohol to tear film disturbances and DED symptoms.
Article
Varying rates of anxiety have been reported in children with Autism Spectrum Disorder (ASD) and Intellectual Disability (ID). Recent reports, using an adapted semi-structured interview approach, suggest that the risk for anxiety in these children is equal to that found in those with ASD and average or above average IQ. This wide range in rates derives from the challenges associated with assessing anxiety in those with limited language/severe developmental delays. Three case vignettes are presented to illustrate an approach for conducting a developmentally sensitive parent interview in order to detect anxiety in those with ASD and ID. Since accurate assessment of anxiety is critical to the important goal of guiding appropriate mental health treatment, practical assessment considerations from our research and the literature are provided including: 1) considering whether a child with ASD and ID might have an anxiety disorder that is undiagnosed, 2) using semi-structured interviews validated for children with ASD with a focus on behavioral examples, 3) considering the Defense Cascade or 6Fs, 4) considering physical symptoms of anxiety, 5) differentiating anticipatory anxiety/fearful avoidance from other underlying emotions, 6) considering idiosyncratic coping methods, 7) considering whether “distinct” areas of anxiety are present, and 8) considering clinician training. A discussion of developmentally appropriate treatment options for the three cases is included. Limitations and future directions regarding clinician training are explored.
Article
Autism Spectrum Disorder (ASD) is a neurodevelopmental disorder that is characterized by difficulties with social-communication and the presence of restricted and repetitive patterns of interest. It is well documented that children with ASD often experience co-occurring psychiatric difficulties, including anxiety. In fact, it is estimated that between 40 and 79% of children and adolescents with ASD experience at least one anxiety disorder. This range in prevalence is likely due to differences in study sample size and recruitment practices (e.g., community versus clinical samples), in the use of screening measures with reduced sensitivity to detect anxiety in ASD, in sample characteristics (e.g., child’s IQ, language skills), as well as differences in the presentation of anxiety in ASD. Anxiety disorders in youth with ASD can significantly interfere with functioning across school, home, and community settings, and anxiety related difficulties are thought to exacerbate core ASD symptoms, including increased avoidance and ritualistic/restricted behaviors. Within school settings specifically, anxiety may negatively impact class attendance and engagement, academic achievement, and peer relationships. Thus, learning more about anxiety difficulties at school can inform the development of school-based mental health interventions for students with ASD. Identifying anxiety within school settings can also facilitate appropriate selection of students with ASD experiencing anxiety, thereby fostering the academic and mental health functioning in these students.
Article
Background Anxiety is a common condition noted to cause significant impairment in some autistic youth. Previous research has found that autistic youth tend to exhibit higher levels of traditional anxiety symptoms with higher IQ scores and higher language abilities. In this study of the relationship between anxiety, intelligence, and language skills in autistic youth, it was hypothesized that a mediational relationship would be observed in which IQ exerts its influence over anxiety through language skills. Method Participants consisted of 293 autistic youth between the ages of 7 and 18. Anxiety was assessed with the Revised Children’s Anxiety and Depression Scale, language with the Oral and Written Language Scales Version II, and IQ (performance, verbal, and full-scale) was measured with the Wechsler Abbreviated Scale of Intelligence Version II. A simple mediation model was used with IQ as the predictor variable, language as the mediator variable, and anxiety as the outcome variable. This analysis was conducted three times so that performance, verbal, and full-scale IQ could be examined as separate predictors. Results The results of this study confirmed our hypothesis with a full mediation effect for each IQ scale, although verbal IQ was too strongly correlated with language scores for it to be considered a separate construct from our language measure. Conclusions This model should inform further autism research in that the influence of IQ and language over anxiety should not be viewed as independent factors but as a set of constructs that exert a shared influence.
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Anxiety is common in children on the autism spectrum, however its impacts are not fully understood. Participation is an important outcome, linked to the health and wellbeing of children. This study examined the relationship between anxiety and participation using parent reports for 131 children on the autism spectrum, aged 6–13 years. Hierarchical multiple regressions explored child and family factors in relation to participation in Home and Community settings. Anxiety was a unique, significant predictor of the frequency of children’s participation (but not involvement in activities) in both settings, when controlling for autism characteristics, communication skills and family income. Anxiety symptomatology may contribute to the less frequent participation of children on the autism spectrum in home and community activities.
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Introduction: Anxiety is highly comorbid in children and adolescents with autism spectrum disorder (ASD), contributing to considerable impairments. In this account, the aim of study was to explore the explanations of anxiety in children and adolescents with ASD in relevant literature. Materials and Methods: This study is an integrative literature review and 3 electronic databases- Scopus, Science Direct, PubMed – from 2000 to 2019 were searched using a comprehensive search strategy. As a result of this search, 576 articles retrieved. According to a PRISMA method and use of an inclusion and exclusion criteria, 11 research papers were selected to enter the research. Results: According to the results of studies, 3 explanation have been found: The core symptoms of autism such as lack of social skills and Sensory Over-Responsivity underlie the anxiety in autism, Emotion regulation impairments underlie the anxiety in autism, and intolerance of uncertainty is a central factor in the emergence of anxiety in autism. Conclusion: Children with autism spectrum disorder have some cognitive deficits and different cognitive architecture. Therefore, it is necessary to pay attention to these features and defects in explaining anxiety in autism and to present a conceptualization of anxiety in autism based on cognitive features. Keywords: Autism Spectrum Disorder, Anxiety, Uncertainty, Child, Adolescent
Article
Relatively few measures have been examined for their psychometric properties when assessing anxiety among children with autism spectrum disorder (ASD), and the relationship between ASD and anxiety symptoms remains poorly understood. This study examined the relationship between ASD symptoms on the Social Responsiveness Scale ( SRS) and comorbid clinical anxiety. In a sample of 2,435 participants, parents of children with ASD and comorbid anxiety endorsed more frequent or severe ASD symptoms than parents of children without comorbid anxiety. Severity of ASD symptoms was a significant predictor of anxiety status and approached clinical significance. Implications for measurement of anxiety among children with ASD are discussed, including that areas of symptom presentation should be carefully evaluated, and that the onset or worsening of anxiety may affect ASD symptom presentation.
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Few studies have been conducted in Greece focusing on the education of conversational skills of individuals with developmental disabilities. The aim of this qualitative research was to educate seven individuals with developmental disabilities, who are living in an intensive treatment residential facility, in social exchanges and particularly in conversational skills. The participants were formed into a group and were given images to discuss among themselves using questions and answers. The results of the study showed that all participants who started from a zero level gained the ability to participate in conversation according to their potential. The training content and the structure provided for this intervention increased the number of exchanges and afforded the opportunity and the means to socialize. In conclusion, as a result of this intervention, it turns out that people with developmental disabilities clearly demonstrated that they are able to learn conversational skills in a group setting.
Chapter
This chapter discusses integration into the world of employment among people with Autism Spectrum Disorder (ASD). In particular, it considers those who received diagnoses of High-Functioning ASD (HF-ASD) or Asperger’s syndrome. This sub-population is characterized by normal intelligence with no significant cognitive delay (Noterdaeme, Wriedt, & Höhne, 2010). The chapter reviews the literature and research on HF-ASD as it relates to employment; presents several case studies of programs that assist people with HF-ASD achieve and maintain employment; delineates principles of support for successful employment; and gives recommendations towards enacting these principles in the field.
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Purpose To analyze current literature that discusses caring for transgender patients, to identify gaps, and suggest future research specific to the medical imaging and radiation therapy profession. Methods Multiple electronic databases were searched to locate scholarly sources that discussed caring for transgender patients. Twenty-two articles, a reference textbook, and a document published by The Joint Commission were included in this literature analysis. Results The literature identified 3 common themes regarding caring for transgender patients: barriers to quality care, education considerations, and imaging considerations. Discussion A lack of awareness among health care providers and communication issues can compromise the care transgender patients receive. Opportunities to integrate transgender-related content into medical education and training programs can improve awareness and offer techniques to enhance communication. Inquiring about pregnancy status, calculating the glomerular filtration rate, and recommending screening guidelines for mammography and other imaging modalities present unique challenges for radiology departments caring for transgender patients. Greater awareness of the transgender population is needed among medical imaging and radiation therapy professionals so quality care is not compromised. Conclusion Further research concerning transgender patient care specific to the medical imaging and radiation therapy profession is needed.
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Purpose of review: This review aims to synthesize the most recent research on anxiety disorders and obsessive-compulsive disorder (OCD) in individuals with autism spectrum disorder (ASD) and discuss the relationship between these conditions and challenges for assessment. Furthermore, implications for treatment and future directions are discussed. Recent findings: Research suggests that anxiety disorders and OCD are highly prevalent in individuals with ASD. However, the significant overlap of ASD features with anxiety and OCD symptomology makes differential diagnosis of these disorders particularly challenging. Though several treatments for anxiety have been adapted for youth with ASD (e.g., cognitive behavior therapy), pharmacological treatments and treatments for adults are still marked undeveloped. Despite the high prevalence of anxiety disorders and OCD in ASD and some recent advances in assessment and treatment, research is needed to clarify the multifaceted relationship of these conditions and develop tailored assessment and treatment approaches appropriate for a full range of individuals with ASD.
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Anxiety disorders are among the most prevalent psychiatric diagnoses in adults and children (Costello, Mustillo, Erkanli, Keeler, & Angold, 2003; Curry, March, & Hervey, 2004; Kessler, Chiu, Demler, & Walters, 2005; Merikangas et al., 2010). Thus, it is common for clinicians to encounter many individuals seeking treatment for anxiety. Given the nature of anxiety, those with an anxiety disorder tend to present their anxious symptoms as the primary, or perhaps only, complaint when they make the decision to seek treatment. This tendency holds even when there may be other factors negatively impacting their day-to-day functioning. Furthermore, there are several other diagnoses that tend to co-occur with anxiety disorders, including a second anxiety disorder, depression, Attention-De ficit Hyperactivity Disorder (ADHD), or substance use disorder. © Springer Science+Business Media New York 2013. All rights reserved.
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Purpose To determine a population-based estimate of communication disorders (CDs) in children; the co-occurrence of intellectual disability (ID), autism, and emotional/behavioral disorders; and the impact of these conditions on the prevalence of CDs. Method Surveillance targeted 8-year-olds born in 1994 residing in 2002 in the 3 most populous counties in Utah (n = 26,315). A multiple-source record review was conducted at all major health and educational facilities. Results A total of 1,667 children met the criteria of CD. The prevalence of CD was estimated to be 63.4 per 1,000 8-year-olds (95% confidence interval = 60.4–66.2). The ratio of boys to girls was 1.8:1. Four percent of the CD cases were identified with an ID and 3.7% with autism spectrum disorders (ASD). Adjusting the CD prevalence to exclude ASD and/or ID cases significantly affected the CD prevalence rate. Other frequently co-occurring emotional/behavioral disorders with CD were attention deficit/hyperactivity disorder, anxiety, and conduct disorder. Conclusions Findings affirm that CDs and co-occurring mental health conditions are a major educational and public health concern.
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Fourteen autistic children and youth matched with nonhandicapped same age, same sex peers ranging in age from 2 1/2 to 17 years of age were rated by their parents on the Revised Fear Survey Schedule for Children. Percent of autistic children rated as having specific common fears (i.e., “fears of the unknown”) was higher for autistic than the non-handicapped children. Further, some fears were quite different. Thunderstorms, getting punished by father, dark places, being in a big crowd, going to bed in the dark, closed places, and going to the dentist were in the top 10 fears for autistic children but not for the non-handicapped persons. Such differences suggest either qualitative variations or developmental differences between these groups. Similar in scope to the fears of younger normal children, loud sounds, dark places and strangers were rated as producing more fear in autistic persons. The implications of these data are discussed.
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Little is known about the symptoms of anxiety in very young children with autism spectrum disorders, particularly comparisons between Autistic Disorder (AD) and Pervasive Developmental Disorder-Not Otherwise Specified (PDD-NOS). In the current study, toddlers (i.e., 17–37 months of age) with diagnoses of either AD (N=159) or PDD-NOS (N=154) were compared to atypically developing toddlers who did not meet criteria for an autism spectrum disorder (N=200). Results indicated an overall pattern whereby toddlers with AD had more severe anxious and avoidant symptoms than either toddlers with PDD-NOS or controls. Further, toddlers with PDD-NOS were significantly more severe than controls. Additional analyses examining specific differences between the groups on anxious and avoidant items were conducted as well. Overall, toddlers with AD appear to have more severe anxiety than either those with PDD-NOS or controls, who did not differ on many items.
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The present study examined the prevalence and types of anxiety exhibited by high-functioning adolescents With autism spectrum disorders and factors related to this anxiety. Results suggest that adolescents With autism spectrum disorders exhibit anxiety levels that are significantly higher than those of the general population. The study found a loW negative correlation betWeen assertive social skills and social anxiety. In addition, a moderate curvilinear relationship Was found betWeen empathic skills and the various social anxiety measures. Results of the study support an emerging body of research demonstrating elevated anxiety levels in high-functioning individuals With autism spectrum disorders.
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This investigation consisted of two studies designed to look at the underlying structure of the Autism Spectrum Disorders-Diagnostic for Children (ASD-DC). Study 1 was a factor analysis of the 40-item informant based scale with 149 children, 2-16years old, who met criteria for an ASD. A four factor solution consisting of social relationships, nonverbal communication/socialization, verbal communication, and restricted interests/insistence on sameness was obtained. For study 2, these 149 children were compared to 125 peers who were either typically developing or had a non-ASD diagnosis on the four factor structure established in study 1. Children with ASD displayed significantly more symptoms on all four factors of the scale. Implications of these data are discussed.
Chapter
The treatment of childhood anxiety disorders is one of the most interest ing and gratifying experiences in clinical psychology. For example, by using techniques such as exposure to feared stimuli, a clinician can regularly effect significant reductions of psychopathology in many youth in as little as a single session for some disorders (e.g., specific phobias; cf., st, Svensson, Hellström,&Lindwall, 2001). Moreover, the clinician is afforded the invigorating oppor tunity to handle and manage various stimuli (e.g., snakes, dogs, and insects) that defy the common treatment session stereotype. Although certainly not all anxiety disorders are so quickly amenable to treatment efforts, there has been something of a renaissance in child anxiety treatment research since the intro duction of evidence-based practices (EBPs) over a decÖade ago and the identifi cation of the first empirically supported treatments (ESTs) for children. Simultaneously, however, this attention and research is overdue and deserved. There is an urgent need to continue child treatment research, particularly with anxiety disorders. Based upon a recent review, it has been estimated that between 2.4% and 23.9% of preadolescent children have anxiety disorders depending on the disorder(s), sample, time period, and methodologies used (Cartwright-Hatton, McNicol,&Doubleday, 2006). Moreover, results of at least one study indicate that by 16 years of age 36.7% of children will meet diagnostic criteria for at least one DSM-IV disorder (i.e., Diagnostic and Statistical Manual of Mental Disorders fourth edition, American Psychiatric Association, 1994), and that 9.9% will meet criteria for an anxiety disorder (Costello, Mustillo, Erkanli, Keeler,&Angold, 2003).
Chapter
According to the Diagnostic and Statistical Manual of Mental Disorders-4th edition (DSM-IV-TR, American Psychiatric Association, 2000) there are more than a dozen anxiety disorders and phobias which can be diagnosed in children. Most of these disorders include a criterion requiring interference in social and academic situations or, as is the case in agoraphobia, interference from embarrassment or the need of a companion (cf. DSM-IV-TR). As a diagnostic group, as well, these disorders are associated with a variety of social difficulties including social withdrawal, shyness, problematic peer relations, parent–child interaction difficulties, skills deficits, and cognitive distortions (Elizabeth et al., 2006; Ollendick & Hirshfeld-Becker, 2002; Rapee & Spence, 2004; Spence, Donovan, & Brechman-Toussaint, 1999). Anxiety disorders also cast a negative stigma upon children with these disorders (Jorm & Wright, 2008).
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Autism spectrum disorders (ASD) in children are a serious and complex set of conditions that researchers have been attempting to quantify for many decades. In addition to the core symptoms of ASD, comorbid psychopathology is often present as well. Despite this fact and despite the many attempts to develop scaling methods for ASD, little has been done to develop tests specific to childhood psychopathology in ASD children. In this study we describe the initial psychometric properties of a new scale designed specifically to fill this assessment need, the Autism Spectrum Disorders-Comorbid for Children (ASD-CC). One-hundred and thirteen children with ASD between the ages of 2 and 16years were assessed in order to determine interrater, test–retest, and internal reliabilities of this new scale. Implications of these promising findings with respect to further development of the ASD-DC are discussed.
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The Autism Spectrum Disorders-Diagnostic for Children (ASD-DC) is a 40-item Likert format scale designed to serve in the diagnosis of children and adolescents from 2 to 16 years of age. The reliability and factor structure of the scale have been established in previous research. Studies 1 and 2 were designed to evaluate the validity of the measure by establishing cut-off scores for 161 participants falling into the categories of typical development, atypical development/psychopathology, and ASD (i.e., autism, PDD-NOS, and Asperger's syndrome), as assessed by a licensed psychologist using ICD-10 and DSM-IV-TR criteria and in conjunction with standardized measures of autism (ADI-R, CARS, or CHAT) and Asperger's syndrome (CAST, GADS, or KADI). In study 3, the accuracy of ASD scores was compared with ICD-10 and DSM-IV-TR criteria for autism, PDD-NOS, and Asperger's syndrome in 219 children. The ASD-DC, which can be administered in 10–15 min proved to be a relatively accurate and valid diagnostic instrument when compared to the diagnostic methods described above. The implications of these data for further development of this scale are discussed.
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A limited number of studies currently exist focusing on comorbid psychopathology of children with autism spectrum disorders (ASDs). Due to the heterogeneity of ASD symptoms, communication deficits, and impairments in intellectual functioning, assessing symptoms of psychopathology is complicated. The Autism Spectrum Disorders-Comorbidity for Children (ASD-CC) is a new measure, incorporated in an extensive assessment battery, designed to assess children with ASD for comorbid psychopathology. Reliability analyses of the ASD-CC have been conducted [Matson, J. L., & Wilkins, J. (2008). Reliability of the Autism Spectrum Disorders-Comorbidity for Children (ASD-CC). Journal of Developmental and Physical Disabilities, 20, 155–165]. The aim of this study was to identify the factor structure of the ASD-CC and evaluate construct validity of the measure by correlating the empirically derived factors with subscales of the Behavioral Assessment System for Children, Version 2 (BASC-2). Results of the analyses included a seven-factor solution. The factors were composed of items consistent with Tantrum Behavior, Repetitive Behavior, Worry/Depressed, Avoidant Behavior, Under-Eating, Over-Eating, and Conduct. Convergence between some factors of the ASD-CC and related subscales was observed as was discrimination between unrelated factors of the two measures. The ASD-CC appears to be a valid measure of comorbid psychopathology in the ASD population.
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Symptoms of psychiatric disorders have been found to co-occur at high rates in those diagnosed with Autistic Disorder (AD). However, to date, no study has yet examined the developmental trajectory of comorbid psychiatric symptoms across the lifespan within the AD population. Therefore, the purpose of this study was to conduct a cross-sectional investigation of symptoms of anxiety across the lifespan, using a sample of individuals diagnosed with AD. This study utilizes a sample with an age range from infancy to adulthood. Endorsement rates of overlapping anxiety symptoms from measures that have been found reliable and valid for the specific purpose of examining psychiatric symptoms within the AD population are utilized for this study. Results indicate that there is a significant difference between different age cohorts on symptom endorsements of anxiety. Additionally, a cubic trend was found when examining the pattern of anxiety symptoms across the lifespan in those diagnosed with AD. That is, anxiety rises from toddlerhood to childhood, decreases from childhood to young adulthood, but again increases from young adulthood into older adulthood. Implications of these findings, limitations of this study, and future directions for research are discussed.
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This paper reports on the prevalence of both anxiety symptoms and DSM-III anxiety disorder diagnoses found in a sample of 600 children presenting to a community speech clinic. The age and sex distribution of the anxiety disordered children is presented, and these findings are compared to those reported in epidemiological studies.
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Anxiety disorders have been found to be highly comorbid with autism spectrum disorders (ASDs). Even so, the identification and dissemination of empirically supported treatments for anxiety in adults or children who have ASD has lagged behind the larger evidence-based trend. This review examines the efficacy of cognitive-behavioral therapy as a treatment for anxiety in children who have an ASD and delineates and summarizes the trends in modifying efficacious cognitive-behavioral therapies for anxiety for use with those having an ASD. Limitations and recommendations for future research toward a standardized treatment model for anxiety in children are discussed.
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A considerable amount of attention has occurred with respect to the diagnosis and treatment of Autism Spectrum Disorders (ASDs) of children and youth. Furthermore, the rationale for using the most restrictive of the applied behavior analysis methods and medication has been largely based on the presence of severe challenging behaviors such as self-injury, aggression, and stereotypes. Despite the extensive treatment efforts, there has not been a scale developed specifically to address the screening and identification of these problem behaviors for children with ASD. The present study was specifically designed to report on the reliability and factor structure of a brief behavior problem inventory, which is part of a diagnostic battery for children suspected of evincing autism, PDD-NOS, or Asperger's syndrome. The initial psychometric properties of the Autism Spectrum Disorders-Behavior Problems for Children (ASD-BPC) are described and the implications for future research are presented.
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Autism Spectrum Disorders (ASD) are a group of conditions characterized by symptoms that onset in early childhood. Deficits in social skills and communication are two of the core features of ASD and, if not remediated, can lead to poor long-term outcomes. Few researchers have examined characteristics of social skills and communication in infants with ASD. The social skills and communicative ability of 886 infants and toddlers 17-37 months of age with autism, PDD-NOS or 'at risk' for other developmental delays were evaluated using the Baby and Infant Screen for Children with aUtIsm Traits (BISCUIT). A Kruskal-Wallis test with follow-up Mann-Whitney tests were used to test for significance. Infants and toddlers with autism, followed by PDD-NOS, had greater social and communication deficits than children 'at risk' for developmental delays. Items which distinguished between these diagnostic groups were determined. Outcomes suggest that social and communication deficits can be identified at early ages in a population of developmentally delayed toddlers. Implications are that pinpointing emerging social and communicative autistic traits earlier will allow for more accurate assessment and diagnosis in infants with ASD. This translates into earlier intervention and more effective treatment practices.
Article
Anxiety and poor stress management are common concerns in clinical samples of children with autism spectrum disorders (ASD). Anxiety may worsen during adolescence, as young people face an increasingly complex social milieu and often become more aware of their differences and interpersonal difficulties. This review summarizes the state of research on the prevalence, phenomenology, and treatment of anxiety in youth with autism and related conditions such as Asperger's Disorder. Using search words autism, asperger(s), or pervasive developmental disorder and anxiety or anxious to find reports published between 1990 and 2008, this review identified 40 papers. The results of the review suggest that anxiety, whether measured categorically or dimensionally, is indeed common in children and adolescents with autism spectrum disorders and may be a source of additional morbidity. The assessment of anxiety disorders in ASD should be conducted using multiple informants and modalities, as children with ASD often do not display age-typical symptoms of anxiety. To date, relatively few controlled intervention studies using well-characterized samples have been conducted despite preliminary evidence for efficacy of select pharmacological and psychosocial approaches. Recommendations for future applied research are presented and clinical implications are explored.
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The behavioral and/or psychiatric symptoms in autistic people as described above have been viewed by many professionals dealing with autistic populations as associated features of autism that may result from these individuals' inability to cope with the environmental demands and physical discomfort. Traditionally, in treating individuals with autism, special education intervention including behavioral modifications has been the main emphasis. Such an approach has made some progress in milder and uncomplicated cases of autism. However, if many of these behavioral and/or psychiatric symptoms in those with more severe associated features can be viewed as symptoms of various comorbid psychiatric disorders, there are data suggesting that with an appropriate evaluation, predrug workups, a specific diagnosis, and multiple measures of outcome, pharmacotherapy can be a safe and efficacious adjunct treatment for some symptoms in autistic persons. Nevertheless, the data presented here were obtained mainly from autistic children. A great deal of work remains to be done Future research should put more emphasis on developing agreeable, reliable, and valid diagnostic instruments for identifying comorbid psychiatric disorders in autistic people. Future research should also emphasize employing a randomized double-blind placebo-controlled crossover design, as well as involving multicenters and using uniformed diagnostic criteria to study autistic adolescents and adults.
Article
To examine the association between early childhood speech and language disorders and young adult psychiatric disorders. In a longitudinal community study conducted in the Ottawa-Carleton region of Ontario, Canada, interviewers administered structured psychiatric interviews to age 19 participants who were originally identified as speech-impaired only, language-impaired, or nonimpaired at age 5. The first stage of the study took place in 1982 when participants were 5 years old, and the latest stage of the study took place between 1995 and 1997 when participants had a mean age of 19 years. This report examines the association between early childhood speech/language status and young adult psychiatric outcome. Children with early language impairment had significantly higher rates of anxiety disorder in young adulthood compared with nonimpaired children. The majority of participants with anxiety disorders had a diagnosis of social phobia. Trends were found toward associations between language impairment and overall and antisocial personality disorder rates. Males from the language-impaired group had significantly higher rates of antisocial personality disorder compared with males from the control group. Age of onset and comorbidity did not differ by speech/language status. The majority of participants with a disorder had more than one. Results support the association between early childhood speech and language functioning and young adult psychiatric disorder over a 14-year period. This association underscores the importance of effective and early interventions.
Article
Little is known about lifetime prevalence or age of onset of DSM-IV disorders. To estimate lifetime prevalence and age-of-onset distributions of DSM-IV disorders in the recently completed National Comorbidity Survey Replication. Nationally representative face-to-face household survey conducted between February 2001 and April 2003 using the fully structured World Health Organization World Mental Health Survey version of the Composite International Diagnostic Interview. Nine thousand two hundred eighty-two English-speaking respondents aged 18 years and older. Lifetime DSM-IV anxiety, mood, impulse-control, and substance use disorders. Lifetime prevalence estimates are as follows: anxiety disorders, 28.8%; mood disorders, 20.8%; impulse-control disorders, 24.8%; substance use disorders, 14.6%; any disorder, 46.4%. Median age of onset is much earlier for anxiety (11 years) and impulse-control (11 years) disorders than for substance use (20 years) and mood (30 years) disorders. Half of all lifetime cases start by age 14 years and three fourths by age 24 years. Later onsets are mostly of comorbid conditions, with estimated lifetime risk of any disorder at age 75 years (50.8%) only slightly higher than observed lifetime prevalence (46.4%). Lifetime prevalence estimates are higher in recent cohorts than in earlier cohorts and have fairly stable intercohort differences across the life course that vary in substantively plausible ways among sociodemographic subgroups. About half of Americans will meet the criteria for a DSM-IV disorder sometime in their life, with first onset usually in childhood or adolescence. Interventions aimed at prevention or early treatment need to focus on youth.
Article
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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Early intervention for autism spectrum disorder (ASD) has proven to be a successful strategy for remediating many difficulties experienced by these children. As a result, accurate diagnoses of children with this range of disorders has become more critical. Additionally, while current training programs are for 3-4 year olds, in efforts to start treatment at younger ages, clinicians are giving these diagnoses at younger and younger ages. A considerable amount of research activity on a technology for making differential diagnoses of ASD has been emerging in recent years. The purpose of this paper is to provide an overview of some of these developments, and to offer opinions on the current status of the area.
Article
Unlabelled: High levels of anxiety can negatively affect the lives of children and adolescents. Thirty-six adolescents who stutter and 36 adolescents who do not stutter were administered standardized scales for anxiety and self-esteem. Significant differences were found for the total T-scores for Revised Children's Manifest Anxiety Scale for the two groups, although both groups mean T-scores were within normal range. Eighty-three percent of adolescents who stutter and 95% of adolescents who do not stutter earned scores in the normal range. No significant differences were found on the self-esteem scale, with 86% of adolescents who stutter and 97% of adolescents who do not stutter earning scores in the normal/positive range. Adolescents who stutter with co-occurring disorders displayed significantly higher levels of anxiety than adolescents who stutter with no co-occurring disorders. No significant differences were found between groups on ethnicity, socioeconomic class, gender and anxiety levels. A positive, significant correlation between anxiety scores and self-esteem scores was found for both groups. Learning outcomes: Readers will learn about and understand (a) the role of anxiety and self-esteem in stuttering; (b) the methods used to evaluate anxiety and self-esteem in adolescents; and (c) the similarities between adolescents who stutter and adolescents who do not stutter on anxiety and self-esteem scales.
PTSD, anxiety, and phobias Treating childhood psychopathology and developmental disorders (pp. 183–220) Anxiety and avoidance in infants and toddlers with autism spectrum disorders: Evidence for differing symptom severity and presentation
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Davis, T. E., III (2009). PTSD, anxiety, and phobias. In J. Matson, F. Andrasik, & M. Matson (Eds.), Treating childhood psychopathology and developmental disorders (pp. 183–220). New York: Springer Science and Business Media, LLC. Davis, T. E., III, Fodstad, J. C., Jenkins, W., Hess, J. A., Moree, B. N., Dempsey, T., et al. (2010). Anxiety and avoidance in infants and toddlers with autism spectrum disorders: Evidence for differing symptom severity and presentation. Research in Autism Spectrum Disorders, 4, 305–313.
Social and communication behaviors in infants and toddlers with autism and pervasive developmental disorder not otherwise specified
  • Matson