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Spencer SD, Pinciotti CM, Murphy C, Hertz A, Wiese AD, Wood JJ, Kendall PC, Storch EA. Concurrent Validity of the Anxiety Disorders Section of the Anxiety Disorder Interview Schedule- Autism Spectrum Addendum (ADIS-ASA) in Autistic Youth. J Autism Dev Disord 2024:10.1007/s10803-024-06496-y. [PMID: 39096461 DOI: 10.1007/s10803-024-06496-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/16/2024] [Indexed: 08/05/2024]
Abstract
PURPOSE Examine the concurrent validity of specific Anxiety Disorders Section of the Anxiety Disorder Interview Schedule for DSM-IV-Autism Spectrum Addendum (ADIS-ASA)-Parent Interview in a sample of 167 autistic youth who met diagnostic criteria for an anxiety-related disorder (Mage = 9.91; 78.4% male; 82% non-Hispanic; 77.67% White). METHODS Concurrent validity of Diagnostic and Statistical Manual (DSM)-defined ADIS-ASA anxiety disorder diagnostic caseness was examined via relations with (a) parent-reported dimensions of youth anxiety symptomology and (b) dimensional measures of youth anxiety-related functional impairment, respectively, using logistic regression models and point-biserial correlations. RESULTS Significant relations were found between separation anxiety disorder and social anxiety disorder (but not generalized anxiety disorder nor obsessive-compulsive disorder) caseness, respectively, and theoretically consistent facets of dimensional youth anxiety symptomology. Relations between ADIS-ASA diagnostic caseness and youth functional impairment-related variables revealed that only separation anxiety disorder demonstrated robust evidence of convergent validity. CONCLUSION Despite mixed findings concerning relations between ADIS-ASA anxiety disorder diagnostic caseness and dimensional measures of anxiety severity and anxiety-related impairment, the present findings provide further support for the status of the ADIS-ASA as a gold standard for assessment of anxiety in autistic youth. This work also highlights the importance of continuing to improve precision in measurement of anxiety symptomology in autistic youth, with implications for clinical assessment.
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Affiliation(s)
- Samuel D Spencer
- Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA.
| | - Caitlin M Pinciotti
- Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA
| | - Callie Murphy
- Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA
| | - Alyssa Hertz
- Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA
| | - Andrew D Wiese
- Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA
| | - Jeffrey J Wood
- Department of Education, University of California, Los Angeles, USA
- Department of Psychiatry, University of California, Los Angeles, USA
| | - Philip C Kendall
- Department of Psychology and Neuroscience, Temple University, Philadelphia, USA
| | - Eric A Storch
- Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA
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Mingins JE, Tarver J, Pearson E, Edwards G, Bird M, Crawford H, Oliver C, Shelley L, Waite J. Development and psychometric properties of the Clinical Anxiety Scale for People with Intellectual Disabilities (ClASP-ID). J Neurodev Disord 2024; 16:43. [PMID: 39068415 PMCID: PMC11283710 DOI: 10.1186/s11689-024-09554-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2024] [Accepted: 06/25/2024] [Indexed: 07/30/2024] Open
Abstract
BACKGROUND There is a critical need for the development of dependable and valid anxiety assessment tools suitable for people with moderate to severe intellectual disabilities, particularly those who speak few or no words. Distinguishing anxiety from distress caused by physical discomfort (pain) or characteristics associated with autism, prevalent in this population, necessitates specialised assessment tools. This study (a) developed a parent-report anxiety questionnaire tailored for individuals with severe to moderate intellectual disabilities, potentially with a co-diagnosis of autism, and (b) evaluated the psychometric attributes of this novel measure. METHODS A comprehensive approach involving literature reviews, inspection of existing tools, and interviews with clinicians and parents guided the creation of the Clinical Anxiety Scale for People with Intellectual Disabilities. The tool was completed by parents or caregivers (N = 311) reporting on individuals aged 4 or older with intellectual disabilities. RESULTS Exploratory factor analysis indicated a four-factor structure encompassing anxiety, pain, low energy/withdrawal, and consolability. The anxiety factor explained the most variance in scores (26.3%). The anxiety, pain, low energy/withdrawal subscales demonstrated robust internal consistency (α = 0.81-0.92), and convergent, divergent, and discriminant validity. Robustness of these subscales was further evidenced by test-retest reliability (ICC = 0.79-0.88) and inter-rater reliability (ICC = 0.64-0.71). Subgroup analyses consistently demonstrated strong psychometric properties among individuals diagnosed with non-syndromic autism (N = 98), children (N = 135), adults (N = 175), and across diverse communication abilities within the sample. Moreover, individuals diagnosed with both autism and anxiety exhibited significantly higher scores on the anxiety subscale compared to those without an anxiety diagnosis, while showing no difference in autism characteristic scores. CONCLUSIONS The findings indicate that the Clinical Anxiety Scale for People with Intellectual Disabilities is a promising measure for use across diverse diagnostic groups, varying communication abilities, and with people with moderate to severe intellectual disabilities.
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Affiliation(s)
- Jessica Eliza Mingins
- School of Psychology, College of Health and Life Sciences, Aston University, Birmingham, B4 7 ET, United Kingdom.
| | - Joanne Tarver
- School of Psychology, College of Health and Life Sciences, Aston University, Birmingham, B4 7 ET, United Kingdom
| | - Effie Pearson
- School of Psychology, College of Health and Life Sciences, Aston University, Birmingham, B4 7 ET, United Kingdom
| | - Georgina Edwards
- School of Health and Care, Coventry University, Priory St, Coventry, CV1 5FB, England
| | - Megan Bird
- School of Psychology, College of Health and Life Sciences, Aston University, Birmingham, B4 7 ET, United Kingdom
| | - Hayley Crawford
- Mental Health and Wellbeing Unit, Warwick Medical School, University of Warwick, Coventry, CV4 7AL, England
| | - Chris Oliver
- School of Psychology, University of Birmingham, Edgbaston, B15 2TT, England
| | - Lauren Shelley
- School of Psychology, College of Health and Life Sciences, Aston University, Birmingham, B4 7 ET, United Kingdom
| | - Jane Waite
- School of Psychology, College of Health and Life Sciences, Aston University, Birmingham, B4 7 ET, United Kingdom
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3
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Kim SY, Lecavalier L. Stability and Validity of Self-Reported Depression and Anxiety in Autistic Youth. J Autism Dev Disord 2024:10.1007/s10803-024-06456-6. [PMID: 39001970 DOI: 10.1007/s10803-024-06456-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/24/2024] [Indexed: 07/15/2024]
Abstract
The aim of this study was to assess test-retest reliability and diagnostic validity of self-report instruments of depression and anxiety in autistic youth. Participants were 55 autistic youth aged 8-17 years presenting with depressive or anxiety symptoms. They were interviewed with the Kiddie Schedule for Affective Disorders and Schizophrenia for School-Age Children (K-SADS-PL) and completed the Children's Depression Inventory, Second Edition - Self Report Short (CDI 2:SR[S]) and the Revised Child Anxiety and Depression Scale (RCADS) twice, separated by a two-week interval. Test-retest reliability was measured with intraclass correlation coefficients (ICCs), and diagnostic validity was assessed using receiver operating characteristic (ROC) curves with the summary ratings on the K-SADS-PL as the criterion. The effect of participant characteristics was analyzed through a moderation analysis. Generalized anxiety (GAD) and social anxiety disorder (SOC) were the two most prevalent disorders in the sample. Test-retest reliability for most of the subscales was good (ICC = 0.74 - 0.87), with the exception of the RCADS obsessive-compulsive disorder (OCD) and GAD. The Adaptive Behavior conceptual score was a significant moderator of the reliability of the CDI 2:SR[S]. The ROC analysis suggested the RCADS SOC and the CDI 2:SR[S] to be good screening tools with inadequate specificity when appropriately sensitive cutoff scores are used. Optimal cutoff scores in this sample were lower than originally published. The findings suggest that autistic youth can provide stable reports of anxiety and depressive symptoms over time. Diagnostic validity varied according to the construct and instrument.
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Affiliation(s)
- Soo Youn Kim
- Department of Psychology, The Ohio State University, Columbus, OH, USA
- Nisonger Center, The Ohio State University, Columbus, OH, USA
| | - Luc Lecavalier
- Department of Psychology, The Ohio State University, Columbus, OH, USA.
- Nisonger Center, The Ohio State University, Columbus, OH, USA.
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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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Liu J, Girault JB, Nishino T, Shen MD, Kim SH, Burrows CA, Elison JT, Marrus N, Wolff JJ, Botteron KN, Estes AM, Dager SR, Hazlett HC, McKinstry RC, Schultz RT, Snyder AZ, Styner M, Zwaigenbaum L, Pruett Jr JR, Piven J, Gao W. Atypical functional connectivity between the amygdala and visual, salience regions in infants with genetic liability for autism. Cereb Cortex 2024; 34:30-39. [PMID: 38696599 PMCID: PMC11065105 DOI: 10.1093/cercor/bhae092] [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: 11/15/2023] [Revised: 02/13/2024] [Accepted: 02/20/2024] [Indexed: 05/04/2024] Open
Abstract
The amygdala undergoes a period of overgrowth in the first year of life, resulting in enlarged volume by 12 months in infants later diagnosed with ASD. The overgrowth of the amygdala may have functional consequences during infancy. We investigated whether amygdala connectivity differs in 12-month-olds at high likelihood (HL) for ASD (defined by having an older sibling with autism), compared to those at low likelihood (LL). We examined seed-based connectivity of left and right amygdalae, hypothesizing that the HL and LL groups would differ in amygdala connectivity, especially with the visual cortex, based on our prior reports demonstrating that components of visual circuitry develop atypically and are linked to genetic liability for autism. We found that HL infants exhibited weaker connectivity between the right amygdala and the left visual cortex, as well as between the left amygdala and the right anterior cingulate, with evidence that these patterns occur in distinct subgroups of the HL sample. Amygdala connectivity strength with the visual cortex was related to motor and communication abilities among HL infants. Findings indicate that aberrant functional connectivity between the amygdala and visual regions is apparent in infants with genetic liability for ASD and may have implications for early differences in adaptive behaviors.
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Affiliation(s)
- Janelle Liu
- Department of Biomedical Sciences and Imaging, Cedars-Sinai Medical Center, 8700 Beverly Blvd., Los Angeles, CA 90048, USA
- Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, 116 N. Robertson Bldv., Los Angeles, CA 90048, USA
- Department of Medicine, David Geffen School of Medicine, UCLA, 10833 Le Conte Ave., Los Angeles, CA 90095, USA
| | - Jessica B Girault
- Department of Psychiatry, UNC Chapel Hill, 333 S. Columbia Street, Chapel Hill, NC, 27514, USA
- Carolina Institute for Developmental Disabilities, UNC Chapel Hill , 101 Renee Lynne Court, Carrboro, NC 27510, USA
| | - Tomoyuki Nishino
- Institute for Child Development, University of Minnesota, 51 East River Rd., Minneapolis, MN 55454, USA
| | - Mark D Shen
- Department of Psychiatry, UNC Chapel Hill, 333 S. Columbia Street, Chapel Hill, NC, 27514, USA
- Carolina Institute for Developmental Disabilities, UNC Chapel Hill , 101 Renee Lynne Court, Carrboro, NC 27510, USA
| | - Sun Hyung Kim
- Department of Psychiatry, UNC Chapel Hill, 333 S. Columbia Street, Chapel Hill, NC, 27514, USA
| | - Catherine A Burrows
- Institute for Child Development, University of Minnesota, 51 East River Rd., Minneapolis, MN 55454, USA
| | - Jed T Elison
- Institute for Child Development, University of Minnesota, 51 East River Rd., Minneapolis, MN 55454, USA
| | - Natasha Marrus
- Department of Psychiatry, Washington University School of Medicine, 660 S Euclid Ave., St. Louis, MO 63110, USA
| | - Jason J Wolff
- Department of Educational Psychology, University of Minnesota, 56 E River Rd., Minneapolis, MN 55455, USA
| | - Kelly N Botteron
- Department of Psychiatry, Washington University School of Medicine, 660 S Euclid Ave., St. Louis, MO 63110, USA
| | - Annette M Estes
- Department of Speech and Hearing Science, University of Washington, 1417 NE 42nd St., Seattle, WA 98105, USA
| | - Stephen R Dager
- Department of Radiology, University of Washington, 1959 NE Pacific St., Seattle, WA 98195, USA
| | - Heather C Hazlett
- Department of Psychiatry, UNC Chapel Hill, 333 S. Columbia Street, Chapel Hill, NC, 27514, USA
- Carolina Institute for Developmental Disabilities, UNC Chapel Hill , 101 Renee Lynne Court, Carrboro, NC 27510, USA
| | - Robert C McKinstry
- Department of Radiology, Washington University School of Medicine, 660 S Euclid Ave., St. Louis, MO 63110, USA
| | - Robert T Schultz
- Center for Autism Research, Children’s Hospital of Philadelphia, 2716 South St., Philadelphia, PA 19104, USA
| | - Abraham Z Snyder
- Department of Radiology, Washington University School of Medicine, 660 S Euclid Ave., St. Louis, MO 63110, USA
| | - Martin Styner
- Department of Psychiatry, UNC Chapel Hill, 333 S. Columbia Street, Chapel Hill, NC, 27514, USA
| | - Lonnie Zwaigenbaum
- Department of Pediatrics, University of Alberta, 116 St. and 85 Ave, Edmonton, Alberta, T6G 2R3, CA
| | - John R Pruett Jr
- Department of Psychiatry, Washington University School of Medicine, 660 S Euclid Ave., St. Louis, MO 63110, USA
| | - Joseph Piven
- Department of Psychiatry, UNC Chapel Hill, 333 S. Columbia Street, Chapel Hill, NC, 27514, USA
- Carolina Institute for Developmental Disabilities, UNC Chapel Hill , 101 Renee Lynne Court, Carrboro, NC 27510, USA
| | - Wei Gao
- Department of Biomedical Sciences and Imaging, Cedars-Sinai Medical Center, 8700 Beverly Blvd., Los Angeles, CA 90048, USA
- Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, 116 N. Robertson Bldv., Los Angeles, CA 90048, USA
- Department of Medicine, David Geffen School of Medicine, UCLA, 10833 Le Conte Ave., Los Angeles, CA 90095, USA
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6
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Waizbard-Bartov E, Ferrer E, Heath B, Andrews DS, Rogers S, Kerns CM, Wu Nordahl C, Solomon M, Amaral DG. Changes in the severity of autism symptom domains are related to mental health challenges during middle childhood. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2024; 28:1216-1230. [PMID: 37691349 PMCID: PMC10924781 DOI: 10.1177/13623613231195108] [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] [Indexed: 09/12/2023]
Abstract
LAY ABSTRACT For many autistic children, the severity of their autism symptoms changes during middle childhood. We studied whether these changes are associated with the emergence of other mental health challenges such as anxiety and attention-deficit hyperactivity disorder. Children who had increased social-communication challenges had more anxiety and attention-deficit hyperactivity disorder symptoms and disruptive behavior problems than other children. Children who decreased their restricted and repetitive behaviors, on the contrary, had more anxiety. We discuss why these changes in autism symptoms may lead to increases in other mental health concerns.
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Harris HK, Kook M, Boedeker P, Gusick AG, Lyons-Warren AM, Goin-Kochel RP, Murali C, Berry LN, Storch EA. The Impact of Cognitive Behavioral Therapy on Sleep Problems in Autistic Children with Co-occurring Anxiety. J Autism Dev Disord 2024:10.1007/s10803-024-06309-2. [PMID: 38557905 DOI: 10.1007/s10803-024-06309-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/22/2024] [Indexed: 04/04/2024]
Abstract
PURPOSE This study seeks to examine the relationship between anxiety-symptom severity and sleep behaviors in autistic children receiving cognitive behavioral therapy (CBT). METHODS We conducted a secondary-data analysis from a sample of 93 autistic youth, 4 to 14 years, participating in 24 weeks of CBT. Clinicians completed the Pediatric Anxiety Rating Scale (PARS) and parents completed the Children's Sleep Habits Questionnaire, Abbreviated/Short Form (CSHQ-SF) at baseline, mid-treatment, post-treatment and 3 months post-treatment. Mediation analysis evaluated the role of anxiety symptoms in mediating the effect of time in treatment on sleep. RESULTS There was a negative association between time in treatment and scores on the CSHQ-SF (b = - 3.23, SE = 0.493, t = - 6.553, p < 0.001). Increased time in treatment was associated with decreased anxiety (b = - 4.66, SE = 0.405, t = - 11.507, p < 0.001), and anxiety symptoms decreased with CSHQ-SF scores (b = 0.322, SE = 0.112, t = 2.869, p = 0.005). The indirect effect of time in treatment on CSHQ-SF scores through PARS reduction was negative, but not statistically significant. CONCLUSION Increased time in CBT was associated with decreased anxiety severity and improved sleep behaviors. Reductions in anxiety symptoms may mediate improvements in sleep problems, but larger sample sizes are necessary to explore this further.
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Affiliation(s)
- Holly K Harris
- Department of Pediatrics, Baylor College of Medicine, Houston, TX, USA.
- Division of Developmental-Behavioral Pediatrics, Meyer Center for Developmental Pediatrics and Autism, 8080 North Stadium Drive, Suite 100, Houston, TX, 77054, USA.
| | - Minjee Kook
- Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA
| | - Peter Boedeker
- Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA
- Department of Education, Innovation and Technology, Baylor College of Medicine, Houston, TX, USA
| | - Andrew G Gusick
- Department of Psychiatry, University of Pennsylvania, Philadelphia, PA, USA
| | - Ariel M Lyons-Warren
- Department of Pediatrics, Baylor College of Medicine, Houston, TX, USA
- Jan and Dan Duncan Neurological Research Institute, Texas Children's Hospital, Houston, TX, USA
| | - Robin P Goin-Kochel
- Department of Pediatrics, Baylor College of Medicine, Houston, TX, USA
- Autism Program, Meyer Center for Developmental and Behavioral Pediatrics, Texas Children's Hospital, Houston, TX, USA
| | - Chaya Murali
- Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, TX, USA
| | - Leandra N Berry
- Department of Pediatrics, Baylor College of Medicine, Houston, TX, USA
- Autism Program, Meyer Center for Developmental and Behavioral Pediatrics, Texas Children's Hospital, Houston, TX, USA
| | - Eric A Storch
- Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA
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8
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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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9
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Burrows CA, Lasch C, Gross J, Girault JB, Rutsohn J, Wolff JJ, Swanson MR, Lee CM, Dager SR, Cornea E, Stephens R, Styner M, John TS, Pandey J, Deva M, Botteron KN, Estes AM, Hazlett HC, Pruett JR, Schultz RT, Zwaigenbaum L, Gilmore JH, Shen MD, Piven J, Elison JT. Associations between early trajectories of amygdala development and later school-age anxiety in two longitudinal samples. Dev Cogn Neurosci 2024; 65:101333. [PMID: 38154378 PMCID: PMC10792190 DOI: 10.1016/j.dcn.2023.101333] [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: 06/13/2023] [Revised: 12/18/2023] [Accepted: 12/19/2023] [Indexed: 12/30/2023] Open
Abstract
Amygdala function is implicated in the pathogenesis of autism spectrum disorder (ASD) and anxiety. We investigated associations between early trajectories of amygdala growth and anxiety and ASD outcomes at school age in two longitudinal studies: high- and low-familial likelihood for ASD, Infant Brain Imaging Study (IBIS, n = 257) and typically developing (TD) community sample, Early Brain Development Study (EBDS, n = 158). Infants underwent MRI scanning at up to 3 timepoints from neonate to 24 months. Anxiety was assessed at 6-12 years. Linear multilevel modeling tested whether amygdala volume growth was associated with anxiety symptoms at school age. In the IBIS sample, children with higher anxiety showed accelerated amygdala growth from 6 to 24 months. ASD diagnosis and ASD familial likelihood were not significant predictors. In the EBDS sample, amygdala growth from birth to 24 months was associated with anxiety. More anxious children had smaller amygdala volume and slower rates of amygdala growth. We explore reasons for the contrasting results between high-familial likelihood for ASD and TD samples, grounding results in the broader literature of variable associations between early amygdala volume and later anxiety. Results have the potential to identify mechanisms linking early amygdala growth to later anxiety in certain groups.
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Affiliation(s)
| | - Carolyn Lasch
- Institute of Child Development, University of Minnesota, Minneapolis, MN, USA
| | - Julia Gross
- Carolina Institute for Developmental Disabilities and Department of Psychiatry, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC, USA
| | - Jessica B Girault
- Carolina Institute for Developmental Disabilities and Department of Psychiatry, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC, USA
| | - Joshua Rutsohn
- Department of Biostatistics, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Jason J Wolff
- Department of Educational Psychology, University of Minnesota, Minneapolis, MN, USA
| | - Meghan R Swanson
- School of Behavioral and Brain Sciences, University of Texas at Dallas, Dallas, TX, USA
| | - Chimei M Lee
- Department of Pediatrics, University of Minnesota, Minneapolis, MN, USA
| | - Stephen R Dager
- Deptartment of Radiology, University of Washington Medical Center, Seattle, WA, USA
| | - Emil Cornea
- Center for Autism Research, Children's Hospital of Philadelphia, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Rebecca Stephens
- Department of Psychiatry, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC, USA
| | - Martin Styner
- Department of Psychiatry, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC, USA
| | - Tanya St John
- University of Washington Autism Center, University of Washington, Seattle, WA, USA
| | - Juhi Pandey
- Center for Autism Research, Children's Hospital of Philadelphia, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Meera Deva
- Department of Psychiatry, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC, USA
| | - Kelly N Botteron
- Department of Psychiatry, Washington University School of Medicine in St. Louis, St. Louis, MO, USA
| | - Annette M Estes
- University of Washington Autism Center, University of Washington, Seattle, WA, USA; Deptartment of Speech and Hearing Science, University of Washington, Seattle, WA, USA
| | - Heather C Hazlett
- Carolina Institute for Developmental Disabilities and Department of Psychiatry, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC, USA
| | - John R Pruett
- Department of Psychiatry, Washington University School of Medicine in St. Louis, St. Louis, MO, USA
| | - Robert T Schultz
- Center for Autism Research, Children's Hospital of Philadelphia, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | | | - John H Gilmore
- Department of Psychiatry, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC, USA
| | - Mark D Shen
- Carolina Institute for Developmental Disabilities and Department of Psychiatry, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC, USA; Department of Psychiatry, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC, USA
| | - Joseph Piven
- Carolina Institute for Developmental Disabilities and Department of Psychiatry, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC, USA
| | - Jed T Elison
- Department of Pediatrics, University of Minnesota, Minneapolis, MN, USA; Institute of Child Development, University of Minnesota, Minneapolis, MN, USA
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10
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Neuhaus E, Bernier RA, Webb SJ. Social motivation by self- and caregiver-report: Reporter concordance and social correlates among autistic and neurotypical youth. Autism Res 2024; 17:55-65. [PMID: 37987233 PMCID: PMC10843724 DOI: 10.1002/aur.3054] [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: 02/22/2023] [Accepted: 10/19/2023] [Indexed: 11/22/2023]
Abstract
Differences in social motivation underlie the core social-communication features of autism according to several theoretical models, with decreased social motivation among autistic youth relative to neurotypical peers. However, research on social motivation often relies on caregiver reports and rarely includes firsthand perspectives of children and adolescents with autism. Furthermore, social motivation is typically assumed to be constant across social settings when it may actually vary by social context. Among a sample of 58 verbally fluent youth (8-13 years old; 22 with autism, 36 neurotypical), we examined correspondence between youth and caregiver reports of social motivation with peers and with adults, as well as diagnostic group differences and associations with social outcomes. Results suggest youth and caregivers provide overlapping but distinct information. Autistic youth had lower levels of social motivation relative to neurotypical youth, and reported relatively consistent motivation toward peers and adults. Youth self- and caregiver-report were correlated for motivation toward adults, but not toward peers. Despite low correspondence between self- and caregiver-reported motivation toward peers, autistic youths' self-report corresponded to caregiver-reported social skills and difficulties whereas caregiver-report of peer motivation did not. For neurotypical youth, self- and caregiver-reported motivation toward adults was correlated, but motivation by both reporters was largely independent of broader social outcomes. Findings highlight the unique value of self-report among autistic children and adolescents, and warrant additional work exploring the development, structure, and correlates of social motivation among autistic and neurotypical youth.
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Affiliation(s)
- Emily Neuhaus
- Seattle Children’s Research Institute; Center on Child Health, Behavior and Development
- University of Washington Psychiatry & Behavioral Sciences
| | - Raphael A. Bernier
- Seattle Children’s Research Institute; Center on Child Health, Behavior and Development
- University of Washington Psychiatry & Behavioral Sciences
| | - Sara Jane Webb
- Seattle Children’s Research Institute; Center on Child Health, Behavior and Development
- University of Washington Psychiatry & Behavioral Sciences
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11
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Nakhid D, Patel D, McMorris CA, Gibbard WB, Tortorelli C, Pei J, Lebel C. Limbic brain subregions associated with mental health symptoms in youth with and without prenatal alcohol exposure. ALCOHOL, CLINICAL & EXPERIMENTAL RESEARCH 2023; 47:2033-2044. [PMID: 38226747 DOI: 10.1111/acer.15181] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/14/2023] [Revised: 07/20/2023] [Accepted: 08/24/2023] [Indexed: 01/17/2024]
Abstract
BACKGROUND Prenatal alcohol exposure (PAE) can result in reduced brain volume and an increased risk of mental health challenges. Limbic brain structures such as the hippocampus, thalamus, and amygdala often exhibit smaller volumes in youth with PAE, and similar volume reductions are observed in unexposed youth with symptoms of depression, bipolar disorder, anxiety, and schizophrenia. However, the role of volume reductions in these brain regions in mental health challenges remains unclear for individuals with PAE. METHODS Thirty-four youth with PAE and 72 unexposed youth aged 7-16 years completed a T1-weighted magnetic resonance imaging scan. FreeSurfer was used to process and extract volumes for hippocampal subfields, thalamic subnuclei, and amygdalar subnuclei. Depression and anxiety symptoms were measured using the Behavioral Assessment System for Children (BASC-2/3-PRS), the Children's Depression Inventory, and the Multidimensional Anxiety Scale for Children. We tested whether limbic subregion volumes differed between youth with and those without PAE and whether volumes were associated with depression and/or anxiety symptoms, controlling for age and gender. RESULTS Multiple hippocampal and thalamic subregions, but not amygdalar subnuclei, were smaller in individuals with PAE. Multiple group-brain interactions were observed for depression symptoms and subregion volumes. Negative associations between anxiety and limbic subregions were observed across groups. CONCLUSIONS These findings show extensive volume reductions in the hippocampus and thalamus in youth with PAE. PAE also appears to disrupt the association between depression symptoms and limbic subregions in youth, which may have implications for interventions in these individuals. Anxiety symptoms in youth with and without PAE are similarly associated with limbic volumes.
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Affiliation(s)
- Daphne Nakhid
- Neuroscience, University of Calgary, Calgary, Alberta, Canada
- Alberta Children's Hospital Research Institute (ACHRI), University of Calgary, Calgary, Alberta, Canada
- Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada
| | - Darpal Patel
- Neuroscience, University of Calgary, Calgary, Alberta, Canada
- Alberta Children's Hospital Research Institute (ACHRI), University of Calgary, Calgary, Alberta, Canada
| | - Carly A McMorris
- Alberta Children's Hospital Research Institute (ACHRI), University of Calgary, Calgary, Alberta, Canada
- Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada
- Werklund School of Education, School and Applied Child Psychology, University of Calgary, Calgary, Alberta, Canada
- Department of Pediatrics, University of Calgary, Calgary, Alberta, Canada
| | - W Ben Gibbard
- Alberta Children's Hospital Research Institute (ACHRI), University of Calgary, Calgary, Alberta, Canada
- Department of Pediatrics, University of Calgary, Calgary, Alberta, Canada
| | - Christina Tortorelli
- Department of Child Studies and Social Work, Mount Royal University, Calgary, Alberta, Canada
| | - Jacqueline Pei
- Department of Educational Psychology, University of Alberta, Edmonton, Alberta, Canada
| | - Catherine Lebel
- Alberta Children's Hospital Research Institute (ACHRI), University of Calgary, Calgary, Alberta, Canada
- Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada
- Department of Radiology, University of Calgary, Calgary, Alberta, Canada
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12
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Lai MC. Mental health challenges faced by autistic people. Nat Hum Behav 2023; 7:1620-1637. [PMID: 37864080 DOI: 10.1038/s41562-023-01718-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Accepted: 09/07/2023] [Indexed: 10/22/2023]
Abstract
Mental health challenges impede the well-being of autistic people. This Review outlines contributing neurodevelopmental and physical health conditions, rates and developmental trajectories of mental health challenges experienced by autistic people, as well as unique clinical presentations. A framework is proposed to consider four contributing themes to aid personalized formulation: social-contextual determinants, adverse life experiences, autistic cognitive features, and shared genetic and early environmental predispositions. Current evidence-based and clinical-knowledge-informed intervention guidance and ongoing development of support are highlighted for specific mental health areas. Tailored mental health support for autistic people should be neurodivergence-informed, which is fundamentally humanistic and compatible with the prevailing bio-psycho-social frameworks. The personalized formulation should be holistic, considering physical health and transdiagnostic neurodevelopmental factors, intellectual and communication abilities, and contextual-experiential determinants and their interplay with autistic cognition and biology, alongside resilience. Supporting family well-being is integral. Mutual empathic understanding is fundamental to creating societies in which people across neurotypes are all empowered to thrive.
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Affiliation(s)
- Meng-Chuan Lai
- Margaret and Wallace McCain Centre for Child, Youth & Family Mental Health and Azrieli Adult Neurodevelopmental Centre, Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada.
- Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.
- Department of Psychology, Faculty of Arts and Science, University of Toronto, Toronto, Ontario, Canada.
- Department of Psychiatry, Hospital for Sick Children, Toronto, Ontario, Canada.
- Autism Research Centre, Department of Psychiatry, University of Cambridge, Cambridge, UK.
- Department of Psychiatry, National Taiwan University Hospital and College of Medicine, Taipei, Taiwan.
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13
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Rodgers J, Brice S, Welsh P, Ingham B, Wilson C, Evans G, Steele K, Cropper E, Le Couteur A, Freeston M, Parr JR. A Pilot Randomised Control Trial Exploring the Feasibility and Acceptability of Delivering a Personalised Modular Psychological Intervention for Anxiety Experienced by Autistic Adults: Personalised Anxiety Treatment-Autism (PAT-A). J Autism Dev Disord 2023:10.1007/s10803-023-06112-5. [PMID: 37728782 DOI: 10.1007/s10803-023-06112-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/15/2023] [Indexed: 09/21/2023]
Abstract
Anxiety is commonly experienced by autistic people and impacts on quality of life and social participation. New anxiety interventions are required to effectively meet the needs of autistic people. Personalised Anxiety Treatment-Autism (PAT-A©) is a bespoke, modular approach to treating anxiety in up to 12 sessions. This study explored the feasibility and acceptability of delivering PAT-A© in the UK National Health Service (NHS). A single-blind randomised controlled trial design. Thirty-four autistic adults were recruited via clinical services and randomised to receive either PAT-A© or enhanced treatment as usual (CCSP). Outcome assessments relating to anxiety, quality of life and related constructs were completed at baseline, immediately post intervention; and at 3 and 12 months. Seventy-one percent of the PAT-A© group and 65% of the CCSP met diagnostic threshold for at least three anxiety disorders. Retention was good across both groups, with 82% (N = 14/17) completing the full course of PAT-A© and 71% (N = 12/17) attending both psychoeducational sessions in CCSP. 94% in PAT-A© and 82% in CCSP completed some follow up assessment 3 months post-intervention. Thematic analysis of interview data revealed that many participants valued the personalised approach, developed transferable skills and experienced positive changes to their anxiety. Participants were willing to be recruited and randomised, PAT-A© was feasible to deliver in the NHS and the trial methods and materials were acceptable. Our findings indicate that a fully powered clinical and cost-effectiveness trial of PAT-A© is warranted.
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Affiliation(s)
- Jacqui Rodgers
- Population Health Sciences Institute, Newcastle University, Newcastle Upon Tyne, UK.
| | - Samuel Brice
- Population Health Sciences Institute, Newcastle University, Newcastle Upon Tyne, UK
- Cumbria, Northumberland, Tyne and Wear NHS Foundation Trust, 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
| | - Colin Wilson
- Population Health Sciences Institute, Newcastle University, Newcastle Upon Tyne, UK
| | - Gemma Evans
- Cumbria, Northumberland, Tyne and Wear NHS Foundation Trust, Newcastle Upon Tyne, UK
| | - Katie Steele
- School of Psychology, Newcastle University, Newcastle Upon Tyne, UK
| | - Emily Cropper
- School of Psychology, Newcastle University, Newcastle Upon Tyne, UK
| | - Ann Le Couteur
- Population Health Sciences Institute, Newcastle University, Newcastle Upon Tyne, UK
| | - Mark Freeston
- School of Psychology, Newcastle University, Newcastle Upon Tyne, UK
| | - 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
- Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle Upon Tyne, UK
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14
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Harrop C, Bodfish J, Lecavalier L, Dallman AR, Jones D, Pritchett J, Whitten A, Boyd BA. Refining our Understanding of Anxiety in Autistic Youth: Examining the Role of Behavioral Inflexibility. J Autism Dev Disord 2023:10.1007/s10803-023-06079-3. [PMID: 37530916 DOI: 10.1007/s10803-023-06079-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/22/2023] [Indexed: 08/03/2023]
Abstract
Prior research has demonstrated that cognitive inflexibility is associated with anxiety in autistic individuals. Everyday patterns of behavioral inflexibility (e.g. observable inflexible behavior in the context of the need to change or adapt and that is manifested in real-world everyday settings) is common in autism and can be distinguished from performance on discrete cognitive tasks that tap flexible attention, learning, or decision-making. The purpose of this study was to extend this prior work on inflexibility in autism but with measures specifically developed with input from stakeholders (caregivers and clinicians) for autistic youth designed to measure everyday behavioral inflexibility (BI). We characterized anxiety in a large sample of autistic (N = 145) and non-autistic youth (N = 91), ages 3 to 17 years, using the Parent Rated Anxiety Scale for Autism Spectrum Disorder (PRAS-ASD). Further, we sought to understand how BI, measured via the Behavioral Inflexibility Scale (BIS), predicted anxiety compared to other variables known to increase anxiety in youth (chronological age, IQ, autism diagnosis, assigned sex at birth). Autistic youth had higher parent-related anxiety and BI compared to non-autistic youth. BI was the strongest predictor of anxiety scores, irrespective of diagnosis. Overall, our findings highlight the importance of BI to the understanding of anxiety in autistic youth.
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Affiliation(s)
- Clare Harrop
- University of North Carolina at Chapel Hill, Bondurant Hall, Chapel Hill, NC, USA.
| | - James Bodfish
- Vanderbilt University Medical Center, Nashville, USA
| | | | | | | | | | | | - Brian A Boyd
- University of North Carolina at Chapel Hill, Bondurant Hall, Chapel Hill, NC, USA
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15
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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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16
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Khalfe N, Goetz AR, Trent ES, Guzick AG, Smarason O, Kook M, Olsen S, Ramirez AC, Weinzimmer SA, Berry L, Schneider SC, Goodman WK, Storch EA. Psychometric properties of the revised children's anxiety and depression scale (RCADS) for autistic youth without co-occurring intellectual disability. JOURNAL OF MOOD AND ANXIETY DISORDERS 2023; 2:100017. [PMID: 37693105 PMCID: PMC10486182 DOI: 10.1016/j.xjmad.2023.100017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/12/2023]
Abstract
Autistic youth often present with comorbid anxiety and depression yet there is a dearth of validated assessment tools. The Revised Children's Anxiety and Depression Scale (RCADS) assesses internalizing symptoms but there is little psychometric data in autistic youth. Treatment-seeking autistic youth with anxiety or obsessive-compulsive symptoms (N = 74; age 6-14 years), and caregivers, were administered the RCADS-Parent, RCADS-Child, and assessments of internalizing, externalizing symptoms and social impairment indicative of autism. RCADS-Parent and RCADS-Child total anxiety scores demonstrated excellent internal consistency, and the six subscales demonstrated acceptable-to-good internal consistency. The RCADS-Child and Parent total anxiety scores were weakly correlated, and neither child age nor gender altered the strength of this association. Convergent validity was supported by moderate-to-strong correlations with clinician and parent-reported anxiety symptoms. Support for divergent validity was mixed. Results provide support for the RCADS-Parent and RCADS-Child as reliable, valid measures of internalizing symptoms in autistic youth.
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Affiliation(s)
- Nasim Khalfe
- Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA
| | - Amy R. Goetz
- Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA
| | - Erika S. Trent
- Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA
- Department of Psychology, University of Houston, Houston, TX, USA
| | - Andrew G. Guzick
- Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA
| | - Orri Smarason
- Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA
- Faculty of Psychology, University of Iceland, Reykjavik, Iceland
| | - Minjee Kook
- Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA
| | - Sean Olsen
- Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA
| | - Ana C. Ramirez
- Department of Psychological Science, University of Texas Rio Grande Valley, Edinburg, TX, USA
| | - Saira A. Weinzimmer
- Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA
| | - Leandra Berry
- Department of Pediatrics, Baylor College of Medicine, Houston, TX, USA
| | - Sophie C. Schneider
- Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA
| | - Wayne K. Goodman
- Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA
| | - Eric A. Storch
- Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA
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17
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Klein J, Kerns C, Hills K, Hogan A, Matherly S, Roberts J. Brief Report: Prevalence and Predictors of DSM-Specific and Distinct Anxiety in Cognitively Impaired Autistic Preschool Children. J Autism Dev Disord 2023:10.1007/s10803-023-05978-9. [PMID: 37039980 DOI: 10.1007/s10803-023-05978-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/28/2023] [Indexed: 04/12/2023]
Abstract
Autistic individuals are twice as likely to meet criteria for anxiety than neurotypical children; yet we lack understanding of early presentations of anxiety in young autistic children, especially those with cognitive impairment. This study is the first to utilize an autism-specific anxiety diagnostic interview with 28 preschool cognitively impaired, autistic children and 18 neurotypical, age-matched controls. Results indicate that 64% of autistic children met criteria for DSM-specified or "other specified," herein referred to as "distinct," anxiety disorders; 32% met criteria for multiple anxiety disorders, with phobias occurring most often. Results indicate that anxiety is highly prevalent in cognitively-impaired, autistic preschool children, highlighting the need for developmentally-tailored assessment and treatment in early childhood.
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Affiliation(s)
- Jordan Klein
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC, USA.
| | - Connor Kerns
- University of British Columbia, Vancouver, BC, Canada
| | - Kimberly Hills
- Department of Psychology, University of South Carolina, Columbia, SC, USA
| | - Abigail Hogan
- Department of Psychology, University of South Carolina, Columbia, SC, USA
| | | | - Jane Roberts
- Department of Psychology, University of South Carolina, Columbia, SC, USA
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18
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Houck EJ, Dracobly JD. Trauma-Informed Care for Individuals with Intellectual and Developmental Disabilities: From Disparity to Policies for Effective Action. Perspect Behav Sci 2023; 46:67-87. [PMID: 37006597 PMCID: PMC10050265 DOI: 10.1007/s40614-022-00359-6] [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: 08/15/2022] [Indexed: 11/25/2022] Open
Abstract
People with intellectual disabilities (ID) are an often overlooked minority population. They experience significant health disparities and a high risk of exposure to traumatic events that can lead to stress-related disorders. Access to effective treatments for stress-related disorders is limited for people with ID due to a lack of appropriate assessments and common communication deficits. We discuss and analyze four factors that have led to these disparities: (1) historical segregation; (2) society's response to identification of trauma in vulnerable populations; (3) lack of accessible assessments and treatments for stress disorders in people with ID; and (4) communication deficits common in people with ID. Based on this analysis, we suggest behavior analysts advocate for policy development that would (1) increase acknowledgement of trauma in people with ID and mandate sharing of information about trauma across providers; (2) require observable and measurable goals be included in the assessment and treatment of trauma-related behavior change; and (3) increase funding for services and research in this area.
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Affiliation(s)
- Elizabeth J. Houck
- University of North Texas, 1155 Union Circle, Box 310919, Denton, TX 76201 USA
| | - Joseph D. Dracobly
- University of North Texas, 1155 Union Circle, Box 310919, Denton, TX 76201 USA
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19
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Meyer AT, Moody EJ, Keefer A, O'Kelley S, Duncan A, Blakeley-Smith A, Reaven J. Effect of Co-occurring Psychiatric Disorders on Treatment of Children with Autism Spectrum Disorder and Anxiety. J Autism Dev Disord 2023; 53:569-579. [PMID: 32462457 DOI: 10.1007/s10803-020-04540-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Co-occurring psychiatric diagnoses are very common in individuals with ASD. Little is known about the effect that co-occurring psychiatric conditions may have on treatment response to CBT for children with ASD and anxiety. The present study examined the relationship between co-occurring psychiatric diagnoses and response to CBT for anxiety in ninety youth with ASD. Psychiatric complexity did not appear to differentially impact treatment response. A notable portion of youth with anxiety and externalizing disorders such as ADHD, no longer met criteria for those externalizing diagnoses following intervention. Results indicate that youth with ASD and anxiety present with complex psychiatric profiles and CBT for anxiety may positively affect co-occurring diagnoses. In addition, thorough and nuanced assessment of psychiatric symptoms in youth with ASD is needed to ensure the differentiation between diagnoses of anxiety and other co-occurring psychiatric symptoms.
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Affiliation(s)
- Allison T Meyer
- JFK Partners, Department of Pediatrics, University of Colorado School of Medicine, Education 2 South, 13121 E. 17th Ave, Aurora, CO, 80045, USA.
| | - Eric J Moody
- Wyoming Institude for Disabilities, College of Health Sciences, University of Wyoming, Laramie, WY, USA
| | - Amy Keefer
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Kennedy Krieger Institute, Baltimore, MD, USA
- Center for Autism and Related Disorders, Kennedy Krieger Institute, Baltimore, MD, USA
| | - Sarah O'Kelley
- Department of Psychology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Amie Duncan
- Division of Developmental and Behavioral Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Audrey Blakeley-Smith
- JFK Partners, Department of Psychiatry, University of Colorado Anschutz Medical Center, Aurora, CO, USA
| | - Judy Reaven
- JFK Partners, Department of Psychiatry, University of Colorado Anschutz Medical Center, Aurora, CO, USA
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20
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Byrne G, Ghráda ÁN, O’Mahony T. Parent-Led Cognitive Behavioural Therapy for Children with Autism Spectrum Conditions. A Pilot Study. J Autism Dev Disord 2023; 53:263-274. [PMID: 35020117 PMCID: PMC8753322 DOI: 10.1007/s10803-022-05424-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/30/2021] [Indexed: 02/03/2023]
Abstract
This article reports on a pilot study of a parent-only cognitive behavioural therapy (CBT) programme for parents of children with autism spectrum disorders (ASD) and anxiety difficulties. Twenty-one parents of anxious children with ASD (5-11 of age) completed the From Timid to Tiger intervention. Parent outcome measures were assessed at post-intervention and at 3-month follow-up. Analysis indicated significant reductions in both parent and clinician reports of child anxiety symptoms. Specifically, 38% of children were free of their primary diagnosis at treatment end and this increased to 57% when measured at 3-month follow-up. Positive gains were evidenced regarding parents' ability to manage their child's anxiety without accommodating to it. The results provide preliminary evidence of parent-only CBT programs for children with ASD.
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Affiliation(s)
- Gary Byrne
- Psychology Department, Primary Care Psychology Services, Churchtown Primary Care Services, Health Service Executive, Churchtown, Dublin 14, Ireland
| | - Áine Ní Ghráda
- Psychology Department, Primary Care Psychology Services, Churchtown Primary Care Services, Health Service Executive, Churchtown, Dublin 14, Ireland
| | - Teresa O’Mahony
- Psychology Department, HSE Community Healthcare East, Vergemount Hall, Clonskeagh, Dublin, Ireland
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21
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Chan N, Fenning RM, Neece CL. Prevalence and Phenomenology of Anxiety in Preschool-Aged Children with Autism Spectrum Disorder. Res Child Adolesc Psychopathol 2023; 51:33-45. [PMID: 36048376 DOI: 10.1007/s10802-022-00964-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/06/2022] [Indexed: 10/14/2022]
Abstract
Individuals with autism spectrum disorder (ASD) are at a higher risk for developing co-occurring anxiety symptoms and diagnosable anxiety disorders compared to children with neurotypical development (NTD). The objective of the current study was to characterize the prevalence and phenomenology of anxiety in preschool-aged children with ASD. Our sample consisted of preschoolers (M = 52.8 months, SD = 10.8 months) with ASD (n = 77, 66% with co-occurring intellectual disability, ID) and NTD (n = 55). We employed multi-method (questionnaire and semi-structured diagnostic interview) and multi-informant (parent- and teacher-report) assessments of anxiety. Children with ASD were significantly more likely to meet criteria for an anxiety disorder than children with NTD. Over 70% of our sample with ASD met DSM-5 criteria for an anxiety disorder, with Specific Phobia and Separation Anxiety Disorder being the most prevalent. A range of specific fears was endorsed in the group with ASD, many of which overlapped with ASD symptoms. Parents, but not teachers, also reported greater anxiety symptoms for children with ASD relative to the comparison sample. Prevalence and phenomenology of anxiety in our sample with ASD generally did not differ between those with and without co-occurring ID, with the exception of higher rates of generalized anxiety in those without ID. Results showed poor concordance between parent questionnaires and a semi-structured diagnostic interview in detecting clinically-elevated anxiety in children with ASD. Implications for clinical practice and research are discussed.
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Affiliation(s)
| | - Rachel M Fenning
- Claremont McKenna College, Claremont, CA, USA.,California State University, Fullerton, Fullerton, CA, USA
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22
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Hennessy A, Seguin D, Correa S, Wang J, Martinez-Trujillo JC, Nicolson R, Duerden EG. Anxiety in children and youth with autism spectrum disorder and the association with amygdala subnuclei structure. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2022; 27:1053-1067. [PMID: 36278283 PMCID: PMC10108338 DOI: 10.1177/13623613221127512] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Autism spectrum disorder (ASD) is clinically characterized by social and communication difficulties as well as repetitive behaviors. Many children with ASD also suffer from anxiety, which has been associated with alterations in amygdala structure. In this work, the association between amygdala subnuclei volumes and anxiety was assessed in a cohort of 234 participants (mean age = 11.0 years, SD = 3.9, 95 children with ASD, 139 children were non-autistic). Children underwent magnetic resonance imaging. Amygdala subnuclei volumes were extracted automatically. Anxiety was assessed using the Screen for Child Anxiety Related Disorders, the Child Behavior Checklist, and the Strength and Difficulties Questionnaire. Children with ASD had higher anxiety scores relative to non-autistic children on all anxiety measures (all, p < 0.05). Anxiety levels were significantly predicted in children with ASD by right basal (right: B = 0.235, p = 0.002) and paralaminar (PL) (B = −0.99, p = 0.009) volumes. Basal nuclei receive multisensory information from cortical and subcortical areas and have extensive projections within the limbic system while the PL nuclei are involved in emotional processing. Alterations in basal and PL nuclei in children with ASD and the association with anxiety may reflect morphological changes related to in the neurocircuitry of anxiety in ASD. Lay abstract Autism spectrum disorder (ASD) is clinically characterized by social communication difficulties as well as restricted and repetitive patterns of behavior. In addition, children with ASD are more likely to experience anxiety compared with their peers who do not have ASD. Recent studies suggest that atypical amygdala structure, a brain region involved in emotions, may be related to anxiety in children with ASD. However, the amygdala is a complex structure composed of heterogeneous subnuclei, and few studies to date have focused on how amygdala subnuclei relate to in anxiety in this population. The current sample consisted of 95 children with ASD and 139 non-autistic children, who underwent magnetic resonance imaging (MRI) and assessments for anxiety. The amygdala volumes were automatically segmented. Results indicated that children with ASD had elevated anxiety scores relative to peers without ASD. Larger basal volumes predicted greater anxiety in children with ASD, and this association was not seen in non-autistic children. Findings converge with previous literature suggesting ASD children suffer from higher levels of anxiety than non-autistic children, which may have important implications in treatment and interventions. Our results suggest that volumetric estimation of amygdala’s subregions in MRI may reveal specific anxiety-related associations in children with ASD.
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Affiliation(s)
| | | | | | | | | | | | - Emma G Duerden
- Western University, Canada
- The University of Western Ontario, Canada
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23
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Verhulst I, MacLennan K, Haffey A, Tavassoli T. The Perceived Causal Relations Between Sensory Reactivity Differences and Anxiety Symptoms in Autistic Adults. AUTISM IN ADULTHOOD 2022; 4:183-192. [PMID: 36606154 PMCID: PMC9648696 DOI: 10.1089/aut.2022.0018] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Background Rates of anxiety are inordinately high in autistic adults. Sensory reactivity differences, such as hyperreactivity (e.g., strong reactions to sound), hyporeactivity (e.g., no, or slower reactions to pain), and seeking (e.g., fascination with spinning objects), are a diagnostic criterion of autism and have been linked with anxiety. Understanding how individuals perceive these to be causally related can impact the assessment and treatment of anxiety. Therefore, we examined the perceived causal relations (PCR) between sensory reactivity differences and anxiety in autistic adults. Method Two hundred forty-six autistic adults aged 18-76 years took part in an online study. They completed self-report assessments of sensory reactivity differences, and anxiety, followed by the PCR scale, indicating whether they perceived their sensory reactivity differences to be more of a cause or an effect of their anxiety symptoms. Results We found sensory reactivity hyperreactivity, hyporeactivity, and seeking to be significantly correlated with anxiety. Further, we found total sensory hyperreactivity, and visual, auditory, and olfactory hyperreactivity, to be perceived as significantly more of a cause of anxiety than an effect, and total sensory seeking, and tactile and vestibular seeking, to be perceived as significantly more of an effect of anxiety than a cause. Conclusion Future individualized approaches to treating anxiety in autistic individuals may benefit from differentiating between potential sensory causes of anxiety (e.g. hypersensitivities) vs. potential sensory effects of anxiety (e.g. sensory seeking behaviors).
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Affiliation(s)
- Isabelle Verhulst
- Department of Psychology, Royal Holloway, University of London, Egham, United Kingdom
| | - Keren MacLennan
- School of Psychology and Clinical Language Sciences, The University of Reading, Berkshire, United Kingdom
| | - Anthony Haffey
- School of Psychology and Clinical Language Sciences, The University of Reading, Berkshire, United Kingdom
| | - Teresa Tavassoli
- School of Psychology and Clinical Language Sciences, The University of Reading, Berkshire, United Kingdom
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24
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Lee JK, Andrews DS, Ozturk A, Solomon M, Rogers S, Amaral DG, Nordahl CW. Altered Development of Amygdala-Connected Brain Regions in Males and Females with Autism. J Neurosci 2022; 42:6145-6155. [PMID: 35760533 PMCID: PMC9351637 DOI: 10.1523/jneurosci.0053-22.2022] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Revised: 04/30/2022] [Accepted: 06/08/2022] [Indexed: 02/05/2023] Open
Abstract
Altered amygdala development is implicated in the neurobiology of autism, but little is known about the coordinated development of the brain regions directly connected with the amygdala. Here we investigated the volumetric development of an amygdala-connected network, defined as the set of brain regions with monosynaptic connections with the amygdala, in autism from early to middle childhood. A total of 950 longitudinal structural MRI scans were acquired from 282 children (93 female) with autism and 128 children with typical development (61 female) at up to four time points (mean ages: 39, 52, 64, and 137 months, respectively). Volumes from 32 amygdala-connected brain regions were examined using mixed effects multivariate distance matrix regression. The Social Responsiveness Scale-2 was administered to assess degree of autistic traits and social impairments. The amygdala-connected network exhibited persistent diagnostic differences (p values ≤ 0.03) that increased over time (p values ≤ 0.02). These differences were most prominent in autistics with more impacted social functioning at baseline. This pattern was not observed across regions without monosynaptic amygdala connection. We observed qualitative sex differences. In males, the bilateral subgenual anterior cingulate cortices were most affected, while in females the left fusiform and superior temporal gyri were most affected. In conclusion, (1) autism is associated with widespread alterations to the development of brain regions connected with the amygdala, which were associated with autistic social behaviors; and (2) autistic males and females exhibited different patterns of alterations, adding to a growing body of evidence of sex differences in the neurobiology of autism.SIGNIFICANCE STATEMENT Global patterns of development across brain regions with monosynaptic connection to the amygdala differentiate autism from typical development, and are modulated by social functioning in early childhood. Alterations to brain regions within the amygdala-connected network differed in males and females with autism. Results also indicate larger volumetric differences in regions having monosynaptic connection with the amygdala than in regions without monosynaptic connection.
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Affiliation(s)
- Joshua K Lee
- MIND Institute, University of California Davis School of Medicine, Sacramento, California 95817
- Department of Psychiatry and Behavioral Sciences
| | - Derek S Andrews
- MIND Institute, University of California Davis School of Medicine, Sacramento, California 95817
- Department of Psychiatry and Behavioral Sciences
| | - Arzu Ozturk
- Department of Radiology, University of California Davis School of Medicine, Sacramento, California 95817
| | - Marjorie Solomon
- MIND Institute, University of California Davis School of Medicine, Sacramento, California 95817
- Department of Psychiatry and Behavioral Sciences
| | - Sally Rogers
- MIND Institute, University of California Davis School of Medicine, Sacramento, California 95817
- Department of Psychiatry and Behavioral Sciences
| | - David G Amaral
- MIND Institute, University of California Davis School of Medicine, Sacramento, California 95817
- Department of Psychiatry and Behavioral Sciences
| | - Christine Wu Nordahl
- MIND Institute, University of California Davis School of Medicine, Sacramento, California 95817
- Department of Psychiatry and Behavioral Sciences
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25
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Andrews DS, Aksman L, Kerns CM, Lee JK, Winder-Patel BM, Harvey DJ, Waizbard-Bartov E, Heath B, Solomon M, Rogers SJ, Altmann A, Nordahl CW, Amaral DG. Association of Amygdala Development With Different Forms of Anxiety in Autism Spectrum Disorder. Biol Psychiatry 2022; 91:977-987. [PMID: 35341582 PMCID: PMC9116934 DOI: 10.1016/j.biopsych.2022.01.016] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Revised: 01/18/2022] [Accepted: 01/22/2022] [Indexed: 11/23/2022]
Abstract
BACKGROUND The amygdala is widely implicated in both anxiety and autism spectrum disorder. However, no studies have investigated the relationship between co-occurring anxiety and longitudinal amygdala development in autism. Here, the authors characterize amygdala development across childhood in autistic children with and without traditional DSM forms of anxiety and anxieties distinctly related to autism. METHODS Longitudinal magnetic resonance imaging scans were acquired at up to four time points for 71 autistic and 55 typically developing (TD) children (∼2.5-12 years, 411 time points). Traditional DSM anxiety and anxieties distinctly related to autism were assessed at study time 4 (∼8-12 years) using a diagnostic interview tailored to autism: the Anxiety Disorders Interview Schedule-IV with the Autism Spectrum Addendum. Mixed-effects models were used to test group differences at study time 1 (3.18 years) and time 4 (11.36 years) and developmental differences (age-by-group interactions) in right and left amygdala volume between autistic children with and without DSM or autism-distinct anxieties and TD children. RESULTS Autistic children with DSM anxiety had significantly larger right amygdala volumes than TD children at both study time 1 (5.10% increase) and time 4 (6.11% increase). Autistic children with autism-distinct anxieties had significantly slower right amygdala growth than TD, autism-no anxiety, and autism-DSM anxiety groups and smaller right amygdala volumes at time 4 than the autism-no anxiety (-8.13% decrease) and autism-DSM anxiety (-12.05% decrease) groups. CONCLUSIONS Disparate amygdala volumes and developmental trajectories between DSM and autism-distinct forms of anxiety suggest different biological underpinnings for these common, co-occurring conditions in autism.
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Affiliation(s)
- Derek Sayre Andrews
- Medical Investigation of Neurodevelopmental Disorders (MIND) Institute and Department of Psychiatry and Behavioral Sciences, University of California Davis, Davis, California.
| | - Leon Aksman
- Stevens Neuroimaging and Informatics Institute, Keck School of Medicine of the University of Southern California, Los Angeles, California,Centre for Medical Image Computing, Department of Medical Physics and Biomedical Engineering, University College London, London, United Kingdom
| | - Connor M. Kerns
- Department of Psychology, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Joshua K. Lee
- Medical Investigation of Neurodevelopmental Disorders (MIND) Institute and Department of Psychiatry and Behavioral Sciences, University of California Davis, Davis, California
| | - Breanna M. Winder-Patel
- MIND Institute and Department of Pediatrics, University of California Davis, Davis, California
| | - Danielle Jenine Harvey
- Division of Biostatistics, Department of Public Health Sciences, University of California Davis, Davis, California
| | - Einat Waizbard-Bartov
- MIND Institute and Department of Psychology, University of California Davis, Davis, California
| | - Brianna Heath
- Medical Investigation of Neurodevelopmental Disorders (MIND) Institute and Department of Psychiatry and Behavioral Sciences, University of California Davis, Davis, California
| | - Marjorie Solomon
- Medical Investigation of Neurodevelopmental Disorders (MIND) Institute and Department of Psychiatry and Behavioral Sciences, University of California Davis, Davis, California
| | - Sally J. Rogers
- Medical Investigation of Neurodevelopmental Disorders (MIND) Institute and Department of Psychiatry and Behavioral Sciences, University of California Davis, Davis, California
| | - Andre Altmann
- Centre for Medical Image Computing, Department of Medical Physics and Biomedical Engineering, University College London, London, United Kingdom
| | - Christine Wu Nordahl
- Medical Investigation of Neurodevelopmental Disorders (MIND) Institute and Department of Psychiatry and Behavioral Sciences, University of California Davis, Davis, California
| | - David G. Amaral
- Medical Investigation of Neurodevelopmental Disorders (MIND) Institute and Department of Psychiatry and Behavioral Sciences, University of California Davis, Davis, California
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26
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Spackman E, Lerh JW, Rodgers J, Hollocks MJ, South M, McConachie H, Ozsivadjian A, Vaughan Van Hecke A, Libove R, Hardan AY, Leekam SR, Simonoff E, Frazier TW, Alvares GA, Schwartzman JM, Magiati I, Uljarević M. Understanding the heterogeneity of anxiety in autistic youth: A person-centered approach. Autism Res 2022; 15:1742-1754. [PMID: 35642170 DOI: 10.1002/aur.2744] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Accepted: 04/18/2022] [Indexed: 11/10/2022]
Abstract
The present study aimed to examine anxiety profiles among children and adolescents on the autism spectrum. It further aimed to characterize the association between the identified anxiety profiles and key clinical and developmental variables. The Spence Children's Anxiety Scale-Parent Version (SCAS-P) data from a large international pooled sample of 870 caregivers of autistic children and adolescents (Mage = 11.6 years, SDage = 2.77; 107 females) was used. Latent profile analysis identified a three-anxiety profile solution exhibiting high entropy (0.80) and high latent profile probabilities, with good classification accuracy. Identified profiles fell along the severity spectrum and were named as the mild (n = 498), moderate (n = 272) and severe (n = 100) anxiety profiles. There were no statistically significant differences between the three anxiety profiles in terms of sex distribution. Participants in the mild profile were significantly younger than those in the severe profile, had significantly fewer social communication difficulties than youth in the moderate anxiety profile group and had significantly fewer restricted and repetitive behaviors and lower cognitive functioning scores compared to participants in moderate and severe anxiety profiles. This is the first study to move beyond identifying associations and group-level differences to exploring and identifying characteristics of anxiety-based subgroups at an individual level that differ on key clinical and developmental variables. The subgroups identified in this study are a preliminary, yet important, first step towards informing future assessment and individualized interventions aiming to support young people on the autism spectrum to reduce and manage anxiety. LAY SUMMARY: This study tried to understand if there are subgroups of autistic young people who may have similar anxiety profiles. We found that we could meaningfully group young people into three groups based on how severe the anxiety symptoms their caregivers reported were: a group with low levels of anxiety, those with moderate anxiety, and those with more severe anxiety. We also found that the young people in the mild group were younger, had fewer autism traits and lower levels of intellectual functioning than young people in the other two groups.
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Affiliation(s)
- Emily Spackman
- Melbourne School of Psychological Sciences, University of Melbourne, Melbourne, Victoria, Australia
| | - Jian Wei Lerh
- Department of Psychology, National University of Singapore, Singapore, Singapore
| | - Jacqui Rodgers
- Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
| | - Matthew J Hollocks
- Department of Child & Adolescent Psychiatry, King's College London, London, UK.,Central and North West London NHS Foundation Trust, London, UK
| | - Mikle South
- Emory University School of Medicine, Emory University, Atlanta, Georgia, USA
| | - Helen McConachie
- Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
| | - Ann Ozsivadjian
- Evelina London Children's Hospital, Guys and St Thomas' NHS Foundation Trust, London, UK
| | | | - Robin Libove
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford University, Stanford, California, USA
| | - Antonio Y Hardan
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford University, Stanford, California, USA
| | - Susan R Leekam
- Wales Autism Research Centre, School of Psychology, Cardiff University, Cardiff, UK
| | - Emily Simonoff
- Department of Child & Adolescent Psychiatry, King's College London, London, UK
| | - Thomas W Frazier
- Department of Psychology, John Carroll University, University Heights, Ohio, USA
| | - Gail A Alvares
- School of Psychological Science, University of Western Australia, Perth, Western Australia, Australia
| | - Jessica M Schwartzman
- Vanderbilt Child and Adolescent Psychiatry, Vanderbilt University, Nashville, Tennessee, USA
| | - Iliana Magiati
- School of Psychological Science, University of Western Australia, Perth, Western Australia, Australia
| | - Mirko Uljarević
- Melbourne School of Psychological Sciences, University of Melbourne, Melbourne, Victoria, Australia
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27
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Fombonne E, Croen LA, Bulkley JE, Varga AM, Daida YG, Hatch BA, Dickerson JF, Lynch FL. Emotional and Behavioral Problems in Youth with Autism: High Prevalence and Impact on Functioning. J Dev Behav Pediatr 2022; 43:140-148. [PMID: 34693924 PMCID: PMC9021329 DOI: 10.1097/dbp.0000000000001028] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2021] [Accepted: 09/02/2021] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Emotional and behavioral problems (EBPs) may co-occur with autism spectrum disorder (ASD) and impair children's functioning beyond autism symptomatology. We compared the prevalence of EBPs in youths with or without ASD and evaluated their unique contribution to impairment in ASD. METHODS We surveyed 1267 children (79.4% boys, mean age: 9.2 years, range: 3-17) recruited at 3 sites in Kaiser Permanente and OCHIN primary care clinical networks, with confirmed International Classification of Diseases-10th ed. diagnosis of ASD (N = 564), asthma (N = 468), or neither (N = 429). Children from the 2 comparison groups were age-matched and sex-matched to the ASD group. EBPs and impairment were measured by the Strengths and Difficulties Questionnaire and autism symptomatology by the Social Responsiveness Scale in the ASD group only. RESULTS EBPs and impairment mean scores were significantly (p < 0.001) higher in participants with ASD compared with children from the 2 comparison groups, across sexes and age groups, with no significant difference between the asthma and control groups. Among children with ASD, both EBPs and autistic symptoms were significantly correlated with impairment (r = 0.64 and r = 0.65, respectively) and explained a significant proportion of impairment variance (R2 = 0.525; p < 0.001) in multiple linear regression. In the relative importance analysis, EBPs and autistic symptoms explained comparable proportions of impairment variance (46% and 52%, respectively) with no significant difference between their relative weights (mean difference: 0.03; 95% confidence interval: -0.049 to 0.114). CONCLUSION Among youth with ASD, high levels of EBPs impair daily functioning as much as autistic symptoms. Systematic detection and management of EBPs may improve functioning and outcomes in youth with ASD.
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Affiliation(s)
| | | | - Joanna E. Bulkley
- Center for Health Research, Kaiser Permanente Northwest, Portland, OR
| | | | - Yihe G. Daida
- Center for Integrated Health Care Research, Kaiser Permanente, Honolulu, HI
| | - Brigit A. Hatch
- Oregon Health & Science University, Portland, OR
- OCHIN, Inc., Portland, OR
| | - John F. Dickerson
- Center for Health Research, Kaiser Permanente Northwest, Portland, OR
| | - Frances L. Lynch
- Center for Health Research, Kaiser Permanente Northwest, Portland, OR
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28
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Predictors of Suicidal Thoughts in Children with Autism Spectrum Disorder and Anxiety or Obsessive-Compulsive Disorder: The Unique Contribution of Externalizing Behaviors. Child Psychiatry Hum Dev 2022; 53:223-236. [PMID: 33462740 DOI: 10.1007/s10578-020-01114-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/09/2020] [Indexed: 12/28/2022]
Abstract
Children with autism spectrum disorder (ASD) are at elevated risk of suicidal ideation, particularly those with comorbid anxiety disorders and/or obsessive-compulsive disorder (OCD). We investigated the risk factors associated with suicidal ideation in 166 children with ASD and comorbid anxiety disorders/OCD, and the unique contribution of externalizing behaviors. Suicidal ideation was reported in the child sample by 13% of parents. Controlling for child age, sex, and IQ, perceived loneliness positively predicted the likelihood of suicidal ideation. In addition, externalizing behaviors positively predicted suicidal ideation, controlling for all other factors. Reliance on parental report to detect suicidal ideation in youth with ASD is a limitation of this study. Nonetheless, these findings highlight the importance of assessing and addressing suicidal ideation in children with ASD and comorbid anxiety disorders/OCD, and more importantly in those with elevated externalizing behaviors and perceptions of loneliness.
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Abstract
PURPOSE OF REVIEW To summarize recent findings regarding anxiety and trauma-related disorders in children diagnosed with autism spectrum disorder (autism), focusing on the distinct ways in which these conditions may be expressed, as well as advances in evidence-based assessment and treatment. RECENT FINDINGS Current findings suggest both anxiety and trauma-related disorders may be more prevalent, yet more complicated to address in autistic relative to non-autistic children. Overlapping symptoms and distinct manifestations of these disorders pose challenges for the accurate identification, assessment, and treatment of anxiety and trauma-related disorders in autistic children. Emerging evidence recommends adapting traditional assessment and treatment approaches to better meet the needs of autistic children. Recent research suggests autism-centered conceptualizations, which accommodate complexity in how anxiety and trauma-related disorders are experienced and expressed by autistic people, are needed to enhance the psychiatric care of this population.
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30
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Moskowitz LJ, Braconnier M. Assessing anxiety in youth with autism spectrum disorder. PSYCHOLOGY IN THE SCHOOLS 2022. [DOI: 10.1002/pits.22669] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
| | - Megan Braconnier
- Department of Psychology St. John's University New York City New York USA
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31
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Rosen TE, Pickard K, Ponomaryova A, Kerns CM, Reaven J. From Clinic to Classroom: Two Case Studies of Youth With ASD and Anxiety From the School-Based Facing Your Fears Program. J Cogn Psychother 2022; 36:24-41. [PMID: 35121677 DOI: 10.1891/jcpsy-d-20-00051] [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: 11/25/2022]
Abstract
Cognitive behavioral therapy (CBT) is considered best practice for treating anxiety in youth with autism spectrum disorder (ASD) in clinic settings. However, there is significant need to translate CBT into school settings. This paper presents two case illustrations of students who participated in the Facing Your Fears: School-Based program (FYF-SB), a manualized, group CBT intervention for anxiety in ASD, adapted for delivery in schools by interdisciplinary school providers. Students showed improvement in anxiety across multiple domains following intervention, according to clinical interview and parent- and self-report. These outcomes suggest that anxious youth with ASD can benefit from CBT delivered by interdisciplinary school providers. Importantly, decreases in anxiety symptoms were evident in domains that were not explicitly targeted during intervention. Overall, these case illustrations help frame areas of future research, including examining how treatment gains may generalize across anxiety domains as well as whether corresponding improvement in school functioning occurs.
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Affiliation(s)
- Tamara E Rosen
- JFK Partners, Department of Psychiatry and Pediatrics, University of Colorado, Aurora, Colorado, USA
| | - Katherine Pickard
- Marcus Autism Center, Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, USA
| | - Anastasiya Ponomaryova
- Department of Psychiatry and Behavioral Sciences, Montefiore Hospital/Albert Einstein College of Medicine, Bronx, New York, USA
| | - Connor M Kerns
- Department of Psychology, University of British Columbia, Vancouver, BC, Canada
| | - Judy Reaven
- JFK Partners, Department of Psychiatry and Pediatrics, University of Colorado, Aurora, Colorado, USA
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32
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Hunsche MC, Cervin M, Storch EA, Kendall PC, Wood JJ, Kerns CM. Social functioning and the presentation of anxiety in children on the autism spectrum: A multimethod, multiinformant analysis. JOURNAL OF PSYCHOPATHOLOGY AND CLINICAL SCIENCE 2022; 131:198-208. [PMID: 35230861 PMCID: PMC9439580 DOI: 10.1037/abn0000724] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Co-occurring anxiety in children on the autism spectrum is associated with greater social challenges, including poorer social skills and relationships, which may influence the severity and presentation of anxiety symptoms, particularly social anxiety. The current study used Bayesian network analytics (Williams & Mulder, 2020) and a multimethod approach to examine (a) how different facets of social functioning relate to one another and to anxiety severity and comorbidity, (b) which facet(s) are most influential and thus may represent optimal targets for intervention, and (c) how social functioning relates to the presentation of social fears in a large treatment-seeking sample of autistic children with anxiety disorders (n = 191, 7-13 years). Results indicated strong associations among measures of social ability (i.e., theory of mind [ToM], social motivation, friendship attainment) and among measures of social integration (i.e., bullying, interpersonal and peer difficulties), with only bullying demonstrating a significant association with anxiety. ToM was the most interconnected variable in the network, and social motivation demonstrated the strongest individual connections with other variables, particularly with other facets of social ability. Socially anxious children with impaired ToM were less likely to express fears of negative evaluation, resulting in a distinct diagnostic presentation of social fears. Findings suggest that social motivation and ToM may represent important targets for intervention for autistic children with co-occurring anxiety. Further, social-cognitive difficulties associated with autism, like ToM, may play a role in distinct manifestations of anxiety in these youth. (PsycInfo Database Record (c) 2022 APA, all rights reserved).
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Affiliation(s)
- Michelle C. Hunsche
- University of British Columbia, 2136 West Mall, Vancouver, BC V6T IZ4, Canada
| | | | - Eric A. Storch
- Baylor College of Medicine, 1 Baylor Plaza, Houston, TX 77030, United States
| | - Philip C. Kendall
- Temple University, 1801 N Broad St, Philadelphia, PA 19122, United States
| | - Jeffrey J. Wood
- University of California, Los Angeles (UCLA) Los Angeles, CA 90095, United States
| | - Connor M. Kerns
- University of British Columbia, 2136 West Mall, Vancouver, BC V6T IZ4, Canada
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33
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Nordahl CW, Andrews DS, Dwyer P, Waizbard-Bartov E, Restrepo B, Lee JK, Heath B, Saron C, Rivera SM, Solomon M, Ashwood P, Amaral DG. The Autism Phenome Project: Toward Identifying Clinically Meaningful Subgroups of Autism. Front Neurosci 2022; 15:786220. [PMID: 35110990 PMCID: PMC8801875 DOI: 10.3389/fnins.2021.786220] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Accepted: 12/20/2021] [Indexed: 12/23/2022] Open
Abstract
One of the most universally accepted facts about autism is that it is heterogenous. Individuals diagnosed with autism spectrum disorder have a wide range of behavioral presentations and a variety of co-occurring medical and mental health conditions. The identification of more homogenous subgroups is likely to lead to a better understanding of etiologies as well as more targeted interventions and treatments. In 2006, we initiated the UC Davis MIND Institute Autism Phenome Project (APP) with the overarching goal of identifying clinically meaningful subtypes of autism. This ongoing longitudinal multidisciplinary study now includes over 400 children and involves comprehensive medical, behavioral, and neuroimaging assessments from early childhood through adolescence (2-19 years of age). We have employed several strategies to identify sub-populations within autistic individuals: subgrouping by neural, biological, behavioral or clinical characteristics as well as by developmental trajectories. In this Mini Review, we summarize findings to date from the APP cohort and describe progress made toward identifying meaningful subgroups of autism.
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Affiliation(s)
- Christine Wu Nordahl
- MIND Institute, University of California, Davis, Davis, CA, United States
- Department of Psychiatry and Behavioral Sciences, School of Medicine, University of California, Davis, Davis, CA, United States
| | - Derek Sayre Andrews
- MIND Institute, University of California, Davis, Davis, CA, United States
- Department of Psychiatry and Behavioral Sciences, School of Medicine, University of California, Davis, Davis, CA, United States
| | - Patrick Dwyer
- Center for Mind and Brain, University of California, Davis, Davis, CA, United States
- Department of Psychology, University of California, Davis, Davis, CA, United States
| | - Einat Waizbard-Bartov
- MIND Institute, University of California, Davis, Davis, CA, United States
- Department of Psychiatry and Behavioral Sciences, School of Medicine, University of California, Davis, Davis, CA, United States
| | - Bibiana Restrepo
- MIND Institute, University of California, Davis, Davis, CA, United States
- Department of Pediatrics, School of Medicine, University of California, Davis, Davis, CA, United States
| | - Joshua K. Lee
- MIND Institute, University of California, Davis, Davis, CA, United States
- Department of Psychiatry and Behavioral Sciences, School of Medicine, University of California, Davis, Davis, CA, United States
| | - Brianna Heath
- MIND Institute, University of California, Davis, Davis, CA, United States
- Department of Psychiatry and Behavioral Sciences, School of Medicine, University of California, Davis, Davis, CA, United States
| | - Clifford Saron
- MIND Institute, University of California, Davis, Davis, CA, United States
- Center for Mind and Brain, University of California, Davis, Davis, CA, United States
| | - Susan M. Rivera
- MIND Institute, University of California, Davis, Davis, CA, United States
- Center for Mind and Brain, University of California, Davis, Davis, CA, United States
- Department of Psychology, University of California, Davis, Davis, CA, United States
| | - Marjorie Solomon
- MIND Institute, University of California, Davis, Davis, CA, United States
- Department of Psychiatry and Behavioral Sciences, School of Medicine, University of California, Davis, Davis, CA, United States
| | - Paul Ashwood
- MIND Institute, University of California, Davis, Davis, CA, United States
- Department of Medical Microbiology and Immunology, School of Medicine, University of California, Davis, Davis, CA, United States
| | - David G. Amaral
- MIND Institute, University of California, Davis, Davis, CA, United States
- Department of Psychiatry and Behavioral Sciences, School of Medicine, University of California, Davis, Davis, CA, United States
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Winder-Patel B, Tudor ME, Kerns CM, Davis K, Nordahl CW, Amaral DG, Solomon M. Often Undiagnosed but Treatable: Case Vignettes and Clinical Considerations for Assessing Anxiety Disorders in Youth with Autism Spectrum Disorder and Intellectual Disability. EVIDENCE-BASED PRACTICE IN CHILD AND ADOLESCENT MENTAL HEALTH 2022; 7:24-40. [PMID: 35284637 PMCID: PMC8916744 DOI: 10.1080/23794925.2021.1923090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Affiliation(s)
- Breanna Winder-Patel
- The MIND Institute, Sacramento, CA,Department of Pediatrics, University of California, Davis, Davis, CA
| | - Megan E. Tudor
- The MIND Institute, Sacramento, CA,Department of Pediatrics, University of California, Davis, Davis, CA
| | - Connor M. Kerns
- Department of Psychology, University of British Columbia, Vancouver, BC, Canada
| | - Konnor Davis
- The MIND Institute, Sacramento, CA,Department of Psychiatry and Behavioral Sciences, University of California Davis, Davis, CA, USA
| | - Christine Wu Nordahl
- The MIND Institute, Sacramento, CA,Department of Psychiatry and Behavioral Sciences, University of California Davis, Davis, CA, USA
| | - David G. Amaral
- The MIND Institute, Sacramento, CA,Department of Psychiatry and Behavioral Sciences, University of California Davis, Davis, CA, USA
| | - Marjorie Solomon
- The MIND Institute, Sacramento, CA,Department of Psychiatry and Behavioral Sciences, University of California Davis, Davis, CA, USA
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Kerns CM, Winder-Patel B, Iosif AM, Nordahl CW, Heath B, Solomon M, Amaral DG. Clinically Significant Anxiety in Children with Autism Spectrum Disorder and Varied Intellectual Functioning. JOURNAL OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY : THE OFFICIAL JOURNAL FOR THE SOCIETY OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY, AMERICAN PSYCHOLOGICAL ASSOCIATION, DIVISION 53 2021; 50:780-795. [PMID: 31971849 PMCID: PMC9372909 DOI: 10.1080/15374416.2019.1703712] [Citation(s) in RCA: 60] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Objective: To evaluate how distinct presentations of anxiety symptoms and intellectual impairment influence the measurement and estimated rate of clinically significant anxiety in autism spectrum disorder (ASD).Method: The sample included 75 children (ages 9-13 years) with ASD and varied IQ and 52 typically developing (TD) controls and parents. Parents completed anxiety symptom scales and a diagnostic interview, designed to (1) differentiate anxiety and ASD and (2) examine DSM-specified and unspecified ("distinct") anxiety presentations in each child, including fears of change, special interests, idiosyncratic stimuli and social confusion rather than evaluation. Children completed standard intellectual and ASD diagnostic assessments.Results: 69% of those with ASD had clinically-significant anxiety, including 21% DSM-specified anxiety disorders, 17% distinct anxiety, and 31% both. Only 8% of TD children had clinically-significant anxiety, all DSM-specified. DSM-specified anxiety disorders in children with ASD and intellectual impairment (IQ<70) were predominantly specific phobias. DSM-specified anxiety other than specific phobia was significantly less common in children with, versus without, intellectual impairment; this was not the case for distinct anxiety. The sensitivities of anxiety scales were moderate to poor, particularly in cases with intellectual impairment.Conclusions: ASD is associated with more frequent and varied presentations of clinical anxiety, which may align with and differ from the specified anxiety disorders of the DSM. Standard parent report anxiety scales have reduced sensitivity to detect clinical anxiety in ASD, particularly in children with intellectual impairment.
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Affiliation(s)
- Connor M Kerns
- Department of Psychology, University of British Columbia
| | | | - Ana Maria Iosif
- Division of Biostatistics, Department of Public Health Sciences, University of California
- Department of Psychiatry and Behavioral Sciences, UC Davis
| | - Christine Wu Nordahl
- The MIND Institute, UC Davis
- Department of Psychiatry and Behavioral Sciences, UC Davis
| | - Brianna Heath
- The MIND Institute, UC Davis
- Department of Psychiatry and Behavioral Sciences, UC Davis
| | - Marjorie Solomon
- The MIND Institute, UC Davis
- Department of Psychiatry and Behavioral Sciences, UC Davis
| | - David G Amaral
- The MIND Institute, UC Davis
- Department of Psychiatry and Behavioral Sciences, UC Davis
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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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Tung R, Reiter MA, Linke A, Kohli JS, Kinnear MK, Müller RA, Carper RA. Functional connectivity within an anxiety network and associations with anxiety symptom severity in middle-aged adults with and without autism. Autism Res 2021; 14:2100-2112. [PMID: 34264028 DOI: 10.1002/aur.2579] [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] [Received: 12/17/2020] [Revised: 06/29/2021] [Accepted: 06/30/2021] [Indexed: 12/20/2022]
Abstract
Anxiety is highly prevalent in autism spectrum disorders (ASDs). However, few functional magnetic resonance imaging (fMRI) studies of ASDs have focused on anxiety (and fewer still on anxiety in middle-aged adults). Thus, relationships between atypical connectivity and anxiety in this population are poorly understood. The current study contrasted functional connectivity within anxiety network regions across adults (40-64 years) with and without autism, and tested for group by functional connectivity interactions on anxiety. Twenty-two adults with ASDs (16 males) and 26 typical control (TC) adults (22 males) completed the Beck Anxiety Inventory and a resting-state fMRI scan. An anxiety network consisting of 12 regions of interest was defined, based on a meta-analysis in TC individuals and two studies on anxiety in ASDs. We tested for main effects of group and group by anxiety interactions on connectivity within this anxiety network, controlling for head motion using ANCOVA. Results are reported at an FDR adjusted threshold of q < 0.1 (corrected) and p < 0.05 (uncorrected). Adults with ASDs showed higher anxiety and underconnectivity within the anxiety network, mostly involving bilateral insula. Connectivity within the anxiety network in the ASD group showed distinct relationships with anxiety symptoms that did not relate to ASD symptom severity. Functional connectivity involving the bilateral posterior insula was positively correlated with anxiety in the ASD (but not the TC) group. Increased anxiety in middle-aged adults with ASD is associated with atypical functional connectivity, predominantly involving bilateral insula. Results were not related to ASD symptom severity suggesting independence of anxiety-related effects. LAY SUMMARY: Anxiety is very common in adults with autism but the brain basis of this difference is not well understood. We compared functional connectivity between anxiety-related brain regions in middle-aged adults with and without autism. Adults with autism were more anxious and showed weaker functional connections between these regions. Some relationships between functional connectivity and higher anxiety were specific to the autism group. Results suggest that anxiety functions differently in autism.
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Affiliation(s)
- Ryan Tung
- Brain Development Imaging Laboratories, Department of Psychology, San Diego State University, San Diego, California, USA.,Center for Autism and Development Disorders, Department of Psychology, San Diego State University, San Diego, California, USA
| | - Maya A Reiter
- Brain Development Imaging Laboratories, Department of Psychology, San Diego State University, San Diego, California, USA.,Center for Autism and Development Disorders, Department of Psychology, San Diego State University, San Diego, California, USA.,San Diego Joint Doctoral Program in Clinical Psychology, San Diego State University/University of California, San Diego, California, USA
| | - Annika Linke
- Brain Development Imaging Laboratories, Department of Psychology, San Diego State University, San Diego, California, USA.,Center for Autism and Development Disorders, Department of Psychology, San Diego State University, San Diego, California, USA
| | - Jiwandeep S Kohli
- Brain Development Imaging Laboratories, Department of Psychology, San Diego State University, San Diego, California, USA.,Center for Autism and Development Disorders, Department of Psychology, San Diego State University, San Diego, California, USA.,San Diego Joint Doctoral Program in Clinical Psychology, San Diego State University/University of California, San Diego, California, USA
| | - Mikaela K Kinnear
- Brain Development Imaging Laboratories, Department of Psychology, San Diego State University, San Diego, California, USA.,Center for Autism and Development Disorders, Department of Psychology, San Diego State University, San Diego, California, USA
| | - Ralph-Axel Müller
- Brain Development Imaging Laboratories, Department of Psychology, San Diego State University, San Diego, California, USA.,Center for Autism and Development Disorders, Department of Psychology, San Diego State University, San Diego, California, USA.,San Diego Joint Doctoral Program in Clinical Psychology, San Diego State University/University of California, San Diego, California, USA
| | - Ruth A Carper
- Brain Development Imaging Laboratories, Department of Psychology, San Diego State University, San Diego, California, USA.,Center for Autism and Development Disorders, Department of Psychology, San Diego State University, San Diego, California, USA.,San Diego Joint Doctoral Program in Clinical Psychology, San Diego State University/University of California, San Diego, California, USA
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Nathanson EW, Rispoli KM. School Psychologists’ Assessment Practices for Students with Co-Occurring Anxiety and Autism Spectrum Disorder. JOURNAL OF APPLIED SCHOOL PSYCHOLOGY 2021. [DOI: 10.1080/15377903.2021.1941468] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- Emma W. Nathanson
- Department of Counseling, Educational Psychology and Special Education, Michigan State University, East Lansing, Michigan, USA
| | - Kristin M. Rispoli
- Department of Counseling, Educational Psychology and Special Education, Michigan State University, East Lansing, Michigan, USA
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Chew XY, Leong DJ, Khor KM, Tan GMY, Wei KC, Magiati I. Clarifying Self-Report Measures of Social Anxiety and Obsessive-Compulsive Disorder to Improve Reporting for Autistic Adults. AUTISM IN ADULTHOOD 2021; 3:129-146. [PMID: 36601465 PMCID: PMC8992892 DOI: 10.1089/aut.2019.0064] [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] [Indexed: 01/07/2023]
Abstract
Background Phenotypic similarities exist between autism-related experiences and anxiety (especially social anxiety and obsessive-compulsive disorder [OCD]), making it difficult for autistic people to self-report their experiences using existing measures developed for nonautistic adults. We examined whether clarifications aiming to tease out autism-related experiences from social anxiety or OCD in self-report questionnaires would influence autistic and nonautistic participants' ratings. Methods Two autistic consultants and two experienced clinicians were consulted to develop item clarifications aiming to disentangle autistic from anxiety experiences for two questionnaires: the Social Anxiety Questionnaire (SAQ) and the Padua Inventory (PI) for OCD. Autistic adults (n = 50) and nonautistic university students with higher (n = 81) and lower autistic traits (ATs; n = 104) completed the original questionnaire followed by the clarified questionnaire items online. Results For social anxiety, there were few significant differences between the original and clarified item and total SAQ scores. For OCD, participants reported significantly lower scores for the OCD-clarified PI items than for the original items and the autism-clarified items. Larger original-clarified PI mean item differences were noted in items describing repetitive behaviors, "obsessional" thoughts, and contamination fears. Similar patterns of differences were found in autistic and nonautistic participants with higher and lower ATs, but differences were often larger in the autistic group. Conclusion The SAQ in its original form appears to be an appropriate measure for autistic people to self-report social anxiety. However, autistic people appeared to complete the original PI items to reflect, to some extent, their autism-related experiences, rather than the originally intended OCD symptoms. Thus, the original OCD self-report ratings were inflated using the PI. Professionals should therefore clarify the intended meanings of different items of the PI to ensure more accurate and relevant ratings of OCD symptoms in autistic people. Lay summary Why was this study done?: Autistic people and people with higher autistic traits (ATs) often experience higher rates of anxiety. Anxiety measures developed for the general population may not be appropriate or accurate for measuring anxiety in autistic people. We investigated whether clarifying items in existing self-report questionnaires to tease out anxiety from autistic experiences would influence the way autistic adults self-report their social anxiety and obsessive-compulsive disorder (OCD) symptoms, and if so in what ways. We also wanted to know whether providing these item clarifications would affect the ratings of nonautistic individuals with varying rates of ATs to the same extent.What did the researchers do?: We initially consulted two autistic adults and two clinicians with experience working with autistic adults and co-occurring mental health difficulties. We selected two measures: the Social Anxiety Questionnaire (SAQ) for social anxiety symptoms and the Padua Inventory for OCD symptoms. The consultants identified social anxiety and OCD items that could be interpreted or experienced differently by autistic people and proposed ways to clarify them to make their meaning clearer.Next, 50 autistic people and 185 nonautistic university students participated in our online study. The nonautistic participants were grouped into those with higher or lower ATs. Participants completed the original social anxiety and OCD questionnaires first, followed by the clarified versions of the two questionnaires.What were the results of the study?: For social anxiety, we only found small differences in ratings when participants used measures with or without clarifications. This was true in both autistic and nonautistic participants. For OCD symptoms, autistic people's OCD ratings were significantly lower for many items after we provided clarifications, especially for items describing repetitive behaviors, "obsessional" thoughts, and contamination fears. This finding suggests that in the original questionnaire, autistic people may have also been rating their autism-related experiences, not just the OCD experiences or symptoms the questionnaire was trying to measure. We found similar differences between the original and clarified item ratings in nonautistic participants with higher and lower ATs. However, the differences were more common and pronounced with the autistic participants.What do these findings add to what was already known?: These findings suggest that original self-report measures of anxiety may need to be clarified so that autistic adults can better capture and rate their anxiety, rather than their autism-related experiences.What are potential weaknesses in the study?: We used only two anxiety questionnaires, so these findings may or may not be applicable to other OCD or social anxiety questionnaires available. Also, the clarifications we provided may not be representative of all autistic people's experiences, and it is possible that there are other and better ways to clarify the items. We also conducted many item comparisons in this study, so there is a possibility that some findings were due to chance.How will these findings help autistic adults now or in the future?: Our findings can help improve clinical interviews and use of anxiety questionnaires by making them more accurate. They can also help clinicians appreciate the importance of asking clarifying questions to ensure they better capture autistic adults' anxiety experiences.
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Affiliation(s)
- Xie Yin Chew
- Department of Psychology, National University of Singapore, Singapore, Singapore
| | - Dawn-joy Leong
- Autistic Consultant, Independent Researcher and Multi-Artist, Singapore, Singapore
| | | | - Giles Ming Yee Tan
- Adult Neurodevelopmental Service, Department of Developmental Psychiatry, Institute of Mental Health, Singapore, Singapore
| | - Ker-Chiah Wei
- Adult Neurodevelopmental Service, Department of Developmental Psychiatry, Institute of Mental Health, Singapore, Singapore
| | - Iliana Magiati
- Department of Psychology, National University of Singapore, Singapore, Singapore.,Address correspondence to: Iliana Magiati, DClinPsy, PhD, School of Psychological Science, The University of Western Australia (M304), 35 Stirling Highway, Perth 6009, Western Australia, Australia
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40
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MacLennan K, Rossow T, Tavassoli T. The relationship between sensory reactivity, intolerance of uncertainty and anxiety subtypes in preschool-age autistic children. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2021; 25:2305-2316. [PMID: 34030518 DOI: 10.1177/13623613211016110] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
LAY ABSTRACT This study found links between greater sensory hyperreactivity (e.g., over-sensitive to sensory input), intolerance of uncertainty and anxiety, including separation anxiety, in autistic pre-schoolers. Sensory hyperreactivity may predict both anxiety and intolerance of uncertainty, and anxiety and intolerance of uncertainty may both be mutually important, mediating factors. These findings have implications for early anxiety interventions. But there is a pressing need for objective assessments that can be used with preschool-age autistic children.
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Rumball F, Antal K, Happé F, Grey N. Co-occurring mental health symptoms and cognitive processes in trauma-exposed ASD adults. RESEARCH IN DEVELOPMENTAL DISABILITIES 2021; 110:103836. [PMID: 33453693 DOI: 10.1016/j.ridd.2020.103836] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Revised: 11/24/2020] [Accepted: 12/12/2020] [Indexed: 06/12/2023]
Abstract
BACKGROUND Mental health problems are common amongst adults with an Autism Spectrum Disorder (ASD). Stressful and traumatic life events can trigger or exacerbate symptoms of anxiety, depression and PTSD. In the general population, transdiagnostic processes such as suppression and perseverative thinking are associated with responses to trauma and mental health symptoms. AIMS This study explored the relationships between thought suppression, perseverative thinking and symptoms of depression, anxiety and PTSD in ASD adults who reported exposure to a range of DSM-5 and non-DSM-5 traumatic events. METHODS 59 ASD adults completed a series of online self-report questionnaires measuring trauma, transdiagnostic cognitive processes, and mental health symptoms. RESULTS Probable PTSD rarely occurred in isolation and was associated with depression and anxiety symptoms in trauma-exposed ASD adults. All cognitive processes and mental health symptoms were positively associated with one another, regardless of whether the trauma met DSM-5 PTSD Criterion A. When accounting for both cognitive processes, only thought suppression significantly predicted PTSD and anxiety symptoms, while only perseverative thinking significantly predicted depression symptoms. CONCLUSIONS AND IMPLICATIONS These preliminary results suggest that different cognitive processes more strongly affect anxiety/PTSD versus depression symptom severity in trauma-exposed ASD adults, although co-occurring symptoms are common. Implications for assessment, treatment and future research are discussed.
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Affiliation(s)
- Freya Rumball
- King's College London, Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology and Neuroscience - PO80, De Crespigny Park, Denmark Hill, London, SE5 8AF, United Kingdom.
| | - Kinga Antal
- King's College London, Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology and Neuroscience - PO80, De Crespigny Park, Denmark Hill, London, SE5 8AF, United Kingdom
| | - Francesca Happé
- King's College London, Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology and Neuroscience - PO80, De Crespigny Park, Denmark Hill, London, SE5 8AF, United Kingdom
| | - Nick Grey
- King's College London, Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology and Neuroscience - PO80, De Crespigny Park, Denmark Hill, London, SE5 8AF, United Kingdom; Sussex Partnership NHS Foundation Trust, United Kingdom
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Smith K, Hogan AL, Will E, Roberts JE. Attention Bias and Prodromal Anxiety Symptoms in Toddlers With Fragile X Syndrome and Down Syndrome. AMERICAN JOURNAL ON INTELLECTUAL AND DEVELOPMENTAL DISABILITIES 2021; 126:167-181. [PMID: 33651888 PMCID: PMC8108623 DOI: 10.1352/1944-7558-126.2.167] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/21/2019] [Accepted: 11/10/2020] [Indexed: 06/12/2023]
Abstract
Early identification of behavioral risk markers for anxiety is essential to optimize long-term outcomes in children with neurodevelopmental disorders. This study analyzed attentional avoidance and its relation to anxiety and autism spectrum disorder (ASD) symptomatology during social and nonsocial fear conditions in toddlers with fragile X syndrome (FXS) and Down syndrome (DS). Toddlers with FXS and DS exhibited increased nonsocial attentional avoidance relative to typically developing (TD) toddlers. Attentional avoidance was not related to anxiety symptom severity in any group; however, higher ASD symptom severity was related to more social attentional avoidance in the FXS and TD groups. Findings suggest that there may be different underlying mechanisms driving attentional avoidance across neurodevelopmental disorders.
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Affiliation(s)
- Kayla Smith
- Kayla Smith, Abigail L. Hogan, Elizabeth Will, and Jane E. Roberts, University of South Carolina
| | - Abigail L Hogan
- Kayla Smith, Abigail L. Hogan, Elizabeth Will, and Jane E. Roberts, University of South Carolina
| | - Elizabeth Will
- Kayla Smith, Abigail L. Hogan, Elizabeth Will, and Jane E. Roberts, University of South Carolina
| | - Jane E Roberts
- Kayla Smith, Abigail L. Hogan, Elizabeth Will, and Jane E. Roberts, University of South Carolina
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43
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Functional brain abnormalities associated with comorbid anxiety in autism spectrum disorder. Dev Psychopathol 2021; 32:1273-1286. [PMID: 33161905 DOI: 10.1017/s0954579420000772] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Anxiety disorders are common in autism spectrum disorder (ASD) and associated with social-communication impairment and repetitive behavior symptoms. The neurobiology of anxiety in ASD is unknown, but amygdala dysfunction has been implicated in both ASD and anxiety disorders. Using resting-state functional magnetic resonance imaging, we compared amygdala-prefrontal and amygdala-striatal connections across three demographically matched groups studied in the Autism Brain Imaging Data Exchange (ABIDE): ASD with a comorbid anxiety disorder (N = 25; ASD + Anxiety), ASD without a comorbid disorder (N = 68; ASD-NoAnx), and typically developing controls (N = 139; TD). Relative to ASD-NoAnx and TD controls, ASD + Anxiety individuals had decreased connectivity between the amygdala and dorsal/rostral anterior cingulate cortex (dACC/rACC). The functional connectivity of these connections was not affected in ASD-NoAnx, and amygdala connectivity with ventral ACC/medial prefrontal cortex (mPFC) circuits was not different in ASD + Anxiety or ASD-NoAnx relative to TD. Decreased amygdala-dorsomedial prefrontal cortex (dmPFC)/rACC connectivity was associated with more severe social impairment in ASD + Anxiety; amygdala-striatal connectivity was associated with restricted, repetitive behavior (RRB) symptom severity in ASD-NoAnx individuals. These findings suggest comorbid anxiety in ASD is associated with disrupted emotion-monitoring processes supported by amygdala-dACC/mPFC pathways, whereas emotion regulation systems involving amygdala-ventromedial prefrontal cortex (vmPFC) are relatively spared. Our results highlight the importance of accounting for comorbid anxiety for parsing ASD neurobiological heterogeneity.
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Steele M, Uljarević M, Rached G, Frazier TW, Phillips JM, Libove RA, Busch RM, Klaas P, Martinez-Agosto JA, Srivastava S, Eng C, Sahin M, Hardan AY. Psychiatric Characteristics Across Individuals With PTEN Mutations. Front Psychiatry 2021; 12:672070. [PMID: 34489750 PMCID: PMC8418135 DOI: 10.3389/fpsyt.2021.672070] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Accepted: 04/27/2021] [Indexed: 11/13/2022] Open
Abstract
Germline heterozygous PTEN mutations have been associated with high prevalence of autism spectrum disorder (ASD) and elevated rates and severity of broadly defined behavioral problems. However, limited progress has been made toward understanding whether PTEN mutation is associated with specific psychiatric co-morbidity profiles when compared to idiopathic ASD. The current study aimed to utilize a cross-measure approach to compare concurrent psychiatric characteristics across children and adolescents with PTEN mutation with (PTEN-ASD; n = 38) and without ASD (PTEN-No ASD; n = 23), and ASD with macrocephaly but no PTEN mutation (macro-ASD; n = 25) using the Child Behavior Checklist (CBCL) and the Aberrant Behavior Checklist (ABC). There were significant group effects for the CBCL Internalizing and Externalizing broad symptom score, the majority of specific CBCL syndrome scores, and all ABC subscale scores. Post-hoc comparisons revealed greater behavioral symptoms in the ASD groups (PTEN-ASD and macro-ASD) compared to the PTEN-no ASD group on nearly all subtest scores examined. There were no statistically significant differences between the PTEN-ASD and macro-ASD groups; however, there was a trend for the macro-ASD group showing higher levels of aggressive behaviors. Our findings provide evidence of specific behavior profiles across PTEN-No ASD, PTEN-ASD, and macro-ASD groups and highlight the importance of early identification of behavioral vulnerabilities in individuals with PTEN mutations in order to provide access to appropriate evidence-based interventions.
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Affiliation(s)
- Morgan Steele
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA, United States
| | - Mirko Uljarević
- The School of Psychological Sciences, University of Melbourne, Melbourne, VIC, Australia.,La Trobe University, Melbourne, VIC, Australia
| | - Gaëlle Rached
- Saint Joseph University, Faculty of Medicine, Beirut, Lebanon
| | - Thomas W Frazier
- Autism Speaks, New York, NY, United States.,Department of Psychology, John Carroll University, University Heights, OH, United States
| | - Jennifer M Phillips
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA, United States
| | - Robin A Libove
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA, United States
| | - Robyn M Busch
- Genomic Medicine Institute, Cleveland, OH, United States.,Neurological Institute, Cleveland Clinic, Cleveland, OH, United States
| | - Patricia Klaas
- Neurological Institute, Cleveland Clinic, Cleveland, OH, United States
| | - Julian A Martinez-Agosto
- Departments of Human Genetics, Pediatrics and Psychiatry, University of California, Los Angeles, Los Angeles, CA, United States
| | - Siddharth Srivastava
- Translational Neuroscience Center, Department of Neurology, Boston Children's Hospital, Harvard Medical School, Boston, MA, United States
| | - Charis Eng
- Genomic Medicine Institute, Cleveland, OH, United States.,Department of Genetics and Genome Sciences, Case Western University School of Medicine, Cleveland, OH, United States
| | - Mustafa Sahin
- Department of Neurology, Rosamund Stone Zander Translational Neuroscience Center, Boston Children's Hospital, Harvard Medical School, Boston, MA, United States
| | - Antonio Y Hardan
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA, United States
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Hessl D, Libero L, Schneider A, Kerns C, Winder-Patel B, Heath B, Lee J, Coleman C, Sharma N, Solomon M, Nordahl CW, Amaral DG. Fear Potentiated Startle in Children With Autism Spectrum Disorder: Association With Anxiety Symptoms and Amygdala Volume. Autism Res 2020; 14:450-463. [PMID: 33372389 DOI: 10.1002/aur.2460] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Revised: 12/05/2020] [Accepted: 12/08/2020] [Indexed: 12/16/2022]
Abstract
Atypical responses to fearful stimuli and the presence of various forms of anxiety are commonly seen in children with autism spectrum disorder (ASD). The fear potentiated startle paradigm (FPS), which has been studied both in relation to anxiety and as a probe for amygdala function, was carried out in 97 children aged 9-14 years including 48 (12 female) with ASD and 49 (14 female) with typical development (TD). In addition, exploratory analyses were conducted examining the association between FPS and amygdala volume as assessed with magnetic resonance imaging in a subset of the children with ASD with or without an anxiety disorder with available MRI data. While the startle latency was increased in the children with ASD, there was no group difference in FPS. FPS was not significantly associated with traditional Diagnostic and Statistical Manual (DSM) or "autism distinct" forms of anxiety. Within the autism group, FPS was negatively correlated with amygdala volume. Multiple regression analyses revealed that the association between FPS and anxiety severity was significantly moderated by the size of the amygdala, such that the association between FPS and anxiety was significantly more positive in children with larger amygdalas than smaller amygdalas. These findings highlight the heterogeneity of emotional reactivity associated with ASD and the difficulties in establishing biologically meaningful probes of altered brain function. LAY SUMMARY: Many children with autism spectrum disorder (ASD) have additional problems such as anxiety that can greatly impact their lives. How these co-occurring symptoms develop is not well understood. We studied the amygdala, a region of the brain critical for processing fear and a laboratory method called fear potentiated startle for measuring fear conditioning, in children with ASD (with and without an anxiety disorder) and typically developing children. Results showed that the connection between fear conditioning and anxiety is dependent on the size of the amygdala in children with ASD.
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Affiliation(s)
- David Hessl
- The MIND Institute, University of California Davis, Sacramento, CA, USA.,Department of Psychiatry and Behavioral Sciences, University of California Davis, Sacramento, CA, USA
| | - Lauren Libero
- The MIND Institute, University of California Davis, Sacramento, CA, USA.,Department of Psychiatry and Behavioral Sciences, University of California Davis, Sacramento, CA, USA
| | - Andrea Schneider
- The MIND Institute, University of California Davis, Sacramento, CA, USA.,Department of Pediatrics, University of California Davis, Sacramento, CA, USA
| | - Connor Kerns
- Department of Psychology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Breanna Winder-Patel
- The MIND Institute, University of California Davis, Sacramento, CA, USA.,Department of Pediatrics, University of California Davis, Sacramento, CA, USA
| | - Brianna Heath
- Department of Psychiatry and Behavioral Sciences, University of California Davis, Sacramento, CA, USA
| | - Joshua Lee
- The MIND Institute, University of California Davis, Sacramento, CA, USA.,Department of Psychiatry and Behavioral Sciences, University of California Davis, Sacramento, CA, USA
| | - Cory Coleman
- Department of Psychiatry and Behavioral Sciences, University of California Davis, Sacramento, CA, USA
| | - Natasha Sharma
- Department of Psychiatry and Behavioral Sciences, University of California Davis, Sacramento, CA, USA
| | - Marjorie Solomon
- The MIND Institute, University of California Davis, Sacramento, CA, USA.,Department of Psychiatry and Behavioral Sciences, University of California Davis, Sacramento, CA, USA
| | - Christine Wu Nordahl
- The MIND Institute, University of California Davis, Sacramento, CA, USA.,Department of Psychiatry and Behavioral Sciences, University of California Davis, Sacramento, CA, USA
| | - David G Amaral
- The MIND Institute, University of California Davis, Sacramento, CA, USA.,Department of Psychiatry and Behavioral Sciences, University of California Davis, Sacramento, CA, USA
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46
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Toscano R, Hudson JL, Baillie AJ, Lyneham HJ, McLellan LF. Development of the Macquarie Anxiety Behavioural Scale (MABS): A parent measure to assess anxiety in children and adolescents including young people with autism spectrum disorder. J Affect Disord 2020; 276:678-685. [PMID: 32871700 DOI: 10.1016/j.jad.2020.06.076] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2019] [Revised: 06/14/2020] [Accepted: 06/23/2020] [Indexed: 12/28/2022]
Abstract
OBJECTIVE This study examined measurement variance for Autism Spectrum Disorder (ASD) in the Spence Children's Anxiety Scale - Parent Form (SCAS-P; Spence, 1999). In addition, we developed and evaluated a new parent report measure for anxiety (Macquarie Anxiety Behavioural Scale; MABS). METHOD The sample consisted of 734 parents of children aged 3-19 years (i) who were seeking help for their child's anxiety, (ii) who had received a diagnosis of ASD, or (iii) from the community. RESULTS Evidence for measurement variance of the SCAS-P and MABS was found, revealing different factor structures between the ASD and non-ASD groups. MIMIC modelling showed that the scales performed significantly different across ASD and non-ASD groups. Differential item functioning on a number of the SCAS-P and MABS items was also found. LIMITATIONS This study relied on parent report of symptoms and of community acquired diagnoses of ASD. CONCLUSION The MABS is a new parent measure to assess anxiety in children and adolescents and the proposed factor structure produced a reasonably good fit for the data. Similar to the SCAS-P, ASD was found to impact on some of the MABS items indicating that ASD influences parental responding. Eighteen MABS items showed measurement invariance across the anxious and ASD groups and can be considered suitable items for the assessment of anxiety in ASD.
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Affiliation(s)
- Ramona Toscano
- Centre for Emotional Health, Department of Psychology, Macquarie University, Australia
| | - Jennifer L Hudson
- Centre for Emotional Health, Department of Psychology, Macquarie University, Australia.
| | - Andrew J Baillie
- Centre for Emotional Health, Department of Psychology, Macquarie University, Australia
| | - Heidi J Lyneham
- Centre for Emotional Health, Department of Psychology, Macquarie University, Australia
| | - Lauren F McLellan
- Centre for Emotional Health, Department of Psychology, Macquarie University, Australia
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47
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Carruthers S, Kent R, Hollocks MJ, Simonoff E. Brief Report: Testing the Psychometric Properties of the Spence Children's Anxiety Scale (SCAS) and the Screen for Child Anxiety Related Emotional Disorders (SCARED) in Autism Spectrum Disorder. J Autism Dev Disord 2020; 50:2625-2632. [PMID: 30334126 PMCID: PMC7308247 DOI: 10.1007/s10803-018-3774-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Anxiety is a prevalent and impairing co-morbidity among individuals with autism spectrum disorder (ASD), yet assessment measures, including screening tools, are seldom validated with autism samples. We explored the psychometric properties of the child and parent reports of the Spence Children’s Anxiety Scale (SCAS) and the Screen for Anxiety Related Disorder-71 (SCARED-71) with 49 males with ASD (10–16 years, 63% co-occurring anxiety). Both measures had excellent internal consistency and fair-good parent–child agreement. The SCAS has a higher proportion of items evaluating observable behaviors. Predictive power of the measures did not differ. Higher cut-points in the parent reports (SCARED only) and lower cut-points in the child reports may enhance prediction in this sample. Choice of measure and cut-points should be considered alongside intended purpose.
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Affiliation(s)
- Sophie Carruthers
- Institute of Psychology, Psychiatry, and Neuroscience, Department of Child & Adolescent Psychiatry, King's College London, 16 De Crespigny Park, Denmark Hill, London, SE5 8AF, UK. .,Institute of Psychology, Psychiatry and Neuroscience, Department of Psychology, King's College London, 16 De Crespigny Park, Denmark Hill, London, SE5 8AF, UK.
| | - Rachel Kent
- Institute of Psychology, Psychiatry, and Neuroscience, Department of Child & Adolescent Psychiatry, King's College London, 16 De Crespigny Park, Denmark Hill, London, SE5 8AF, UK
| | - Matthew J Hollocks
- Department of Clinical Psychology, Norwich Medical School, University of East Anglia, Norwich, NR4 7TJ, UK
| | - Emily Simonoff
- Institute of Psychology, Psychiatry, and Neuroscience, Department of Child & Adolescent Psychiatry, King's College London, 16 De Crespigny Park, Denmark Hill, London, SE5 8AF, UK
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48
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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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49
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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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50
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Gara SK, Chhetri AG, Alrjoob M, Abbasi SAA, Rutkofsky IH. The Sensory Abnormalities and Neuropsychopathology of Autism and Anxiety. Cureus 2020; 12:e8071. [PMID: 32542126 PMCID: PMC7290113 DOI: 10.7759/cureus.8071] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Autism spectrum disorder (ASD) is a developmental disorder of interpersonal communications and restricted interest and deficits in sensory and social interactions. It co-occurs with anxiety and mostly in 30% of cases related to specific phobia. This review article summarises the sensory association between anxiety and ASD. The role of emotions and neurobiology discussed and sensory over-reactivity (SOR) was related to ASD and anxiety. PubMed database systematically searched for related articles on ASD and anxiety. The keywords used are autism spectrum disorder, autism spectrum disorder and emotion, anxiety disorder, sensory in autism and anxiety, and psychopathology. The results were most significant and related to the sensory association between ASD and anxiety. Out of 19 studies discussed, there were eight systematic reviews with meta-analysis, seven systematic reviews, three traditional reviews, and one included both systematic reviews with randomized controlled trials (RCTs). However, due to possible limitations and considerations, like small sample size and few clinical trials; hence, further recommendations to randomized clinical trials and cohort studies warranted. This review article helps scientists to plan and focus on necessary studies and possible screening for the disease to improve possible clinical outcomes. People gain awareness of the disease. Early recognition, as well as educational, behavioral, and family therapy, might decrease symptoms and support learning and development in children.
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Affiliation(s)
- Sirisha K Gara
- Primary Care, California Institute of Behavioral Neurosciences and Psychology, Fairfield, USA
| | - Ashok G Chhetri
- Primary Care, Department of Research, California Institute of Behavioral Neurosciences and Psychology, Fairfield, USA
| | - Montaser Alrjoob
- Internal Medicine, California Institute of Behavioral Neurosciences and Psychology, Fairfield, USA
| | - Sassi Ashraf Ali Abbasi
- Primary Care, California Institute of Behavioral Neurosciences and Psychology, Fairfield, USA
| | - Ian H Rutkofsky
- Psychiatry, California Institute of Behavioral Neurosciences and Psychology, Fairfield, USA
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