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Pemovska T, Loizou S, Appleton R, Spain D, Stefanidou T, Kular A, Cooper R, Greenburgh A, Griffiths J, Barnett P, Foye U, Baldwin H, Minchin M, Brady G, Saunders KRK, Ahmed N, Jackson R, Olive RR, Parker J, Timmerman A, Sapiets S, Driskell E, Chipp B, Parsons B, Totsika V, Mandy W, Pender R, Clery P, Lloyd-Evans B, Simpson A, Johnson S. Approaches to improving mental health care for autistic children and young people: a systematic review and meta-analysis. Psychol Med 2024:1-31. [PMID: 38757186 DOI: 10.1017/s0033291724001089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/18/2024]
Abstract
Autistic children and young people (CYP) experience mental health difficulties but face many barriers to accessing and benefiting from mental health care. There is a need to explore strategies in mental health care for autistic CYP to guide clinical practice and future research and support their mental health needs. Our aim was to identify strategies used to improve mental health care for autistic CYP and examine evidence on their acceptability, feasibility, and effectiveness. A systematic review and meta-analysis were carried out. All study designs reporting acceptability/feasibility outcomes and empirical quantitative studies reporting effectiveness outcomes for strategies tested within mental health care were eligible. We conducted a narrative synthesis and separate meta-analyses by informant (self, parent, and clinician). Fifty-seven papers were included, with most investigating cognitive behavioral therapy (CBT)-based interventions for anxiety and several exploring service-level strategies, such as autism screening tools, clinician training, and adaptations regarding organization of services. Most papers described caregiver involvement in therapy and reported adaptations to communication and intervention content; a few reported environmental adjustments. In the meta-analyses, parent- and clinician-reported outcomes, but not self-reported outcomes, showed with moderate certainty that CBT for anxiety was an effective treatment compared to any comparison condition in reducing anxiety symptoms in autistic individuals. The certainty of evidence for effectiveness, synthesized narratively, ranged from low to moderate. Evidence for feasibility and acceptability tended to be positive. Many identified strategies are simple, reasonable adjustments that can be implemented in services to enhance mental health care for autistic individuals. Notable research gaps persist, however.
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Affiliation(s)
- Tamara Pemovska
- NIHR Mental Health Policy Research Unit, Division of Psychiatry, University College London, London, UK
| | - Sofia Loizou
- NIHR Mental Health Policy Research Unit, King's College London, London, UK
| | - Rebecca Appleton
- NIHR Mental Health Policy Research Unit, Division of Psychiatry, University College London, London, UK
| | | | - Theodora Stefanidou
- NIHR Mental Health Policy Research Unit, Division of Psychiatry, University College London, London, UK
| | - Ariana Kular
- NIHR Mental Health Policy Research Unit, Division of Psychiatry, University College London, London, UK
| | - Ruth Cooper
- NIHR Mental Health Policy Research Unit, King's College London, London, UK
| | - Anna Greenburgh
- NIHR Mental Health Policy Research Unit, Division of Psychiatry, University College London, London, UK
| | - Jessica Griffiths
- NIHR Mental Health Policy Research Unit, King's College London, London, UK
| | - Phoebe Barnett
- NIHR Mental Health Policy Research Unit, Division of Psychiatry, University College London, London, UK
- Centre for Outcomes Research and Effectiveness, Research Department of Clinical, Educational and Health Psychology, University College London, London, UK
- National Collaborating Centre for Mental Health, Royal College of Psychiatrists, London, UK
| | - Una Foye
- NIHR Mental Health Policy Research Unit, King's College London, London, UK
| | - Helen Baldwin
- NIHR Mental Health Policy Research Unit, Division of Psychiatry, University College London, London, UK
| | - Matilda Minchin
- Division of Psychiatry, University College London, London, UK
| | - Gráinne Brady
- Division of Psychiatry, University College London, London, UK
| | | | - Nafiso Ahmed
- NIHR Mental Health Policy Research Unit, Division of Psychiatry, University College London, London, UK
| | - Robin Jackson
- Lancaster and Morecambe Child and Adolescent Mental Health Services, Lancashire and South Cumbria NHS Foundation Trust, Morecambe, UK
- University of Wolverhampton, Wolverhampton, UK
| | - Rachel Rowan Olive
- NIHR Mental Health Policy Research Unit Lived Experience Working Group, Division of Psychiatry, University College London, London, UK
| | - Jennie Parker
- NIHR Mental Health Policy Research Unit Lived Experience Working Group, Division of Psychiatry, University College London, London, UK
- School of Health and Psychological Sciences, City, University of London, London, UK
- Berkshire Healthcare NHS Foundation Trust, Reading, UK
| | - Amanda Timmerman
- Department of Clinical, Educational and Health Psychology, UCL, London, UK
| | - Suzi Sapiets
- Tizard Centre, University of Kent, Canterbury, UK
| | | | - Beverley Chipp
- NIHR Mental Health Policy Research Unit Lived Experience Working Group, Division of Psychiatry, University College London, London, UK
| | | | - Vaso Totsika
- Division of Psychiatry, University College London, London, UK
| | - Will Mandy
- Department of Clinical, Educational and Health Psychology, UCL, London, UK
| | - Richard Pender
- Department of Clinical, Educational and Health Psychology, UCL, London, UK
| | - Philippa Clery
- Division of Psychiatry, University College London, London, UK
- Camden and Islington NHS Foundation Trust, London, UK
| | - Brynmor Lloyd-Evans
- NIHR Mental Health Policy Research Unit, Division of Psychiatry, University College London, London, UK
| | - Alan Simpson
- NIHR Mental Health Policy Research Unit, King's College London, London, UK
| | - Sonia Johnson
- NIHR Mental Health Policy Research Unit, Division of Psychiatry, University College London, London, UK
- Camden and Islington NHS Foundation Trust, London, UK
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Moore HL, Freeston M, Rodgers J, Cassidy S. A Measurement Invariance Analysis of the Anxiety Scale for Autism-Adults in a Sample of Autistic and Non-Autistic Men and Women. J Autism Dev Disord 2024:10.1007/s10803-024-06260-2. [PMID: 38740697 DOI: 10.1007/s10803-024-06260-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/22/2024] [Indexed: 05/16/2024]
Abstract
The Anxiety Scale for Autism-Adults (ASA-A) captures the autistic anxiety experience, but we do not know whether it is structurally equivalent for men and women, or non-autistic people. Measurement invariance analysis considered gender and diagnostic status (342 cis-gender autistic men (N = 105) and women (N = 237), 316 cis-gender non-autistic men (N = 104) and women (N = 212)). Strict invariance was achieved between autistic men and women and between non-autistic men and women, but the ASA-A structure is quantitatively different in autistic compared to non-autistic adults. Therefore, this tool cannot be used to directly compare anxiety between these groups. Autistic women scored significantly higher on the ASA-A than autistic men and Uncertainty was the highest scoring factor for autistic participants. Future research should include alternative gender identities.
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Affiliation(s)
- Heather L Moore
- School of Psychology, Dame Margaret Barbour Building, Wallace Street, Newcastle upon Tyne, NE2 4DR, UK.
| | - Mark Freeston
- School of Psychology, Dame Margaret Barbour Building, Wallace Street, Newcastle upon Tyne, NE2 4DR, UK
| | - Jacqui Rodgers
- Population Health Sciences Institute, Sir James Spence Institute, Newcastle University, Royal Victoria Infirmary, Level 3, Queen Victoria Road, Newcastle upon Tyne, NE1 4LP, UK
| | - Sarah Cassidy
- School of Psychology, University of Nottingham, University Park, Nottingham, NG7 2RD, UK
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Keefer A, Perrin J, Singh V, Holingue C, Winchell S, Vasa RA. A pilot, single-arm feasibility study of an integrated cognitive-behavioral treatment for anxiety in young autistic children. J Pediatr Psychol 2024; 49:131-141. [PMID: 38216125 DOI: 10.1093/jpepsy/jsad093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Revised: 11/22/2023] [Accepted: 11/28/2023] [Indexed: 01/14/2024] Open
Abstract
OBJECTIVE Anxiety is prevalent in young autistic children under 7 years of age. Yet there is a paucity of empirically based interventions for this age group. DINO Strategies for Anxiety and Uncertainty Reduction (DINOSAUR) is an innovative cognitive behavioral intervention that seeks to optimize treatment response in young autistic children by targeting anxiety and the contributing mechanisms of intolerance of uncertainty and parental accommodation using a telehealth delivery model. This pilot, single-arm study examines the preliminary feasibility of DINOSAUR. METHODS Fourteen autistic children ages 4-6 years with average language and cognitive skills and their parents received the intervention. Quantitative and qualitative data pertaining to parent satisfaction and treatment outcomes were collected. RESULTS Attendance, retention, and parent satisfaction ratings offer preliminary support for the feasibility of the treatment model. Change in clinical severity ratings on a semi-structured parent interview of anxiety and parents' qualitative report suggests the potential to benefit young autistic children. CONCLUSIONS Results support future study of the DINOSAUR model in a larger, randomized controlled trial.
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Affiliation(s)
- Amy Keefer
- Center for Autism and Related Disorders, Kennedy Krieger Institute, Baltimore, United States
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University, Baltimore, United States
| | - Jeremy Perrin
- Center for Autism and Related Disorders, Kennedy Krieger Institute, Baltimore, United States
| | - Vini Singh
- Center for Autism and Related Disorders, Kennedy Krieger Institute, Baltimore, United States
| | - Calliope Holingue
- Center for Autism and Related Disorders, Kennedy Krieger Institute, Baltimore, United States
- Bloomberg School of Public Health, Johns Hopkins University, Baltimore, United States
| | - Sarah Winchell
- Center for Autism and Related Disorders, Kennedy Krieger Institute, Baltimore, United States
| | - Roma A Vasa
- Center for Autism and Related Disorders, Kennedy Krieger Institute, Baltimore, United States
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University, Baltimore, United States
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4
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Keefer A, Singh V, Jang YS, Alon L, Surmacz M, Holingue C, Mostofsky SH, Vasa RA. Exploring the Symptom Profiles of Intolerance of Uncertainty in Autistic Children. J Autism Dev Disord 2024; 54:121-130. [PMID: 36227445 PMCID: PMC10097837 DOI: 10.1007/s10803-022-05744-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/02/2022] [Indexed: 02/06/2023]
Abstract
Intolerance of uncertainty (IU) is a multidimensional construct involving maladaptive responses to uncertainty. IU is strongly associated with autism and anxiety, yet no studies have examined its symptom profile in autistic children. This study compares IU symptom profiles in autistic and NT children and in autistic children with and without anxiety using the Intolerance of Uncertainty Scale for Children. Compared to NT peers, autistic children exhibited heightened IU symptoms in all domains, affective, behavioral, and cognitive; affective symptoms had the highest association with autism. Autistic children with anxiety also exhibited elevated IU symptoms in all domains compared to those without anxiety; behavioral IU symptoms had the highest association with anxiety. IU symptom profiles should be considered in assessment and treatment.
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Affiliation(s)
- Amy Keefer
- Kennedy Krieger Institute, Center for Autism and Related Disorders, Baltimore, MD, US.
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, US.
| | - Vini Singh
- Kennedy Krieger Institute, Center for Autism and Related Disorders, Baltimore, MD, US
| | - Yeon Sik Jang
- Psychology Department, Georgetown University, Washington, DC, US
| | - Leigh Alon
- Psychology Department, Georgetown University, Washington, DC, US
| | - Madison Surmacz
- Johns Hopkins University School of Medicine, Baltimore, MD, US
| | - Calliope Holingue
- Kennedy Krieger Institute, Center for Autism and Related Disorders, Baltimore, MD, US
| | - Stewart H Mostofsky
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, US
- Center for Neurodevelopmental and Imaging Research, Kennedy Krieger Institute, Baltimore, MD, US
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, US
| | - Roma A Vasa
- Kennedy Krieger Institute, Center for Autism and Related Disorders, Baltimore, MD, US
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, US
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Powell HJ, He JL, Khalil N, Wodka EL, DeRonda A, Edden RAE, Vasa RA, Mostofsky SH, Puts NA. Perceptual alterations in the relationship between sensory reactivity, intolerance of uncertainty, and anxiety in autistic children with and without ADHD. Dev Psychopathol 2023:1-13. [PMID: 37990408 DOI: 10.1017/s0954579423001360] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2023]
Abstract
Sensory differences and anxiety disorders are highly prevalent in autistic individuals with and without ADHD. Studies have shown that sensory differences and anxiety are associated and that intolerance of uncertainty (IU) plays an important role in this relationship. However, it is unclear as to how different levels of the sensory processing pathway (i.e., perceptual, affective, or behavioral) contribute. Here, we used psychophysics to assess how alterations in tactile perception contribute to questionnaire measures of sensory reactivity, IU, and anxiety. Thirty-eight autistic children (aged 8-12 years; 27 with co-occurring ADHD) were included. Consistent with previous findings, mediation analyses showed that child-reported IU fully mediated an association between parent-reported sensory reactivity and parent-reported anxiety and that anxiety partially mediated an association between sensory reactivity and IU. Of the vibrotactile thresholds, only simultaneous frequency discrimination (SFD) thresholds correlated with sensory reactivity. Interestingly, we found that sensory reactivity fully mediated an association between SFD threshold and anxiety, and between SFD threshold and IU. Taken together, those findings suggest a mechanistic pathway whereby tactile perceptual alterations contribute to sensory reactivity at the affective level, leading in turn to increased IU and anxiety. This stepwise association can inform potential interventions for IU and anxiety in autism.
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Affiliation(s)
- Helen J Powell
- Department of Forensic and Neurodevelopmental Sciences, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, UK
| | - Jason L He
- Department of Forensic and Neurodevelopmental Sciences, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, UK
| | - Nermin Khalil
- Department of Forensic and Neurodevelopmental Sciences, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, UK
| | - Ericka L Wodka
- Center for Autism and Related Disorders, Kennedy Krieger Institute, Baltimore, MD, USA
- Department of Psychiatry and Behavioural Sciences, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Alyssa DeRonda
- Center for Neurodevelopmental and Imaging Research, Kennedy Krieger Institute, Baltimore, MD, USA
| | - Richard A E Edden
- Department of Radiology and Radiological Science, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
- F.M. Kirby Research Center for Functional Brain Imaging, Kennedy Krieger Institute, Baltimore, MD, USA
| | - Roma A Vasa
- Center for Autism and Related Disorders, Kennedy Krieger Institute, Baltimore, MD, USA
- Department of Psychiatry and Behavioural Sciences, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Stewart H Mostofsky
- Department of Psychiatry and Behavioural Sciences, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Center for Neurodevelopmental and Imaging Research, Kennedy Krieger Institute, Baltimore, MD, USA
- Department of Neurology, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Nicolaas A Puts
- Department of Forensic and Neurodevelopmental Sciences, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, UK
- MRC Centre for Neurodevelopmental Disorders, King's College London, London, UK
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6
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Baribeau DA, Vigod SN, Pullenayegum E, Kerns CM, Vaillancourt T, Duku E, Smith IM, Volden J, Zwaigenbaum L, Bennett T, Elsabbagh M, Zaidman-Zait A, Richard AE, Szatmari P. Developmental cascades between insistence on sameness behaviour and anxiety symptoms in autism spectrum disorder. Eur Child Adolesc Psychiatry 2023; 32:2109-2118. [PMID: 35871413 DOI: 10.1007/s00787-022-02049-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Accepted: 07/06/2022] [Indexed: 12/28/2022]
Abstract
Autistic children experience high rates of anxiety. Insistence on sameness behaviour (IS) is a core feature of autism that appears correlated with anxiety severity. The objective of this study was to examine the longitudinal relations between anxiety and IS in autistic children using a developmental cascade model. A longitudinal cohort of 421 autistic children was followed between 4 and 11 years of age. Anxiety was quantified using items from the Anxiety Problems subscale of the Child Behavior Checklist; sameness behaviours were measured using the Repetitive Behavior Scale-Revised, Ritualistic/sameness subscale (both parent-report measures). Structural equation modelling was used to examine the longitudinal and directional associations between anxiety and IS at four time-points, through cross-lagged panel models (CLPM) with and without a random-intercepts component (RI-CLPM). Both the CLPM and the RI-CLPM had good fit. Significant directional associations were detected whereby elevated or increasing IS preceded elevated or increasing anxiety symptoms 1-2 years later, respectively. Stable baseline tendencies towards anxiety and IS as between-person traits (intercepts) were strongly associated (standardized estimate = 0.69, p < 0.001). The magnitude of the cross-sectional associations between anxiety and IS appeared to lessen with age. IS and anxiety symptoms in autism are closely related. They appear to be shared traits that mirror each other particularly in younger children. Increasing IS may be a sign of emerging future anxiety. Interventions that target IS to reduce or prevent anxiety amongst school-aged autistic children merit further study.
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Affiliation(s)
- Danielle A Baribeau
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada.
- The Hospital for Sick Children, Toronto, ON, Canada.
- The Hospital for Sick Children, University of Toronto, 123 Edward Street, 12th floor, Room 1210, Toronto, ON, M5G 1E2, Canada.
- Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, Toronto, Canada.
| | - Simone N Vigod
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
- Department of Psychiatry, Women's College Hospital and Women's College Research Institute, Toronto, ON, Canada
| | - Eleanor Pullenayegum
- The Hospital for Sick Children, Toronto, ON, Canada
- Child Health Evaluative Sciences, The Hospital for Sick Children Research Institute, Toronto, ON, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Connor M Kerns
- Department of Psychology, University of British Columbia, Vancouver, Canada
| | - Tracy Vaillancourt
- Counselling Psychology, Faculty of Education, University of Ottawa, Ottawa, ON, Canada
| | - Eric Duku
- Offord Centre for Child Studies, Hamilton, ON, Canada
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON, Canada
| | - Isabel M Smith
- Department of Pediatrics, Dalhousie University, Halifax, NS, Canada
- Autism Research Centre, IWK Health Centre, Halifax, NS, Canada
| | - Joanne Volden
- Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, Canada
| | | | - Teresa Bennett
- Offord Centre for Child Studies, Hamilton, ON, Canada
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON, Canada
| | - Mayada Elsabbagh
- Montreal Neurological Institute, McGill University, Montreal, QC, Canada
| | - Anat Zaidman-Zait
- Department of School Counseling and Special Education at the Constantiner School of Education, Tel Aviv University, Tel Aviv, Israel
- The School of Population and Public Health, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Annie E Richard
- Autism Research Centre, IWK Health Centre, Halifax, NS, Canada
| | - Peter Szatmari
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
- The Hospital for Sick Children, Toronto, ON, Canada
- Centre for Addiction and Mental Health, Toronto, ON, Canada
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7
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Vasa RA, Kerns CM, Singh V, McDonald R, Jang YS, Keefer A. Anxiety in autistic preschool children: Phenomenology and a network analysis of correlates. Autism Res 2023; 16:1561-1572. [PMID: 37350221 DOI: 10.1002/aur.2968] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Accepted: 06/03/2023] [Indexed: 06/24/2023]
Abstract
Anxiety disorders in autistic children are associated with significant functional impairment. Few studies have examined impairing anxiety presentations in autistic preschool children (i.e., 3-5 years old). This cross-sectional study examined the phenomenology of impairing anxiety and the strongest correlates of anxiety in 75 autistic preschool children. Parents completed a diagnostic interview that assesses two anxiety types, DSM-5 anxiety disorders and impairing distinct anxiety presentations, and measures of anxiety correlates. An exploratory network analysis examined connections between anxiety and its correlates. Forty percent of children had impairing anxiety. Specific phobia followed by 'other social fear,' a type of distinct anxiety, were the most common anxiety types. Child intolerance of uncertainty (IU) was the only correlate that was associated with anxiety in a network analysis framework. Child IU linked anxiety to two other correlates, sensory over-responsivity and somatic symptoms. Findings emphasize the need for early intervention for anxiety and further research on its correlates.
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Affiliation(s)
- Roma A Vasa
- Center for Autism and Related Disorders, Kennedy Krieger Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Connor M Kerns
- Department of Psychology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Vini Singh
- Center for Autism and Related Disorders, Kennedy Krieger Institute, Baltimore, Maryland, USA
| | - Rachel McDonald
- Department of Psychology, Montclair State University, Montclair, New Jersey, USA
| | - Yeon Sik Jang
- Department of Psychology, Georgetown University, Washington D.C, USA
| | - Amy Keefer
- Center for Autism and Related Disorders, Kennedy Krieger Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
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8
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Smits JAJ, Monfils MH, Otto MW, Telch MJ, Shumake J, Feinstein JS, Khalsa SS, Cobb AR, Parsons EM, Long LJ, McSpadden B, Johnson D, Greenberg A. CO 2 reactivity as a biomarker of exposure-based therapy non-response: study protocol. BMC Psychiatry 2022; 22:831. [PMID: 36575425 PMCID: PMC9793569 DOI: 10.1186/s12888-022-04478-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Accepted: 12/15/2022] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Exposure-based therapy is an effective first-line treatment for anxiety-, obsessive-compulsive, and trauma- and stressor-related disorders; however, many patients do not improve, resulting in prolonged suffering and poorly used resources. Basic research on fear extinction may inform the development of a biomarker for the selection of exposure-based therapy. Growing evidence links orexin system activity to deficits in fear extinction and we have demonstrated that reactivity to an inhaled carbon dioxide (CO2) challenge-a safe, affordable, and easy-to-implement procedure-can serve as a proxy for orexin system activity and predicts fear extinction deficits in rodents. Building upon this basic research, the goal for the proposed study is to validate CO2 reactivity as a biomarker of exposure-based therapy non-response. METHODS We will assess CO2 reactivity in 600 adults meeting criteria for one or more fear- or anxiety-related disorders prior to providing open exposure-based therapy. By incorporating CO2 reactivity into a multivariate model predicting treatment non-response that also includes reactivity to hyperventilation as well as a number of related predictor variables, we will establish the mechanistic specificity and the additive predictive utility of the potential CO2 reactivity biomarker. By developing models independently within two study sites (University of Texas at Austin and Boston University) and predicting the other site's data, we will validate that the results are likely to generalize to future clinical samples. DISCUSSION Representing a necessary stage in translating basic research, this investigation addresses an important public health issue by testing an accessible clinical assessment strategy that may lead to a more effective treatment selection (personalized medicine) for patients with anxiety- and fear-related disorders, and enhanced understanding of the mechanisms governing exposure-based therapy. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT05467683 (20/07/2022).
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Affiliation(s)
- Jasper A. J. Smits
- grid.89336.370000 0004 1936 9924Department of Psychology and Institute for Mental Health Research, University of Texas at Austin, 1 University Station, Austin, TX 78712 USA
| | - Marie-H. Monfils
- grid.89336.370000 0004 1936 9924Department of Psychology and Institute for Mental Health Research, University of Texas at Austin, 1 University Station, Austin, TX 78712 USA
| | - Michael W. Otto
- grid.189504.10000 0004 1936 7558Department of Psychological and Brain Sciences, Boston University, 900 Commonwealth Avenue, Floor 2, Boston, MA 02215 USA
| | - Michael J. Telch
- grid.89336.370000 0004 1936 9924Department of Psychology and Institute for Mental Health Research, University of Texas at Austin, 1 University Station, Austin, TX 78712 USA
| | - Jason Shumake
- grid.89336.370000 0004 1936 9924Department of Psychology and Institute for Mental Health Research, University of Texas at Austin, 1 University Station, Austin, TX 78712 USA
| | - Justin S. Feinstein
- grid.417423.70000 0004 0512 88633The Laureate Institute for Brain Research, 6655 South Yale Ave., Tulsa, Oklahoma 74136 USA
| | - Sahib S. Khalsa
- grid.417423.70000 0004 0512 88633The Laureate Institute for Brain Research, 6655 South Yale Ave., Tulsa, Oklahoma 74136 USA
| | - Adam R. Cobb
- grid.89336.370000 0004 1936 9924Department of Psychology and Institute for Mental Health Research, University of Texas at Austin, 1 University Station, Austin, TX 78712 USA ,grid.259828.c0000 0001 2189 3475Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina and Ralph H. Johnson VAHCS, 67 President Street MSC 862, Charleston, SC 29425 USA
| | - E. Marie Parsons
- grid.189504.10000 0004 1936 7558Department of Psychological and Brain Sciences, Boston University, 900 Commonwealth Avenue, Floor 2, Boston, MA 02215 USA
| | - Laura J. Long
- grid.189504.10000 0004 1936 7558Department of Psychological and Brain Sciences, Boston University, 900 Commonwealth Avenue, Floor 2, Boston, MA 02215 USA
| | - Bryan McSpadden
- grid.89336.370000 0004 1936 9924Department of Psychology and Institute for Mental Health Research, University of Texas at Austin, 1 University Station, Austin, TX 78712 USA
| | - David Johnson
- grid.89336.370000 0004 1936 9924Department of Psychology and Institute for Mental Health Research, University of Texas at Austin, 1 University Station, Austin, TX 78712 USA
| | - Alma Greenberg
- grid.189504.10000 0004 1936 7558Department of Psychological and Brain Sciences, Boston University, 900 Commonwealth Avenue, Floor 2, Boston, MA 02215 USA
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9
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Interventions for Sensory Over-Responsivity in Individuals with Autism Spectrum Disorder: A Narrative Review. CHILDREN (BASEL, SWITZERLAND) 2022; 9:children9101584. [PMID: 36291519 PMCID: PMC9601143 DOI: 10.3390/children9101584] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Revised: 10/15/2022] [Accepted: 10/17/2022] [Indexed: 11/05/2022]
Abstract
Individuals with autism spectrum disorder (ASD) often exhibit sensory over-responsivity (SOR), which is characterized by an overwhelmingly negative reaction to or avoidance of sensory stimulation. Despite the detrimental effects of SOR on people’s personal and social lives, the knowledge of and interventions for the issue remain limited. This paper collates and reviews studies on SOR and information on the potential for effective interventions for people with ASD. This review reveals evidence that SOR has a close relationship with anxiety, depression, insomnia, and family life impairment and an underlying mechanism related to SOR. Four interventions and their theoretical bases in sensory-motor processing are discussed in this paper, namely, physical activity (PA), sensory integration therapy (SIT), mindfulness-based cognitive therapy (MBCT), and cognitive behavioral therapy (CBT). These interventions focus on establishing coping strategies for regulating the emotional response to sensory information, and they have been found to be effective and to have the potential to help children with ASD reduce their SOR behaviors. This paper provides guidance for selecting appropriate interventions and for further investigation of more effective interventions in the future.
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10
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Vagus Nerve Stimulation as a Treatment for Fear and Anxiety in Individuals with Autism Spectrum Disorder. JOURNAL OF PSYCHIATRY AND BRAIN SCIENCE 2022; 7. [PMID: 36303861 PMCID: PMC9600938 DOI: 10.20900/jpbs.20220007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Anxiety disorders affect a large percentage of individuals who have an autism spectrum disorder (ASD). In children with ASD, excessive anxiety is also linked to gastrointestinal problems, self-injurious behaviors, and depressive symptoms. Exposure-based cognitive behavioral therapies are effective treatments for anxiety disorders in children with ASD, but high relapse rates indicate the need for additional treatment strategies. This perspective discusses evidence from preclinical research, which indicates that vagus nerve stimulation (VNS) paired with exposure to fear-provoking stimuli and situations could offer benefits as an adjuvant treatment for anxiety disorders that coexist with ASD. Vagus nerve stimulation is approved for use in the treatment of epilepsy, depression, and more recently as an adjuvant in rehabilitative training following stroke. In preclinical models, VNS shows promise in simultaneously enhancing consolidation of extinction memories and reducing anxiety. In this review, we will present potential mechanisms by which VNS could treat fear and anxiety in ASD. We also discuss potential uses of VNS to treat depression and epilepsy in the context of ASD, and noninvasive methods to stimulate the vagus nerve.
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11
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Normansell-Mossa KM, Top DN, Russell N, Freeston M, Rodgers J, South M. Sensory Sensitivity and Intolerance of Uncertainty Influence Anxiety in Autistic Adults. Front Psychol 2021; 12:731753. [PMID: 34867612 PMCID: PMC8635111 DOI: 10.3389/fpsyg.2021.731753] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Accepted: 10/15/2021] [Indexed: 01/02/2023] Open
Abstract
Several models of anxiety in autistic adults have focused on the role of intolerance of uncertainty which has biological and evolutionary bases, as a cognitive explanation for the high prevalence of anxiety in autism. This framework suggests that all people are born with a healthy level of intolerance of uncertainty, and as we develop, this intolerance is lessened as we learn when situations are safe and begin to understand and manage the uncertainty. This process of learning about managing uncertainty does not happen in the same way in those who are high in autistic traits, which could be the reason for the high levels of anxiety symptoms commonly seen in this population. We examined archival data of 199 non-autistic and 55 autistic adults from prior studies in which we collected self-report measures of autistic traits, intolerance of uncertainty, sensory processing, and anxiety. We conducted two path analyses to examine the role of intolerance of uncertainty in anxiety in autistic adults. The first model tested the idea that intolerance of uncertainty, an evolutionary phenomenon common for all people, could explain some of the cognitive aspects of anxiety in autism. The second model suggests that primary neurodevelopmental differences associated with autistic traits underlie the sensory sensitivity and sensory seeking behaviors, which in turn increase intolerance of uncertainty and subsequent anxiety. We found that the “neurodevelopmental” model had better model fit than the “evolutionary stress” model, suggesting that the neurodevelopmental impact of higher levels of autistic traits could moderate a non-autistic trajectory of learning to manage uncertainty as children develop and understand that uncertainty is common and acceptable.
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Affiliation(s)
| | - D Nicholas Top
- Student Health Services, Utah Valley University, Orem, UT, United States
| | - Nicholas Russell
- Department of Psychology, Brigham Young University, Provo, UT, United States
| | - Mark Freeston
- School of Psychology, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Jacqui Rodgers
- Population Health Sciences Institute, Sir James Spence Institute, Newcastle upon Tyne, United Kingdom
| | - Mikle South
- Department of Psychology, Brigham Young University, Provo, UT, United States.,Neuroscience Center, Brigham Young University, Provo, UT, United States
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12
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Keefer A, Vasa RA. DINOSAUR: an integrated cognitive-behavioral treatment for anxiety in young children with ASD. J Neurodev Disord 2021; 13:46. [PMID: 34635048 PMCID: PMC8504090 DOI: 10.1186/s11689-021-09396-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Accepted: 09/22/2021] [Indexed: 12/28/2022] Open
Abstract
Background Anxiety disorders are highly prevalent in children and adolescents with autism spectrum disorder and often emerge before the age of 6 years. Yet, only a few studies have examined anxiety treatment for this group. Preliminary evidence from these studies suggests that utilizing cognitive behavioral therapy (CBT) as well as strategies to target intolerance of uncertainty (IU) and parental accommodation, known mechanistic and maintaining factors of anxiety may improve anxiety and optimize outcomes in this age group. Main body To meet this need, we developed an integrated treatment called DINO Strategies for Anxiety and intolerance of Uncertainty Reduction (DINOSAUR), a 12-week group telehealth treatment for 4- to 6-year-old children with ASD. DINOSAUR works with young children and their parents to deliver CBT along with interventions targeting IU and parental accommodation. In this paper, we first discuss the rationale for developing this treatment and then describe a pilot study of its feasibility and preliminary efficacy. Conclusions There is a great need to develop anxiety treatments for young children with ASD. We proposed a novel integrated treatment approach that aims to alter the way young children and parents respond to fear, which could potentially improve short- and long-term mental health outcomes for this age group. Trial registration ClinicalTrials.govNCT04432077 on June 03, 2020
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Affiliation(s)
- Amy Keefer
- Center for Autism and Related Disorders, Kennedy Krieger Institute, Baltimore, USA. .,Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, USA.
| | - Roma A Vasa
- Center for Autism and Related Disorders, Kennedy Krieger Institute, Baltimore, USA.,Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, USA
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13
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Dickson KS, Lind T, Jobin A, Kinnear M, Lok H, Brookman-Frazee L. A Systematic Review of Mental Health Interventions for ASD: Characterizing Interventions, Intervention Adaptations, and Implementation Outcomes. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2021; 48:857-883. [PMID: 33884535 PMCID: PMC8411365 DOI: 10.1007/s10488-021-01133-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/07/2021] [Indexed: 11/29/2022]
Abstract
Youth with autism spectrum disorder (ASD) have high rates of co-occurring mental health needs that necessitate mental health interventions. Given the unique clinical characteristics of youth with ASD, there have been significant efforts to adapt and test mental health interventions for this population. Yet, characterization of the nature and types of interventions adaptations is limited, especially across the wide range of interventions tested for youth with ASD with a focus on implementation factors. Additionally, understanding how these interventions may be implemented in community services is limited. The aims of this systematic review are to characterize the (1) types of interventions tested for co-occurring mental health conditions for youth with ASD; (2) adaptations to mental health interventions for use with youth with ASD; and (3) implementation strategies, outcomes, and determinants of mental health interventions to inform their translation to community service settings. Eighty-three articles testing interventions targeting mental health symptoms in youth with ASD that included implementation factors in analyses were reviewed. The Stirman et al. (2013; 2019) FRAME adaptation, Powell et al. (2012;2015) implementation strategies, and Proctor et al. (2011) implementation outcomes taxonomies were applied to characterize the nature and types of adaptations for use with youth with ASD and types of implementation strategies, outcomes, and determinants used, when available, respectively. Of the interventions examined, the majority (64.1%) were originally designed to target youth mental health concerns and were then adapted to be used with ASD. The most common adaptations included those to the intervention content, particularly adding elements with tailoring or refining aspects of the intervention while maintaining core functions. Half of the articles described at least one implementation strategy used during intervention testing. Fidelity and acceptability were the most frequently examined implementation outcomes, with some examination of appropriateness and feasibility. Nineteen percent of articles described implementation determinants (i.e. barriers/facilitators) of these implementation outcomes. The common adaptations for ASD provide direction for future intervention development and for training community therapists. Further examination, specification, and reporting of implementation strategies and outcomes within ongoing efforts to adapt and interventions to meet the co-occurring mental health needs of youth ASD are needed to facilitate their translation to community settings. Areas for future research as well as clinical implications are discussed.
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Affiliation(s)
- Kelsey S Dickson
- San Diego State University, San Diego, USA.
- Child and Adolescent Services Research Center, San Diego, CA, USA.
| | - Teresa Lind
- Child and Adolescent Services Research Center, San Diego, CA, USA
- University of California, San Diego, USA
| | - Allison Jobin
- University of California, San Diego, USA
- California State University, San Marcos, USA
| | | | - Ho Lok
- San Diego State University, San Diego, USA
- Child and Adolescent Services Research Center, San Diego, CA, USA
| | - Lauren Brookman-Frazee
- Child and Adolescent Services Research Center, San Diego, CA, USA
- University of California, San Diego, USA
- Rady Children's Hospital-San Diego, San Diego, USA
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14
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Dickson KS, Lind T, Jobin A, Kinnear M, Lok H, Brookman-Frazee L. Correction to: A Systematic Review of Mental Health Interventions for ASD: Characterizing Interventions, Intervention Adaptations, and Implementation Outcomes. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2021; 48:884-908. [PMID: 34196884 DOI: 10.1007/s10488-021-01144-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Due to the errors occurred in the originally published version, this article is being reprinted in its entirety as Correction. All errors have been corrected. It is the correct version.
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Affiliation(s)
- Kelsey S Dickson
- San Diego State University, San Diego, USA.
- Child and Adolescent Services Research Center, San Diego, CA, USA.
| | - Teresa Lind
- San Diego State University, San Diego, USA
- Child and Adolescent Services Research Center, San Diego, CA, USA
- University of California, San Diego, USA
| | - Allison Jobin
- Child and Adolescent Services Research Center, San Diego, CA, USA
- University of California, San Diego, USA
- California State University, San Marcos, USA
| | | | - Ho Lok
- San Diego State University, San Diego, USA
- Child and Adolescent Services Research Center, San Diego, CA, USA
| | - Lauren Brookman-Frazee
- Child and Adolescent Services Research Center, San Diego, CA, USA
- University of California, San Diego, USA
- Rady Children's Hospital-San Diego, San Diego, USA
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15
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South M, Hanley M, Normansell-Mossa K, Russell NCC, Cawthorne T, Riby DM. "Intolerance of uncertainty" mediates the relationship between social profile and anxiety in both Williams syndrome and autism. Autism Res 2021; 14:1986-1995. [PMID: 34110083 DOI: 10.1002/aur.2554] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Revised: 03/16/2021] [Accepted: 05/18/2021] [Indexed: 12/28/2022]
Abstract
Anxiety is the most significant mental health concern for both Williams syndrome (WS) and autism. Whilst WS and autism are characterized by some syndrome-specific social differences, less is known about cross-syndrome profiles of anxiety symptoms. Previous research has shown that Intolerance of Uncertainty (IU) is a core mechanism of anxiety maintenance for clinically anxious populations and for autistic children, adolescents, and adults. The only published study in this area for WS has shown some similar patterns-with an added emphasis on the role of sensory sensitivities-in a sample of older teens and adults (mean age = 24), with the authors highlighting the need for younger samples to consider developmental influences. Here we report a cross-syndrome, cross-sectional mediation analyses of children diagnosed with WS or autism, including data from parent surveys of 90 children with WS (n = 48) or autism (n = 42). Group differences showed higher trait levels on all measures for the autism group. Importantly, the relationship between social profile and anxiety was fully mediated by IU level for both groups. This suggests possible similar core mechanisms underlying anxiety in these conditions, and the possibility of generalized intervention approaches especially related to managing distress related to uncertainty in multiple contexts. LAY SUMMARY: Autism and Williams Syndrome share some similarities in social profile and also in anxiety traits, but there are also some key differences as well. Comparing them side-by-side at the same time improved identification of ways to reduce feelings of anxiety. We found that the intolerance of uncertainty affected the relationship between social profile and anxiety in the same way for young children diagnosed with autism or Williams syndrome, meaning that intervention approaches could be similar for both.
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Affiliation(s)
- Mikle South
- Department of Psychology, Brigham Young University, Provo, Utah, USA.,Neuroscience Center, Brigham Young University, Provo, Utah, USA.,Centre for Developmental Disorders, Durham University, Durham, UK
| | - Mary Hanley
- Centre for Developmental Disorders, Durham University, Durham, UK.,Department of Psychology, Durham University, Durham, UK
| | | | | | | | - Deborah M Riby
- Centre for Developmental Disorders, Durham University, Durham, UK.,Department of Psychology, Durham University, Durham, UK
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16
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Ozsivadjian A, Hollocks MJ, Magiati I, Happé F, Baird G, Absoud M. Is cognitive inflexibility a missing link? The role of cognitive inflexibility, alexithymia and intolerance of uncertainty in externalising and internalising behaviours in young people with autism spectrum disorder. J Child Psychol Psychiatry 2021; 62:715-724. [PMID: 32827150 DOI: 10.1111/jcpp.13295] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/12/2020] [Indexed: 12/28/2022]
Abstract
BACKGROUND Internalising (anxiety and low mood) and externalising (aggressive or outburst behaviours, and irritability) difficulties are very common in autism spectrum disorder (ASD) across the life span, relatively stable over time and often associated with poorer quality of life. Understanding the cognitive mechanisms underlying internalising and externalising difficulties in ASD is essential for developing targeted supports and interventions. In the present study, we investigated established and less-researched cognitive factors hypothesised to contribute to internalising and/or externalising difficulties in ASD, namely cognitive inflexibility (CI), intolerance of uncertainty (IU) and alexithymia. Based on previous models and clinical experience, we hypothesised that IU would lead to internalising symptoms, with alexithymia contributing to this pathway, and that CI would have a direct effect on externalising behaviours and may indirectly contribute to internalising symptoms via increasing IU. METHODS Our sample consisted of 95 5- to 18-year-olds presenting to a specialist neurodevelopmental clinic and receiving a diagnosis of ASD. Parents/caregivers completed questionnaires assessing ASD symptomatology, internalising and externalising difficulties, CI, IU and alexithymia. Structural equation modelling was used to examine the hypothesised pathways and relationships between the main variables of interest. RESULTS Cognitive Inflexibility played a significant direct role in the pathway from ASD symptoms to externalising symptoms in ASD, and indirect role via IU in the pathway to internalising problems. Relationships between alexithymia and both internalising and externalising symptoms were weaker, with alexithymia predicting internalising difficulties via IU only. CONCLUSIONS The finding of a direct pathway from CI to externalising behaviours is novel, as is the indirect role of CI in internalising symptomatology. Of the three cognitive mechanisms examined, only CI significantly predicted externalising symptoms. Possible implications for interventions and supports targeting these cognitive processes in ASD are discussed.
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Affiliation(s)
- Ann Ozsivadjian
- Evelina London Children's Hospital, Guy's & St Thomas' NHS Foundation Trust, London, UK
| | - Matthew J Hollocks
- Department of Child & Adolescent Psychiatry, Institute of Psychology, Psychiatry, and Neuroscience, King's College London, London, UK
| | - Iliana Magiati
- School of Psychological Science, University of Western Australia (UWA), Crawley, WA, Australia
| | - Francesca Happé
- Social, Genetic and Developmental Psychiatry Centre, Institute of Psychology, Psychiatry, and Neuroscience, King's College London, London, UK
| | - Gillian Baird
- Newcomen Centre, Evelina London Children's Hospital, Guy's & St Thomas' NHS Foundation Trust, London, UK
| | - Michael Absoud
- Newcomen Centre, Evelina London Children's Hospital, Guy's & St Thomas' NHS Foundation Trust, London, UK.,Department of Women and Children's Health, School of Life Course Sciences, Faculty of Life Sciences and Medicine, King's College London, London, UK
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17
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Stark E, Stacey J, Mandy W, Kringelbach ML, Happé F. Autistic Cognition: Charting Routes to Anxiety. Trends Cogn Sci 2021; 25:571-581. [PMID: 33958281 DOI: 10.1016/j.tics.2021.03.014] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Revised: 03/25/2021] [Accepted: 03/26/2021] [Indexed: 12/28/2022]
Abstract
Autism Spectrum Conditions are typified by a divergence in cognitive style from that of the non-autistic population. Cognitive differences in autism may underlie significant strengths, but also increase vulnerability to psychopathology such as anxiety, which is a major problem for many autistic people. Many autistic people also do not respond to typical psychotherapeutic interventions, suggesting that autism-specific models and interventions are needed. We advance a theoretical model explaining how three constructs, attenuated predictions, intolerance of uncertainty, and 'black and white thinking', may interact to lead to anxiety in autism. We hope to start a dialogue surrounding how we can best address specific autistic cognitive differences that may lead to distress by developing appropriate models, measurements, and psychotherapeutic interventions.
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Affiliation(s)
- Eloise Stark
- Department of Psychiatry, University of Oxford, Oxford, UK; Oxford Health National Health Service (NHS) Foundation Trust, Warneford Hospital, Oxford, UK.
| | - James Stacey
- Oxford Health National Health Service (NHS) Foundation Trust, Warneford Hospital, Oxford, UK
| | - Will Mandy
- Research Department of Clinical, Educational, and Health Psychology, University College London, 1-19 Torrington Place, London, UK
| | - Morten L Kringelbach
- Department of Psychiatry, University of Oxford, Oxford, UK; Center for Music in the Brain, Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Francesca Happé
- Social, Genetic, and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, UK
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18
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Storch EA, Wood JJ, Guzick AG, Small BJ, Kerns CM, Ordaz DL, Schneider SC, Kendall PC. Moderators of Response to Personalized and Standard Care Cognitive-Behavioral Therapy for Youth with Autism Spectrum Disorder and Comorbid Anxiety. J Autism Dev Disord 2021; 52:950-958. [PMID: 33826038 DOI: 10.1007/s10803-021-05000-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/31/2021] [Indexed: 10/21/2022]
Abstract
Anxiety/obsessive-compulsive disorders are common among youth with autism spectrum disorder (ASD). Two versions of cognitive behavior therapy (CBT) are effective, with some advantage for a personalized, adapted version. This study evaluated predictors and moderators of standard CBT and adapted CBT. Youth (N = 167) ages 7-13 were randomized to standard or adapted CBT, or treatment-as-usual. Age, IQ, ASD severity, and emotional-behavioral symptom severity were examined. More severe internalizing and emotional-behavioral problems predicted poorer treatment outcomes especially in standard versus personalized CBT. Elevated repetitive behaviors and restricted interests predicted poorer treatment outcomes across treatments, though youth with "moderate" repetitive behaviors and restricted interested experienced poorer outcomes only in standard but not personalized CBT. Externalizing symptoms directly predicted treatment outcomes. Older age predicted improved outcomes in adapted but not standard CBT. Findings highlight the need for further treatment refinements and the value in adapting treatment for youth with more complex presentations. Trial Registration Clinicialtrials.gov: NCT02028247; https://clinicaltrials.gov/ct2/show/NCT02028247 .
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Affiliation(s)
- Eric A Storch
- Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, 1977 Butler Blvd, Suite 4-400, Houston, TX, 77030, USA.
| | - Jeffrey J Wood
- Department of Education, University of California, Los Angeles, CA, USA
| | - Andrew G Guzick
- Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, 1977 Butler Blvd, Suite 4-400, Houston, TX, 77030, USA
| | - Brent J Small
- School of Aging Studies, University of South Florida, Tampa, FL, USA
| | - Connor M Kerns
- Department of Psychology, University of British Columbia, Vancouver, BC, Canada
| | - D Luis Ordaz
- Jacob Center for Evidence-Based Therapy, Boca Raton, FL, USA
| | - Sophie C Schneider
- Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, 1977 Butler Blvd, Suite 4-400, Houston, TX, 77030, USA
| | - Philip C Kendall
- Department of Psychology, Temple University, Philadelphia, PA, USA
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Caregiver- and Child-Reported Anxiety Using an Autism-Specific Measure: Measurement Properties and Correlates of the Anxiety Scale for Children with Autism Spectrum Disorder (ASC-ASD) in Verbal Young People with ASD. J Autism Dev Disord 2020; 51:2646-2662. [PMID: 33025362 DOI: 10.1007/s10803-020-04739-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Identifying and measuring anxiety in young people on the autism spectrum can be challenging. The present study investigated the use of the Anxiety Scale for Children with Autism Spectrum Disorder (ASC-ASD), a self- and caregiver-rated screening tool in a Singaporean sample of ninety-one verbal autistic youths and their caregivers. Internal consistency ranged from satisfactory to desirable (α = .74-.92). Convergent validity with medium-large effect size was established using a structured diagnostic interview, the Mini-International Neuropsychiatric Interview for Children and Adolescents (MINI-KID). ASC-ASD scores were positively associated with autistic symptoms and response patterns indicated strong endorsement of autism-specific items. The findings are discussed in relation to existing literature on assessment of anxiety in ASD and in light of the study's strengths and limitations.
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20
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Perihan C, Burke M, Bowman-Perrott L, Bicer A, Gallup J, Thompson J, Sallese M. Effects of Cognitive Behavioral Therapy for Reducing Anxiety in Children with High Functioning ASD: A Systematic Review and Meta-Analysis. J Autism Dev Disord 2020; 50:1958-1972. [PMID: 30810842 DOI: 10.1007/s10803-019-03949-7] [Citation(s) in RCA: 59] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Children with autism spectrum disorder (ASD) are at greater risk for experiencing high levels of anxiety symptoms. Recent evidence suggests Cognitive behavioral therapy (CBT) may also be effective for anxiety reduction in some presentations of ASD. This meta-analysis evaluated twenty-three studies. Results yielded a moderate effect size (g = - 0.66) for the reduction of anxiety symptoms. Moderators indicated larger effects for studies were achieved with parental involvement (g = - 0.85, p < .05) than with child-only treatments (g = - 0.34, p < .05). Short-term interventions generated a smaller effect (g = - 0.37 p < .05) than either standard-term (g = - 1.02, p < .05) or long-term interventions (g = - 0.69, p < .05).Implications for children with ASD are discussed.
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Affiliation(s)
- Celal Perihan
- Department of Teaching and Education Studies, Idaho State University, 62 E Terry St, 83201, Pocatello, ID, USA.
| | - Mack Burke
- Department of Educational Psychology, Texas A&M University, College Station, TX, USA
| | - Lisa Bowman-Perrott
- Department of Educational Psychology, Texas A&M University, College Station, TX, USA
| | - Ali Bicer
- School of Teacher Education, University of Wyoming, Laramie, WY, USA
| | - Jennifer Gallup
- Department of Teaching and Education Studies, Idaho State University, 62 E Terry St, 83201, Pocatello, ID, USA
| | - Julie Thompson
- Department of Educational Psychology, Texas A&M University, College Station, TX, USA
| | - Mary Sallese
- Department of Educational Psychology, Texas A&M University, College Station, TX, USA
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21
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Vasa RA, Keefer A, McDonald RG, Hunsche MC, Kerns CM. A Scoping Review of Anxiety in Young Children with Autism Spectrum Disorder. Autism Res 2020; 13:2038-2057. [PMID: 32978905 DOI: 10.1002/aur.2395] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Revised: 07/31/2020] [Accepted: 08/27/2020] [Indexed: 12/24/2022]
Abstract
Research on anxiety in children and adolescents with autism spectrum disorder (ASD) has burgeoned in the past 15 years. Most of the research has focused on school-age children, ages 6 to 18 years. Yet, recent studies suggest that anxiety can emerge in young children, under 6 years, with ASD. This scoping review synthesized the literature on anxiety in young children with ASD. Three domains of anxiety research were reviewed: (a) prevalence/severity, phenomenology, and course; (b) correlates; and (c) treatment. Four online databases were searched from the start of the database until March 2020. Keywords pertaining to anxiety, autism, and young children were entered. The search identified 44 articles for inclusion. These studies varied with respect to sample source, informants, and measures to assess anxiety. The overall prevalence of anxiety ranged from 1.6 to 62%. Sixteen of 17 studies found that young children with ASD had higher levels of anxiety compared to various control groups. A variety of DSM anxiety symptoms and disorders were present in young children with the most common symptoms being specific, social, and generalized fears. Correlates of anxiety included sensory over-responsivity, sleep disturbance, aggression/defiance, and attention deficit/hyperactivity disorder. Three cognitive behavioral treatment studies for anxiety and one developmental intervention targeting ASD symptoms showed promise in reducing anxiety. Findings indicate an early emergence of anxiety in some children with ASD. Further research on the measurement, pathophysiology, and treatment of anxiety in early childhood is critical to improving outcomes in children with ASD. LAY SUMMARY: This scoping review synthesizes the literature on anxiety in young children with autism spectrum disorder (ASD). Results indicate that children with ASD have higher levels of anxiety than children without ASD. Potential factors that could be contributing to anxiety include sensory, sleep, and behavioral problems. Preliminary studies show that anxiety can improve with cognitive behavioral treatment. These findings suggest that research on anxiety in young children with ASD should be prioritized to improve mental health outcomes.
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Affiliation(s)
- Roma A Vasa
- Center for Autism and Related Disorders, Kennedy Krieger Institute, Baltimore, Maryland, USA.,Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Amy Keefer
- Center for Autism and Related Disorders, Kennedy Krieger Institute, Baltimore, Maryland, USA.,Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Rachel G McDonald
- Center for Autism and Related Disorders, Kennedy Krieger Institute, Baltimore, Maryland, USA
| | - Michelle C Hunsche
- Department of Psychology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Connor M Kerns
- Department of Psychology, University of British Columbia, Vancouver, British Columbia, Canada
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22
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Jenkinson R, Milne E, Thompson A. The relationship between intolerance of uncertainty and anxiety in autism: A systematic literature review and meta-analysis. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2020; 24:1933-1944. [PMID: 32564625 PMCID: PMC7539603 DOI: 10.1177/1362361320932437] [Citation(s) in RCA: 52] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
LAY ABSTRACT People who find it especially hard to cope with the unexpected or unknown are said to have an intolerance of uncertainty. Autistic individuals often report a preference for certainty and experience levels of anxiety that can interfere with their daily life. Understanding more about the link between the intolerance of uncertainty and anxiety in autistic people might lead to better treatments for anxiety being developed. Therefore, this work aimed to review previous research in order to explore this link. Twelve studies were found and their results were compared and contrasted. The autistic people who participated in the studies completed questionnaires that suggested a large number of them experienced very high levels of anxiety and intolerance of uncertainty. Of 10 studies that used relevant statistics, nine found a statistically significant link between anxiety and the intolerance of uncertainty. In general, the strength of the link was about the same as previous research found in people who did not have a diagnosis of autism. This might mean that interventions that aim to help people who are intolerant of uncertainty could be effective for autistic individuals.
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23
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Hillman K, Dix K, Ahmed K, Lietz P, Trevitt J, O'Grady E, Uljarević M, Vivanti G, Hedley D. Interventions for anxiety in mainstream school-aged children with autism spectrum disorder: A systematic review. CAMPBELL SYSTEMATIC REVIEWS 2020; 16:e1086. [PMID: 37131419 PMCID: PMC8356281 DOI: 10.1002/cl2.1086] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Affiliation(s)
- Kylie Hillman
- Australian Council for Educational ResearchCamberwellVictoriaAustralia
| | - Katherine Dix
- Australian Council for Educational ResearchAdelaideSouth AustraliaAustralia
| | - Kashfee Ahmed
- Australian Council for Educational ResearchAdelaideSouth AustraliaAustralia
| | - Petra Lietz
- Australian Council for Educational ResearchAdelaideSouth AustraliaAustralia
| | - Jenny Trevitt
- Australian Council for Educational ResearchCamberwellVictoriaAustralia
| | - Elizabeth O'Grady
- Australian Council for Educational ResearchCamberwellVictoriaAustralia
| | - Mirko Uljarević
- Division of Child and Adolescent Psychiatry, Stanford Autism Center, Department of Psychiatry and Behavioral Sciences, School of MedicineStanford UniversityPalo AltoCalifornia
| | - Giacomo Vivanti
- A. J. Drexel Autism InstituteDornsife School of Public Health, Drexel UniversityPhiladelphiaPennsylvania
| | - Darren Hedley
- Olga Tennison Autism Research Centre, School of Psychology and Public Health, College of Science, Health and EngineeringLaTrobe UniversityBundooraVictoriaAustralia
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24
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Gaigg SB, Flaxman PE, McLaven G, Shah R, Bowler DM, Meyer B, Roestorf A, Haenschel C, Rodgers J, South M. Self-guided mindfulness and cognitive behavioural practices reduce anxiety in autistic adults: A pilot 8-month waitlist-controlled trial of widely available online tools. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2020; 24:867-883. [PMID: 32267168 PMCID: PMC7418273 DOI: 10.1177/1362361320909184] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
LAY ABSTRACT Anxiety in autism is an important target for psychological therapies because it is very common and because it significantly impacts upon quality of life and well-being. Growing evidence suggests that cognitive behaviour therapies and mindfulness-based therapies can help autistic individuals learn to manage feelings of anxiety but access to such therapies remains problematic. In the current pilot study, we examined whether existing online cognitive behaviour therapy and mindfulness-based therapy self-help tools can help reduce anxiety in autistic adults. Specifically, 35 autistic adults were asked to try either an existing online cognitive behaviour therapy (n = 16) or mindfulness-based therapy (n = 19) programme while a further 19 autistic adults served as a waitlist comparison group. A first important finding was that 23 of the 35 (66%) participants who tried the online tools completed them, suggesting that such tools are, in principle, acceptable to many autistic adults. In addition, adults in the cognitive behaviour therapy and mindfulness-based therapy conditions reported significant decreases in anxiety over 3 and to some extent also 6 months that were less apparent in the waitlist group of participants. On broader measures of mental health and well-being, the benefits of the online tools were less apparent. Overall, the results suggest that online self-help cognitive behaviour therapy and mindfulness-based therapy tools should be explored further as a means of providing cost-effective mental health support to at least those autistic individuals who can engage effectively with such online tools.
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Affiliation(s)
| | | | - Gracie McLaven
- City, University of London, London, UK
- King’s College London, UK
| | - Ritika Shah
- City, University of London, London, UK
- MAPS Psychology, India
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25
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Parr JR, Brice S, Welsh P, Ingham B, Le Couteur A, Evans G, Monaco A, Freeston M, Rodgers J. Treating anxiety in autistic adults: study protocol for the Personalised Anxiety Treatment-Autism (PAT-A©) pilot randomised controlled feasibility trial. Trials 2020; 21:265. [PMID: 32171316 PMCID: PMC7071661 DOI: 10.1186/s13063-020-4161-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2019] [Accepted: 02/11/2020] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Anxiety is common in autistic adults and significantly limits everyday opportunities and quality of life. Evidence-based psychological therapies offered by mental health services often fail to meet the needs of autistic adults. The development of appropriate treatments for mental health conditions and, in particular, anxiety has been identified as a key priority by the autism community. The Personalised Anxiety Treatment-Autism (PAT-A©) trial aims to address this need by investigating the feasibility and acceptability of delivering an individualised psychological treatment for anxiety experienced by autistic adults. METHODS/DESIGN This is a pilot randomised controlled feasibility trial. Up to 40 autistic adults with clinically diagnosed anxiety will be randomised into one of two groups (either the PAT-A© intervention or Current Clinical Services Plus two emotional literacy skills sessions). Before randomisation, participants will receive a detailed clinical assessment to inform formulation and guide anxiety treatment. As part of the baseline assessment participants will also identify two personally important 'target situations' that cause significant anxiety and impact upon their daily life. Based upon the formulation and identified target situations, participants randomised to the PAT-A© intervention will receive up to 12 individualised, one-to-one therapy sessions. Initial emotional literacy training sessions will be followed by a bespoke, modular, needs-based treatment approach utilising one or more of the following approaches: Mindfulness, Coping with Uncertainty in Everyday Situations (CUES), social anxiety and graded exposure within Virtual Reality Environments. Participants in the control arm will receive two psycho-educational sessions focussing on understanding and describing emotions and be signposted to healthcare provision as required. Data will be collected through quantitative and qualitative methods. DISCUSSION This feasibility pilot trial serves as the first stage in the development and evaluation of a manualised personalised, evidence-based psychological therapy treatment for anxiety in autistic adults. Study outcomes will be used to inform an application for a fully powered multi-site intervention trial of adults and young people. TRIAL REGISTRATION ISRCTN, ID: 15881562. Retrospectively registered on 9 August 2019.
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Affiliation(s)
- Jeremy R. Parr
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
- Cumbria, Northumberland, Tyne and Wear NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Samuel Brice
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Patrick Welsh
- Cumbria, Northumberland, Tyne and Wear NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Barry Ingham
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
- Cumbria, Northumberland, Tyne and Wear NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Ann Le Couteur
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Gemma Evans
- Cumbria, Northumberland, Tyne and Wear NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Alexander Monaco
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Mark Freeston
- School of Psychology, Newcastle University, Newcastle upon Tyne, UK
| | - Jacqui Rodgers
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
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26
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Hwang YI(J, Arnold S, Srasuebkul P, Trollor J. Understanding anxiety in adults on the autism spectrum: An investigation of its relationship with intolerance of uncertainty, sensory sensitivities and repetitive behaviours. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2019; 24:411-422. [DOI: 10.1177/1362361319868907] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Anxiety is present in high rates in both children and adults on the autism spectrum. An increasing number of studies have highlighted the potentially important role that intolerance of uncertainty may have in anxiety for those on the spectrum, as well as their interrelationships with sensory sensitivities and repetitive behaviours. In response to a lack of studies involving adults, this study examined self-report survey data regarding intolerance of uncertainty, sensory sensitivities, repetitive behaviours and anxiety in a sample of 176 adults on the autism spectrum (mean age = 42). Intolerance of uncertainty and anxiety were both found to be elevated relative to non-autistic adults ( N = 116) and significant, positive correlations were found between intolerance of uncertainty, anxiety, repetitive behaviours and sensory sensitivities in those on the spectrum. Intolerance of uncertainty was found to be a significant mediator between sensory sensitivities and anxiety, as well as between anxiety and insistence on sameness behaviours. These results were not sensitive to age. Intolerance of uncertainty is an important factor to be considered in the conceptualisation and management of elevated rates of anxiety for adults on the autism spectrum.
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Affiliation(s)
- Ye In (Jane) Hwang
- UNSW Sydney, Australia
- Cooperative Research Centre for Living with Autism (Autism CRC), Australia
| | - Samuel Arnold
- UNSW Sydney, Australia
- Cooperative Research Centre for Living with Autism (Autism CRC), Australia
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27
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Rodgers J, Goodwin J, Parr JR, Grahame V, Wright C, Padget J, Garland D, Osborne M, Labus M, Kernohan A, Freeston M. Coping with Uncertainty in Everyday Situations (CUES©) to address intolerance of uncertainty in autistic children: study protocol for an intervention feasibility trial. Trials 2019; 20:385. [PMID: 31248435 PMCID: PMC6598241 DOI: 10.1186/s13063-019-3479-0] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2018] [Accepted: 05/29/2019] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Anxiety is a common diagnosis in children with autism spectrum disorder (ASD). One key mechanism underlying anxiety is intolerance of uncertainty, which is a tendency to react negatively on an emotional, cognitive, and behavioural level to uncertain situations and events. We developed the first intervention programme specifically targeting intolerance of uncertainty in children with ASD: Coping with Uncertainty in Everyday Situations (CUES). CUES is a parent group intervention providing parents of children with ASD with strategies to increase tolerance to uncertainty for their children in everyday situations. The principal aims of the current study are: 1) evaluate the acceptability and feasibility of delivering CUES to parents who have a child with ASD and anxiety; and 2) inform the design of a fully powered trial. METHOD This is a feasibility and acceptability single-blind pilot randomised controlled trial comparing CUES (intervention) to a brief psychoeducation, emotional literacy, and relaxation programme (enhanced services as usual). Participants will be assessed at baseline and followed-up immediately post-treatment, and at 12 and 26 weeks post-treatment. Parents who have a child with ASD and anxiety (aged 6-16 years) will be invited to take part in the study and written parental informed consent and child assent will be obtained. Participants will be recruited from the National Health Service mental health teams in the UK. Sixty participants will be randomised to either intervention or enhanced services as usual in a 1:1 ratio. DISCUSSION The present study will provide evidence on the acceptability of the CUES intervention to parents and children, and the feasibility of recruitment and delivery to inform the design and sample size for a full-scale randomised controlled trial. Qualitative data will be obtained to understand how feasible CUES is for families, and the experiences of participants regarding their experiences of the intervention. TRIAL REGISTRATION ISRCTN, ISRCTN10139240 . Registered on 14 May 2018.
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Affiliation(s)
- Jacqui Rodgers
- Institute of Neuroscience, Sir James Spence Institute, Newcastle University, Royal Victoria Infirmary, Queen Victoria Road, Newcastle, NE1 4LP UK
| | - Jane Goodwin
- Institute of Neuroscience, Sir James Spence Institute, Newcastle University, Royal Victoria Infirmary, Queen Victoria Road, Newcastle, NE1 4LP UK
| | - Jeremy R. Parr
- Institute of Neuroscience, Sir James Spence Institute, Newcastle University, Royal Victoria Infirmary, Queen Victoria Road, Newcastle, NE1 4LP UK
- Complex Neurodevelopmental Disorders Service, Northumberland Tyne and Wear NHS Foundation Trust, Walkergate Park Hospital, Walkergate Park, NE6 4QD UK
| | - Victoria Grahame
- Complex Neurodevelopmental Disorders Service, Northumberland Tyne and Wear NHS Foundation Trust, Walkergate Park Hospital, Walkergate Park, NE6 4QD UK
| | - Catharine Wright
- Child and Adolescent Mental Health Service, Northumbria Healthcare NHS Foundation Trust, Albion Rd Resource Centre, North Shields, NE29 0HG UK
| | - John Padget
- Complex Neurodevelopmental Disorders Service, Northumberland Tyne and Wear NHS Foundation Trust, Walkergate Park Hospital, Walkergate Park, NE6 4QD UK
| | - Deborah Garland
- Sir James Spence Institute, Newcastle University, Royal Victoria Infirmary, Queen Victoria Road, Newcastle, NE1 4LP UK
| | - Malcolm Osborne
- South Tyneside’s Kids And Young Adults Klub - Special needs support group (KAYAKS), South Shields, NE33 4UG UK
| | - Marie Labus
- Research and Enterprise Services, Faculty of Medical Sciences, Newcastle University, The Medical School, Framlington Place, Newcastle upon Tyne, NE2 4HH UK
| | - Ashleigh Kernohan
- Institute of Health & Society Newcastle University Baddiley-Clark Building, Richardson Road, Newcastle upon Tyne, NE2 4AX UK
| | - Mark Freeston
- School of Psychology, Newcastle University, 4th Floor Ridley Building, Newcastle upon Tyne, NE1 7RU UK
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28
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Priorities for Advancing Research on Youth with Autism Spectrum Disorder and Co-occurring Anxiety. J Autism Dev Disord 2019; 48:925-934. [PMID: 29164436 DOI: 10.1007/s10803-017-3320-0] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Research on anxiety disorders in youth with autism spectrum disorder (ASD) has burgeoned in the past two decades. Yet, critical gaps exist with respect to measuring and treating anxiety in this population. This study used the nominal group technique to identify the most important research priorities on co-occurring anxiety in ASD. An international group of researchers and clinicians with experience in ASD and anxiety participated in the process. Topics ranked as most important focused on understanding how ASD symptoms affect treatment response, implementing treatments in real world settings, developing methods to disentangle overlapping symptoms between anxiety and ASD, and developing objective measures to assess anxiety. Collectively, these priorities can lead to collaborative studies to accelerate research in the field.
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29
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Castriotta N, Dozier ME, Taylor CT, Mayes T, Ayers CR. Intolerance of uncertainty in hoarding disorder. J Obsessive Compuls Relat Disord 2019; 21:97-101. [PMID: 32670782 PMCID: PMC7362959 DOI: 10.1016/j.jocrd.2018.11.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
BACKGROUND Intolerance of uncertainty (IU) has been proposed as a transdiagnostic risk and maintenance factor underlying various forms of psychopathology. Few studies, however, have examined IU in hoarding disorder (HD)-a condition characterized by excessive urges to acquire and difficulties discarding possessions-core symptoms that may be fueled by inflated IU. We examined cross-sectional relationships between IU and different symptom facets of HD, controlling for anxiety and depression severity, and explored whether pre-treatment levels of IU predicted response to exposure-based treatment for HD. METHOD Fifty-seven individuals seeking treatment for HD completed baseline measures of hoarding symptoms, IU, anxiety and depression. Participants then completed 26 sessions of group exposure-based treatment for HD with or without compensatory cognitive training. Hoarding symptoms were assessed following the final treatment session to index treatment response. RESULTS IU was positively and significantly associated with greater urges to acquire and greater difficulties discarding possessions, beyond shared variance accounted for by anxiety and depression. IU was not significantly related to clutter symptom severity. Higher pre-treatment IU predicted increased odds of treatment non-response. CONCLUSIONS Elevated IU is associated with specific hoarding symptom clusters and may be an important target for HD treatment.
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Affiliation(s)
| | - Mary E. Dozier
- Research Service, VA San Diego Healthcare System, USA
- San Diego State University/University of California, San Diego Joint Doctoral Program in Clinical Psychology, USA
| | - Charles T. Taylor
- Department of Psychiatry, University of California, San Diego School of Medicine, USA
| | - Tina Mayes
- Research Service, VA San Diego Healthcare System, USA
| | - Catherine R. Ayers
- Research Service, VA San Diego Healthcare System, USA
- Psychology Service, VA San Diego Healthcare System, USA
- Department of Psychiatry, University of California, San Diego School of Medicine, USA
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30
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Fujino J, Tei S, Itahashi T, Aoki Y, Ohta H, Kubota M, Isobe M, Hashimoto RI, Nakamura M, Kato N, Takahashi H. Need for closure and cognitive flexibility in individuals with autism spectrum disorder: A preliminary study. Psychiatry Res 2019; 271:247-252. [PMID: 30504060 DOI: 10.1016/j.psychres.2018.11.057] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2018] [Revised: 10/25/2018] [Accepted: 11/23/2018] [Indexed: 12/31/2022]
Abstract
The need for closure (NFC), a desire for a firm answer and less ambiguity, has a key role in cognitive flexibility in typical development (TD) populations. This study investigated this motivational construct and its relation to cognitive inflexibility in autism spectrum disorder (ASD). Compared with individuals with TD, those with ASD reported higher levels in preference for predictability and closed-mindedness and lower levels in decisiveness. These NFC facets were significantly associated with cognitive flexibility in ASD as well as TD groups. The study findings provide further insights into the motivational underpinnings of flexible behavior in ASD.
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Affiliation(s)
- Junya Fujino
- Medical Institute of Developmental Disabilities Research, Showa University, 6-11-11 Kita-karasuyama, Setagaya-ku, Tokyo, Japan; Department of Psychiatry, Graduate School of Medicine, Kyoto University, 54 Shogoin-Kawaracho, Sakyo-ku, Kyoto, Japan.
| | - Shisei Tei
- Medical Institute of Developmental Disabilities Research, Showa University, 6-11-11 Kita-karasuyama, Setagaya-ku, Tokyo, Japan; Department of Psychiatry, Graduate School of Medicine, Kyoto University, 54 Shogoin-Kawaracho, Sakyo-ku, Kyoto, Japan; Institute of Applied Brain Sciences, Waseda University, 2-579-15 Mikajima, Tokorozawa, Saitama, Japan; School of Human and Social Sciences, Tokyo International University, 2509 Matoba, Kawagoe, Saitama, Japan
| | - Takashi Itahashi
- Medical Institute of Developmental Disabilities Research, Showa University, 6-11-11 Kita-karasuyama, Setagaya-ku, Tokyo, Japan
| | - Yuta Aoki
- Medical Institute of Developmental Disabilities Research, Showa University, 6-11-11 Kita-karasuyama, Setagaya-ku, Tokyo, Japan
| | - Haruhisa Ohta
- Medical Institute of Developmental Disabilities Research, Showa University, 6-11-11 Kita-karasuyama, Setagaya-ku, Tokyo, Japan; Department of Psychiatry, School of Medicine, Showa University, 6-11-11 Kita-karasuyama, Setagaya-ku, Tokyo, Japan
| | - Manabu Kubota
- Medical Institute of Developmental Disabilities Research, Showa University, 6-11-11 Kita-karasuyama, Setagaya-ku, Tokyo, Japan; Department of Psychiatry, Graduate School of Medicine, Kyoto University, 54 Shogoin-Kawaracho, Sakyo-ku, Kyoto, Japan; Department of Functional Brain Imaging Research, National Institute of Radiological Sciences, National Institutes for Quantum and Radiological Science and Technology, 4-9-1 Anagawa, Inage-ku, Chiba, Japan
| | - Masanori Isobe
- Department of Psychiatry, Graduate School of Medicine, Kyoto University, 54 Shogoin-Kawaracho, Sakyo-ku, Kyoto, Japan
| | - Ryu-Ichiro Hashimoto
- Medical Institute of Developmental Disabilities Research, Showa University, 6-11-11 Kita-karasuyama, Setagaya-ku, Tokyo, Japan; Department of Language Sciences, Graduate School of Humanities, Tokyo Metropolitan University, 1-1 Minami-Osawa, Hachioji-shi, Tokyo, Japan
| | - Motoaki Nakamura
- Medical Institute of Developmental Disabilities Research, Showa University, 6-11-11 Kita-karasuyama, Setagaya-ku, Tokyo, Japan; Kanagawa Psychiatric Center, 2-5-1 Serigaya, Yokohama, Kanagawa, Japan
| | - Nobumasa Kato
- Medical Institute of Developmental Disabilities Research, Showa University, 6-11-11 Kita-karasuyama, Setagaya-ku, Tokyo, Japan
| | - Hidehiko Takahashi
- Medical Institute of Developmental Disabilities Research, Showa University, 6-11-11 Kita-karasuyama, Setagaya-ku, Tokyo, Japan; Department of Psychiatry, Graduate School of Medicine, Kyoto University, 54 Shogoin-Kawaracho, Sakyo-ku, Kyoto, Japan
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31
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Keefer A, Kreiser NL, Singh V, Blakeley-Smith A, Reaven J, Vasa RA. Exploring Relationships Between Negative Cognitions and Anxiety Symptoms in Youth With Autism Spectrum Disorder. Behav Ther 2018; 49:730-740. [PMID: 30146140 DOI: 10.1016/j.beth.2017.12.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2017] [Revised: 12/05/2017] [Accepted: 12/06/2017] [Indexed: 12/22/2022]
Abstract
Although cognitions are central to the conceptualization and treatment of anxiety in typically developing (TD) youth, there is scant research investigating automatic thoughts and their relationship with anxiety in youth with autism spectrum disorder (ASD). We sought to examine the types of automatic thoughts experienced by youth with ASD and co-occurring anxiety as well as the predictive relationship of anxiety to different types of automatic thoughts in 97 children, ages 8-14 years. We also explored the relationship of automatic thoughts and intolerance of uncertainty. Consistent with prior data, there was a strong relationship between anxiety and automatic thoughts pertaining to social and physical threat. Anxiety and IU were independently associated with thoughts pertaining to personal failure which raises the hypothesis that personal failure may serve as a common pathway between anxiety, IU, and depression in ASD youth. These findings highlight the importance of assessing and treating negative cognitions in youth with ASD and anxiety.
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Affiliation(s)
- Amy Keefer
- Kennedy Krieger Institute, Center for Autism and Related Disorders; Johns Hopkins University School of Medicine.
| | | | - Vini Singh
- Kennedy Krieger Institute, Center for Autism and Related Disorders
| | | | - Judy Reaven
- University of Colorado Anschutz Medical Campus School of Medicine
| | - Roma A Vasa
- Kennedy Krieger Institute, Center for Autism and Related Disorders; Johns Hopkins University School of Medicine
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32
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Rodgers J, Herrema R, Honey E, Freeston M. Towards a Treatment for Intolerance of Uncertainty for Autistic Adults: A Single Case Experimental Design Study. J Autism Dev Disord 2018; 48:2832-2845. [PMID: 29589271 PMCID: PMC6061029 DOI: 10.1007/s10803-018-3550-9] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Intolerance of uncertainty (IU) is indicated as an important transdiagnostic process variable in a range of anxiety disorders. Anxiety is very common in autistic adults. This study evaluates a manualised treatment programme for autistic adults, which focused on IU. An eight session programme (CUES-A©) was developed and delivered to four autistic adults on an individual basis. A single case experimental design was used to provide a preliminary evaluation of the feasibility, acceptability and preliminary effectiveness of the programme. Data regarding retention, acceptability and feasibility indicate that the participants valued the programme. Analyses of outcome measures indicate that the programme has promise as a treatment option for autistic adults experiencing IU.
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Affiliation(s)
- J Rodgers
- Clinical Psychology, Faculty of Medical Sciences, Institute of Neuroscience, Sir James Spence Institute, Newcastle University, Royal Victoria Infirmary, Queen Victoria Road, Newcastle, NE1 4LP, UK.
| | - R Herrema
- School of Psychology, Faculty of Medical Sciences, Newcastle University, Newcastle, UK
| | - E Honey
- Northumberland, Tyne and Wear NHS Foundation Trust, Newcastle upon Tyne, UK
| | - M Freeston
- School of Psychology, Faculty of Medical Sciences, Newcastle University, Newcastle, UK
- Northumberland, Tyne and Wear NHS Foundation Trust, Newcastle upon Tyne, UK
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33
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Vasa RA, Kreiser NL, Keefer A, Singh V, Mostofsky SH. Relationships between autism spectrum disorder and intolerance of uncertainty. Autism Res 2018; 11:636-644. [PMID: 29316350 PMCID: PMC5903967 DOI: 10.1002/aur.1916] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2017] [Revised: 11/08/2017] [Accepted: 12/06/2017] [Indexed: 12/21/2022]
Abstract
Intolerance of uncertainty (IU) is a dispositional risk factor involving maladaptive responding under conditions of uncertainty. Recent data indicate that IU is likely elevated in youth with autism spectrum disorder (ASD) and is positively correlated with anxiety. This study examined whether IU may be associated with ASD independent of anxiety. Relationships between anxiety, ASD, and IU were examined in 57 children with ASD without co-occurring intellectual disability and 32 control participants, ages 7-16 years. Hierarchal linear regressions were run to examine whether ASD variables, including emotion dysregulation, were predictive of IU when controlling for anxiety. Severity of social communication deficits, repetitive behaviors, and emotion dysregulation were each related to IU when controlling for the effects of anxiety. When these variables were entered into the regression model together, emotion dysregulation was the only significant predictor of IU. These findings suggest that IU is directly related to features of ASD possibly due to shared genetic, neurological, or psychological underpinnings. Autism Res 2018, 11: 636-644. © 2018 International Society for Autism Research, Wiley Periodicals, Inc. LAY SUMMARY Youth with ASD without co-occurring intellectual disability experience high levels of intolerance of uncertainty (IU), which is related to anxiety. This study found that IU may also have a relationship with certain aspects of ASD, particularly emotion dysregulation.
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Affiliation(s)
- Roma A. Vasa
- Center for Autism and Related Disorders, Kennedy Krieger Institute, 3901 Greenspring Avenue, Baltimore, Maryland, 21211
- Center for Neurodevelopmental and Imaging Research, Kennedy Krieger Institute, 707 North Broadway, Baltimore, Maryland, 21205
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, 1800 Orleans Street, Baltimore, Maryland, 21287
| | - Nicole L. Kreiser
- Department of Psychiatry and Behavioral Sciences, Eastern Virginia Medical School, 825 Fairfax Avenue, Suite 710, Norfolk, Virginia, 23507
| | - Amy Keefer
- Center for Autism and Related Disorders, Kennedy Krieger Institute, 3901 Greenspring Avenue, Baltimore, Maryland, 21211
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, 1800 Orleans Street, Baltimore, Maryland, 21287
| | - Vini Singh
- Center for Autism and Related Disorders, Kennedy Krieger Institute, 3901 Greenspring Avenue, Baltimore, Maryland, 21211
| | - Stewart H. Mostofsky
- Center for Neurodevelopmental and Imaging Research, Kennedy Krieger Institute, 707 North Broadway, Baltimore, Maryland, 21205
- Department of Psychiatry and Behavioral Sciences, Eastern Virginia Medical School, 825 Fairfax Avenue, Suite 710, Norfolk, Virginia, 23507
- Department of Neurology, Johns Hopkins University School of Medicine, 601 N. Caroline Street, Baltimore, Maryland, 21205
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34
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Rodgers J, Ofield A. Understanding, Recognising and Treating Co-occurring Anxiety in Autism. CURRENT DEVELOPMENTAL DISORDERS REPORTS 2018; 5:58-64. [PMID: 29497597 PMCID: PMC5818555 DOI: 10.1007/s40474-018-0132-7] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
PURPOSE OF REVIEW Autistic people are at increased risk of anxiety, with around 50% of autistic adults and children experiencing this debilitating mental health condition. The purpose of this review is to consider some contemporary ideas about underlying mechanisms for anxiety in autism, explore issues in the identification and assessment of anxiety and discuss emerging trends in anxiety interventions for autistic people, before identifying some important next steps in the field. RECENT FINDINGS Emerging evidence suggests that anxiety may present differently in autism compared to the general population and that whilst CBT holds promise, there may be important differences in neurobiological, affective and cognitive responses to stressors for autistic people, which warrant tailored anxiety models, assessments and interventions. SUMMARY We conclude that research is needed to develop and evaluate theoretical frameworks, assessment methods and interventions for anxiety in autism, particularly for autistic adults and those with co-occurring intellectual disability.
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Affiliation(s)
- Jacqui Rodgers
- Clinical Psychology, Institute of Neuroscience, Sir James Spence Institute, Newcastle University, Royal Victoria Infirmary, Queen Victoria Road, Newcastle, NE1 4LP UK
| | - A. Ofield
- Clinical Psychology, Institute of Neuroscience, Sir James Spence Institute, Newcastle University, Royal Victoria Infirmary, Queen Victoria Road, Newcastle, NE1 4LP UK
- Northumberland, Tyne and Wear NHS Foundation, Newcastle upon Tyne, UK
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35
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Top DN, Luke SG, Stephenson KG, South M. Psychophysiological Arousal and Auditory Sensitivity in a Cross-Clinical Sample of Autistic and Non-autistic Anxious Adults. Front Psychiatry 2018; 9:783. [PMID: 30761031 PMCID: PMC6361859 DOI: 10.3389/fpsyt.2018.00783] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2018] [Accepted: 12/28/2018] [Indexed: 12/20/2022] Open
Abstract
Many autistic people report overwhelming sensory experiences and also elevated levels of anxiety. Understanding how these experiences are linked to each other can contribute to improved support and intervention for reducing sensory overload and anxiety. This study included 95 young adult participants including autistic adults, non-autistic adults reporting to a psychotherapy clinic with high levels of anxiety, and neurotypical adults with no psychiatric concerns. We measured pupil size using including a baseline task with no auditory stimulus followed by two blocks of simple auditory habituation. In a subset of 80 participants we also measured self-report levels of sensory processing, anxious apprehension, and intolerance of uncertainty. The autism group showed atypical sensory processing on all four measured domains of the Adolescent and Adult Sensory Profile including sensory sensitivity, sensory seeking, sensory avoidance, and low registration subscales. Dimensional analyses across all participants showed significant positive correlations between sensory sensitivity, sensory seeking, and sensory avoidance domains with scores from the Intolerance of Uncertainty Scale-Short Form and Penn State Worry Questionnaire. The autism group showed significantly larger pupil size than other groups at baseline, before any auditory stimulation. There were no group differences in the rate of auditory habituation, nonetheless the overall, absolute larger pupil size remained in the autism group throughout the experiment. We suggest that this and other findings could indicate chronic hyperarousal in many autistic people. Treatment for anxiety in autism should be informed by knowledge of unique aspects of anxiety in autism and consider the role of sensory experience and everyday psychophysiological arousal.
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Affiliation(s)
- David Nicholas Top
- Department of Psychology, Brigham Young University, Provo, UT, United States
| | - Steven G Luke
- Department of Psychology, Brigham Young University, Provo, UT, United States.,Neuroscience Center, Brigham Young University Provo, UT, United States
| | | | - Mikle South
- Department of Psychology, Brigham Young University, Provo, UT, United States.,Neuroscience Center, Brigham Young University Provo, UT, United States
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Brief Report: Inter-Relationship between Emotion Regulation, Intolerance of Uncertainty, Anxiety, and Depression in Youth with Autism Spectrum Disorder. J Autism Dev Disord 2017; 48:316-325. [DOI: 10.1007/s10803-017-3318-7] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
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37
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Fujino J, Tei S, Hashimoto RI, Itahashi T, Ohta H, Kanai C, Okada R, Kubota M, Nakamura M, Kato N, Takahashi H. Attitudes toward risk and ambiguity in patients with autism spectrum disorder. Mol Autism 2017; 8:45. [PMID: 28824795 PMCID: PMC5559781 DOI: 10.1186/s13229-017-0162-8] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2017] [Accepted: 08/09/2017] [Indexed: 01/02/2023] Open
Abstract
Although the ability to make optimal decisions under uncertainty is an integral part of everyday life, individuals with autism spectrum disorder (ASD) frequently report that they experience difficulties with this skill. In behavioral economics, researchers distinguish two types of uncertainty to understand decision-making in this setting: risk (known probabilities) and ambiguity (unknown probabilities). However, it remains unclear how individuals with ASD behave under risk and ambiguity, despite growing evidence of their altered decision-making under uncertainty. We therefore extended previous research by studying the attitudes of those with ASD toward risk and ambiguity in both positive and negative contexts (i.e., gain and loss). In gain contexts, no significant difference was observed between the groups in risk attitudes, but ambiguity aversion was attenuated in ASD. In loss contexts, ambiguity attitudes did not significantly differ between the groups, but the ASD participants were less risk-seeking compared with the controls. In addition, insensitivity to the context change under risk and ambiguity in ASD was both significantly associated with poor social skills. These results improve our understanding of altered decision-making under uncertainty by disentangling the attitudes toward risk and ambiguity in ASD individuals. Applying behavioral economic tools may provide insights into the mechanisms underlying behavioral disturbances in ASD.
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Affiliation(s)
- Junya Fujino
- Medical Institute of Developmental Disabilities Research, Showa University, 6-11-11 Kita-karasuyama, Setagaya-ku, Tokyo, Japan.,Department of Psychiatry, Graduate School of Medicine, Kyoto University, 54 Shogoin-Kawaracho, Sakyo-ku, Kyoto, Japan
| | - Shisei Tei
- Medical Institute of Developmental Disabilities Research, Showa University, 6-11-11 Kita-karasuyama, Setagaya-ku, Tokyo, Japan.,Department of Psychiatry, Graduate School of Medicine, Kyoto University, 54 Shogoin-Kawaracho, Sakyo-ku, Kyoto, Japan.,Institute of Applied Brain Sciences, Waseda University, 2-579-15 Mikajima, Tokorozawa, Saitama, Japan.,School of Human and Social Sciences, Tokyo International University, 2509 Matoba, Kawagoe, Saitama, Japan
| | - Ryu-Ichiro Hashimoto
- Medical Institute of Developmental Disabilities Research, Showa University, 6-11-11 Kita-karasuyama, Setagaya-ku, Tokyo, Japan.,Department of Language Sciences, Graduate School of Humanities, Tokyo Metropolitan University, 1-1 Minami-Osawa, Hachioji-shi, Tokyo, Japan
| | - Takashi Itahashi
- Medical Institute of Developmental Disabilities Research, Showa University, 6-11-11 Kita-karasuyama, Setagaya-ku, Tokyo, Japan
| | - Haruhisa Ohta
- Medical Institute of Developmental Disabilities Research, Showa University, 6-11-11 Kita-karasuyama, Setagaya-ku, Tokyo, Japan.,Department of Psychiatry, School of Medicine, Showa University, 6-11-11 Kita-karasuyama, Setagaya-ku, Tokyo, Japan
| | - Chieko Kanai
- Medical Institute of Developmental Disabilities Research, Showa University, 6-11-11 Kita-karasuyama, Setagaya-ku, Tokyo, Japan
| | - Rieko Okada
- Medical Institute of Developmental Disabilities Research, Showa University, 6-11-11 Kita-karasuyama, Setagaya-ku, Tokyo, Japan
| | - Manabu Kubota
- Medical Institute of Developmental Disabilities Research, Showa University, 6-11-11 Kita-karasuyama, Setagaya-ku, Tokyo, Japan.,Department of Psychiatry, Graduate School of Medicine, Kyoto University, 54 Shogoin-Kawaracho, Sakyo-ku, Kyoto, Japan.,Department of Functional Brain Imaging Research, National Institute of Radiological Sciences, National Institutes for Quantum and Radiological Science and Technology, 4-9-1 Anagawa, Inage-ku, Chiba, Japan
| | - Motoaki Nakamura
- Medical Institute of Developmental Disabilities Research, Showa University, 6-11-11 Kita-karasuyama, Setagaya-ku, Tokyo, Japan.,Kanagawa Psychiatric Center, 2-5-1 Serigaya, Yokohama, Kanagawa Japan
| | - Nobumasa Kato
- Medical Institute of Developmental Disabilities Research, Showa University, 6-11-11 Kita-karasuyama, Setagaya-ku, Tokyo, Japan
| | - Hidehiko Takahashi
- Medical Institute of Developmental Disabilities Research, Showa University, 6-11-11 Kita-karasuyama, Setagaya-ku, Tokyo, Japan.,Department of Psychiatry, Graduate School of Medicine, Kyoto University, 54 Shogoin-Kawaracho, Sakyo-ku, Kyoto, Japan
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South M, Rodgers J. Sensory, Emotional and Cognitive Contributions to Anxiety in Autism Spectrum Disorders. Front Hum Neurosci 2017; 11:20. [PMID: 28174531 PMCID: PMC5258728 DOI: 10.3389/fnhum.2017.00020] [Citation(s) in RCA: 108] [Impact Index Per Article: 15.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2016] [Accepted: 01/10/2017] [Indexed: 01/28/2023] Open
Abstract
Severe symptoms of anxiety add substantial additional burden to many individuals diagnosed with Autism Spectrum Disorder (ASD). Improved understanding of specific factors that contribute to anxiety in ASD can aid research regarding the causes of autism and also provide targets for more effective intervention. This mini-review article focuses on emerging evidence for three concepts that appear to be related to each other and which also strongly predict anxiety in ASD samples. Atypical sensory function is included in the diagnostic criteria for ASD and is likely an important contributor to anxiety. Difficulties in understanding and labeling emotions (alexithymia), although a co-morbidity, may arise in part from atypical sensory function and can lead to confusion and uncertainty about how to respond to social and emotional situations. Intolerance of uncertainty(IU) describes people who have a particularly hard time with ambiguity and is known to be a key mechanism underlying some anxiety disorders. While evidence for linking these ideas is to date incomplete, we put forward a model including each concept as a framework for future studies. Specifically, we propose that IU is a critical mediator for anxiety in ASD, and explore the relationships between sensory function, alexithymia and IU. We further explore the role of the medial prefrontal cortex (mPFC) in regulating emotional response, in connection with limbic and insula-based networks, and suggest that disrupted integration in these networks underlies difficulties with habituation to strong emotional stimuli, which results in an enhanced perception of threat in many people with ASD. Behavioral and biologically-based treatments for anxiety in ASD will benefit from attending to these specific mechanisms as adjunct to traditional interventions.
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Affiliation(s)
- Mikle South
- Departments of Psychology and Neuroscience, Brigham Young University Provo, UT, USA
| | - Jacqui Rodgers
- Institute of Neuroscience, Newcastle University Newcastle, UK
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