1
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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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2
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Fuselier MN, Guzick AG, Bakhshaie J, Wood JJ, Kendall PC, Kerns CM, Small BJ, Goodman WK, Storch EA. Examining the Relationship Between Anxiety Severity and Autism-Related Challenges During Cognitive Behavioral Therapy for Children with Autism. J Autism Dev Disord 2024; 54:1849-1856. [PMID: 36847894 DOI: 10.1007/s10803-023-05912-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/20/2023] [Indexed: 03/01/2023]
Abstract
PURPOSE Using data from a randomized clinical trial evaluating cognitive behavioral therapy (CBT) for children with autism and co-occurring anxiety, this study examined the relationship between autism features and anxiety symptoms throughout CBT. METHODS Two multilevel mediation analyses were run which examined the mediating role of changes in anxiety for changes in two core features of autism, (a) repetitive and restrictive behaviors (RRBs) and (b) social communication/interaction impairments, between pre- and post-treatment. RESULTS Indirect effects between time and autism characteristics were significant for both models, indicating that as anxiety changes, so do RRBs and social communication/interaction as the outcomes respectively. CONCLUSION Findings suggest a bidirectional relationship between anxiety and autism features. Implications of these findings are discussed.
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Affiliation(s)
- Madeleine N Fuselier
- Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, 1977 Butler Blvd, Suite 4-400, Houston, TX 77030, USA
| | - Andrew G Guzick
- Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, 1977 Butler Blvd, Suite 4-400, Houston, TX 77030, USA
| | - Jafar Bakhshaie
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
| | - Jeffrey J Wood
- Department of Education, University of California, Los Angeles, Los Angeles, CA, USA
- Department of Psychiatry, University of California, Los Angeles, Los Angeles, CA, USA
| | - Philip C Kendall
- Department of Psychology, Temple University, Philadelphia, PA, USA
| | - Connor M Kerns
- Department of Psychology, University of British Columbia, Vancouver, BC, Canada
| | - Brent J Small
- School of Aging Studies, University of South Florida, Tampa, FL, USA
| | - Wayne K Goodman
- Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, 1977 Butler Blvd, Suite 4-400, Houston, TX 77030, USA
| | - Eric A Storch
- Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, 1977 Butler Blvd, Suite 4-400, Houston, TX 77030, USA.
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3
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Shipkova M, Butera CD, Flores GD, Kilroy E, Jayashankar A, Harrison L, Cermak SA, Aziz-Zadeh L. Caregiver and youth inter-rater assessment agreement in autism spectrum disorder, developmental coordination disorder, and typical development. Autism Res 2024; 17:610-625. [PMID: 38450955 PMCID: PMC11022856 DOI: 10.1002/aur.3110] [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: 07/22/2023] [Accepted: 01/31/2024] [Indexed: 03/08/2024]
Abstract
Youth diagnosed with autism spectrum disorder (ASD) and those with developmental coordination disorder (DCD) are at heightened risk for co-occurring mental health diagnoses, especially anxiety and attention-deficit/hyperactivity disorder (ADHD). However, caregiver-child agreement on presence of related symptoms in populations with neurodevelopmental conditions is not well understood. Here, we examine the extent to which 37 ASD, 26 DCD, and 40 typically developing children and their caregivers agree on the degree of the child's symptoms of anxiety and ADHD. All caregiver-child dyads completed the Screen for Child Anxiety Related Emotional Disorders and Conners 3 ADHD Index. Across groups, intraclass correlations indicated generally poor agreement on anxiety and ADHD symptomatology. Although youth generally reported greater internalizing symptoms (i.e., anxiety), caregivers tended to report more observable externalizing behaviors (i.e., ADHD). Together, the results of this study support the need for a multi-informant approach in assessments of anxiety and ADHD in youth with neurodevelopmental disorders.
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Affiliation(s)
- Michelle Shipkova
- USC Mrs. T.H. Chan Division of Occupational Science and Occupational Therapy, University of Southern California, Los Angeles, California, USA
- Brain and Creativity Institute, Dornsife College of Letters, Arts and Sciences, University of Southern California, Los Angeles, California, USA
- Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Christiana D Butera
- USC Mrs. T.H. Chan Division of Occupational Science and Occupational Therapy, University of Southern California, Los Angeles, California, USA
- Brain and Creativity Institute, Dornsife College of Letters, Arts and Sciences, University of Southern California, Los Angeles, California, USA
| | - Genesis D Flores
- USC Mrs. T.H. Chan Division of Occupational Science and Occupational Therapy, University of Southern California, Los Angeles, California, USA
- Brain and Creativity Institute, Dornsife College of Letters, Arts and Sciences, University of Southern California, Los Angeles, California, USA
| | - Emily Kilroy
- USC Mrs. T.H. Chan Division of Occupational Science and Occupational Therapy, University of Southern California, Los Angeles, California, USA
- Brain and Creativity Institute, Dornsife College of Letters, Arts and Sciences, University of Southern California, Los Angeles, California, USA
| | - Aditya Jayashankar
- USC Mrs. T.H. Chan Division of Occupational Science and Occupational Therapy, University of Southern California, Los Angeles, California, USA
- Brain and Creativity Institute, Dornsife College of Letters, Arts and Sciences, University of Southern California, Los Angeles, California, USA
| | - Laura Harrison
- USC Mrs. T.H. Chan Division of Occupational Science and Occupational Therapy, University of Southern California, Los Angeles, California, USA
- Brain and Creativity Institute, Dornsife College of Letters, Arts and Sciences, University of Southern California, Los Angeles, California, USA
| | - Sharon A Cermak
- USC Mrs. T.H. Chan Division of Occupational Science and Occupational Therapy, University of Southern California, Los Angeles, California, USA
| | - Lisa Aziz-Zadeh
- USC Mrs. T.H. Chan Division of Occupational Science and Occupational Therapy, University of Southern California, Los Angeles, California, USA
- Brain and Creativity Institute, Dornsife College of Letters, Arts and Sciences, University of Southern California, Los Angeles, California, USA
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4
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Reactive and proactive aggression subgroups in early adolescents and the interplay among callous-unemotional traits, moral disengagement, empathy and functions of aggression. CURRENT PSYCHOLOGY 2022. [DOI: 10.1007/s12144-020-00858-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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5
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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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6
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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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7
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Ambrose K, Simpson K, Adams D. The relationship between social and academic outcomes and anxiety for children and adolescents on the autism spectrum: A systematic review. Clin Psychol Rev 2021; 90:102086. [PMID: 34598053 DOI: 10.1016/j.cpr.2021.102086] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2020] [Revised: 09/01/2021] [Accepted: 09/13/2021] [Indexed: 12/28/2022]
Abstract
Anxiety is the most common co-occurring condition in children on the autism spectrum but the potential impacts of anxiety on social and academic outcomes of children on the autism spectrum have not been systematically examined. In this review, 50 studies were identified that explore the relationship between anxiety and scores on social or academic measures in children on the autism spectrum. Social competence was frequently measured, and the findings of these studies were mixed. While other social constructs have received little attention, associations were found between anxiety and victimisation, and anxiety and social relationships. Only three studies focused on the impact of anxiety on scores on academic measures, highlighting the need for further research in this area. Anxiety was most frequently measured using subscales from broader behavioural instruments, which may not capture the range of anxiety symptoms of children on the autism spectrum. Future studies that include multi-informant methodologies and proportional representation of females and children with intellectual disability will further knowledge of the impact of anxiety in children on the spectrum.
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Affiliation(s)
- Kathryn Ambrose
- Autism Centre of Excellence, Griffith University, Messines Ridge Road, Mt Gravatt, Brisbane, QLD 4122, Australia; The Co-operative Research Centre for Living with Autism (Autism CRC), PO Box 6068, St Lucia, QLD 4067, Australia.
| | - Kate Simpson
- Autism Centre of Excellence, Griffith University, Messines Ridge Road, Mt Gravatt, Brisbane, QLD 4122, Australia; Griffith Institute for Educational Research, Griffith University, Messines Ridge Road, Mt Gravatt, Brisbane, QLD 4122, Australia; The Co-operative Research Centre for Living with Autism (Autism CRC), PO Box 6068, St Lucia, QLD 4067, Australia
| | - Dawn Adams
- Autism Centre of Excellence, Griffith University, Messines Ridge Road, Mt Gravatt, Brisbane, QLD 4122, Australia; Griffith Institute for Educational Research, Griffith University, Messines Ridge Road, Mt Gravatt, Brisbane, QLD 4122, Australia; The Co-operative Research Centre for Living with Autism (Autism CRC), PO Box 6068, St Lucia, QLD 4067, Australia
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8
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Keary CJ, Mullett JE, Nowinski L, Wagner K, Walsh B, Saro HK, Erhabor G, Thibert RL, McDougle CJ, Ravichandran CT. Parent Description of Anxiety in Angelman Syndrome. J Autism Dev Disord 2021; 52:3612-3625. [PMID: 34417655 DOI: 10.1007/s10803-021-05238-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/10/2021] [Indexed: 01/17/2023]
Abstract
Anxiety is being increasingly identified in Angelman syndrome (AS). Qualitative questions and quantitative assessments were used to evaluate for anxiety in 50 subjects with AS. In-person evaluations assessed behaviors concerning for anxiety and circumstances wherein they occurred. Caregivers completed anxiety and other behavioral rating scales. Caregiver responses were categorized and compared to items from anxiety rating scales. The most common behavioral manifestation of anxiety was "aggression." The most common circumstance was "separation from caregiver/parent." Subjects had elevated scores on anxiety, irritability and hyperactivity scales with lower mean scores among subjects with a maternal deletion. The Pediatric Anxiety Rating Scale best captured behaviors described by caregivers. Existing anxiety scales should be adapted for use in AS.
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Affiliation(s)
- Christopher J Keary
- Angelman Syndrome Program, Massachusetts General Hospital for Children, Boston, MA, USA. .,Lurie Center for Autism, Massachusetts General Hospital, One Maguire Road, Lexington, MA, 02421, USA. .,Department of Psychiatry, Harvard Medical School, Boston, MA, USA.
| | - Jennifer E Mullett
- Lurie Center for Autism, Massachusetts General Hospital, One Maguire Road, Lexington, MA, 02421, USA
| | - Lisa Nowinski
- Lurie Center for Autism, Massachusetts General Hospital, One Maguire Road, Lexington, MA, 02421, USA.,Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | - Karyn Wagner
- Lurie Center for Autism, Massachusetts General Hospital, One Maguire Road, Lexington, MA, 02421, USA
| | - Briana Walsh
- Lurie Center for Autism, Massachusetts General Hospital, One Maguire Road, Lexington, MA, 02421, USA
| | - Hannah K Saro
- Lurie Center for Autism, Massachusetts General Hospital, One Maguire Road, Lexington, MA, 02421, USA
| | - Gillian Erhabor
- Lurie Center for Autism, Massachusetts General Hospital, One Maguire Road, Lexington, MA, 02421, USA.,Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | - Ronald L Thibert
- Angelman Syndrome Program, Massachusetts General Hospital for Children, Boston, MA, USA.,Lurie Center for Autism, Massachusetts General Hospital, One Maguire Road, Lexington, MA, 02421, USA.,Department of Neurology, Harvard Medical School, Boston, MA, USA
| | - Christopher J McDougle
- Angelman Syndrome Program, Massachusetts General Hospital for Children, Boston, MA, USA.,Lurie Center for Autism, Massachusetts General Hospital, One Maguire Road, Lexington, MA, 02421, USA.,Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | - Caitlin T Ravichandran
- Lurie Center for Autism, Massachusetts General Hospital, One Maguire Road, Lexington, MA, 02421, USA.,McLean Hospital, Belmont, MA, USA.,Department of Psychiatry, Harvard Medical School, Boston, MA, USA
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9
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Timko CA, Herrington JD, Bhattacharya A, Kuschner ES, Yerys BE. Caregiver Report of Executive Functioning in Adolescent Females With Anorexia Nervosa or Autism Spectrum Disorder. Front Psychol 2021; 11:586264. [PMID: 33633624 PMCID: PMC7899966 DOI: 10.3389/fpsyg.2020.586264] [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] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Accepted: 11/25/2020] [Indexed: 11/13/2022] Open
Abstract
Current literature suggesting a shared endophenotype between individuals with anorexia nervosa (AN) and autism spectrum disorder (ASD) related to executive functioning (EF) has several limitations: performance-based instead of ecologically valid measures of set-shifting are used, lack of comparisons between same-sex groups, and reliance on adult samples only. This was the first study directly comparing female youth with ASD to female youth with AN using an ecologically valid measure of EF. A secondary data analysis combined caregiver-reported EF on the Behavior Rating Inventory of Executive Functioning (BRIEF) for 22 female adolescent youth with AN and 29 female adolescent youth with ASD. EF in each group was compared to population norms, and EF was compared between groups. Compared to population norms, adolescents with AN had elevated scores on shift, initiate, and emotional control scales, and adolescents with ASD had elevated scores on all scales of the BRIEF and were more likely to have scores in the clinical range. There were significant differences between groups on all but three scales. The cognitive profiles and clinical scores of AN females were not comparable to those of ASD females. The findings reveal a clear clinical impairment in females with ASD but not in females with AN. The results do not support the hypothesis of similar real-world EF profiles between these groups. The results encourage further exploration into the similarities and distinctions between these two disorders.
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Affiliation(s)
- C Alix Timko
- Department of Child and Adolescent Psychiatry and Behavioral Sciences, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.,Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphian, Pennsylvania
| | - John D Herrington
- Department of Child and Adolescent Psychiatry and Behavioral Sciences, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.,Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphian, Pennsylvania
| | - Anushua Bhattacharya
- Department of Child and Adolescent Psychiatry and Behavioral Sciences, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Emily S Kuschner
- Department of Child and Adolescent Psychiatry and Behavioral Sciences, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.,Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphian, Pennsylvania
| | - Benjamin E Yerys
- Department of Child and Adolescent Psychiatry and Behavioral Sciences, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.,Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphian, Pennsylvania
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10
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Bakhtiari R, Hutchison SM, Iarocci G. How do children and youth with autism spectrum disorder self-report on behavior? A study of the validity indexes on the Behavior Assessment System for Children, Second Edition, self-report of personality. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2021; 25:1100-1113. [PMID: 33504172 DOI: 10.1177/1362361320984601] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
LAY ABSTRACT Using self-report questionnaires is an important method in the assessment and treatment of children with autism. Self-reports can provide unique information about children's feelings and thoughts that is not available through other methods such as parent-reports. However, many clinicians are not sure whether children with autism can provide accurate self-reports. To study this, we examined 139 children and youth with and without autism aged 8-17 years. We looked at the effect of having autism, as well as other factors such as age, intelligence quotient, and attention problems on the validity of self-reports in these children. We examined if the children gave overly negative or positive answers and if they responded to the questions randomly or without paying attention. We found that children with autism can provide acceptable self-reports. However, they have more validity problems compared to their peers without autism. Our findings showed that this difference might be related to having attention problems in addition to autism, rather than having autism by itself. Children, with and without autism spectrum disorder, with fewer attention problems and higher intelligence quotient scores and those in the older age group, showed better validity. This article suggests that clinicians can use self-report measures for children with autism, but they should pay attention to important factors such as children's intelligence quotient and attention problems.
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Affiliation(s)
| | - Sarah M Hutchison
- Simon Fraser University, Canada.,University of British Columbia and BC Children's Hospital Research Institute, Canada
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11
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Den houting J, Adams D, Roberts J, Keen D. An exploration of autism‐specific and non‐autism‐specific measures of anxiety symptomatology in school‐aged autistic children. CLIN PSYCHOL-UK 2020. [DOI: 10.1111/cp.12174] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Affiliation(s)
- Jacquiline Den houting
- Autism Centre of Excellence, School of Educational and Professional Studies, Griffith University, Brisbane, Queensland, Australia,
- Cooperative Research Centre for Living with Autism (Autism CRC), Brisbane, Queensland, Australia,
| | - Dawn Adams
- Autism Centre of Excellence, School of Educational and Professional Studies, Griffith University, Brisbane, Queensland, Australia,
- Cooperative Research Centre for Living with Autism (Autism CRC), Brisbane, Queensland, Australia,
| | - Jacqueline Roberts
- Autism Centre of Excellence, School of Educational and Professional Studies, Griffith University, Brisbane, Queensland, Australia,
- Cooperative Research Centre for Living with Autism (Autism CRC), Brisbane, Queensland, Australia,
| | - Deb Keen
- Autism Centre of Excellence, School of Educational and Professional Studies, Griffith University, Brisbane, Queensland, Australia,
- Cooperative Research Centre for Living with Autism (Autism CRC), Brisbane, Queensland, Australia,
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12
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Keith JM, Jamieson JP, Bennetto L. The Importance of Adolescent Self-Report in Autism Spectrum Disorder: Integration of Questionnaire and Autonomic Measures. JOURNAL OF ABNORMAL CHILD PSYCHOLOGY 2020; 47:741-754. [PMID: 30073571 DOI: 10.1007/s10802-018-0455-1] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Anxiety and sensory symptoms are highly prevalent and meaningful in the daily lives of individuals with autism spectrum disorder (ASD). Despite the importance of carefully measuring, researching, and treating these symptoms, current methods in ASD seldom include self-report. This study investigated the consistency of adolescent and parent reports of anxiety and auditory sensitivity in individuals with ASD, and examined their validity via comparisons with sympathetic arousal at baseline and in response to an auditory challenge. Fifty adolescent-parent dyads (n = 26 ASD, n = 24 typically developing; 12-16 years old; IQ>80) completed parallel versions of both anxiety and auditory hypersensitivity scales, which were compared to heart rate collected at rest and during an aversive noise task. Adolescents with ASD exhibited greater anxiety and auditory hypersensitivity than their peers, based on both self and parent report. Across groups, self-report was higher than parent report. In individuals with ASD, a significant relationship was found between self-reported anxiety and autonomic arousal at rest, and between self-reported auditory sensitivity and autonomic reactivity during the noise task. These relationships were not significant for parent-report. These findings extend past work by demonstrating greater self-reported (than parent-reported) anxiety and sensory symptoms. Furthermore, the presence of significant correlations between self-reported symptoms and sympathetic arousal supports the validity of self-report in adolescents with ASD with average or above average cognitive abilities. This indicates that adolescents with ASD have a unique perspective on their internal experience, which can complement parent reports and provide a more comprehensive assessment of symptoms in research and clinical settings.
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Affiliation(s)
- Jessica M Keith
- Department of Clinical and Social Sciences in Psychology, University of Rochester, Rochester, NY, 14627, USA.
| | - Jeremy P Jamieson
- Department of Clinical and Social Sciences in Psychology, University of Rochester, Rochester, NY, 14627, USA
| | - Loisa Bennetto
- Department of Clinical and Social Sciences in Psychology, University of Rochester, Rochester, NY, 14627, USA
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13
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Baribeau DA, Vigod S, Pullenayegum E, Kerns CM, Mirenda P, Smith IM, Vaillancourt T, Volden J, Waddell C, Zwaigenbaum L, Bennett T, Duku E, Elsabbagh M, Georgiades S, Ungar WJ, Zaidman-Zait A, Szatmari P. Repetitive Behavior Severity as an Early Indicator of Risk for Elevated Anxiety Symptoms in Autism Spectrum Disorder. J Am Acad Child Adolesc Psychiatry 2020; 59:890-899.e3. [PMID: 31541676 DOI: 10.1016/j.jaac.2019.08.478] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2019] [Revised: 07/15/2019] [Accepted: 09/13/2019] [Indexed: 12/28/2022]
Abstract
OBJECTIVE A significant proportion of children with autism spectrum disorder (ASD) will develop an anxiety disorder during childhood. Restricted and repetitive behavior severity in ASD positively correlates with anxiety severity in cross-sectional surveys. The longitudinal relationship between restricted/repetitive behavior and future anxiety symptoms is unclear. METHOD In a longitudinal cohort of children with ASD (n = 421), restricted/repetitive behavior severity at enrollment (age 2-5 years) was categorized as "mild," "moderate," or "severe" using the Autism Diagnostic Interview-Revised. Elevated anxiety symptoms were defined by a Child Behavior Checklist (parent report) Anxiety subscale T-score of >65 at ages 8 to 11 years. Multivariable logistic regression with multiple imputation for missing data was used to examine the association between restricted/repetitive behavior severity and elevated anxiety symptoms while adjusting for age, sex, adaptive functioning, baseline anxiety, income, and parenting stress, generating adjusted odds ratios (aORs) and 95% CIs. RESULTS Approximately 58% of children with severe restricted/repetitive behavior at enrollment had elevated anxiety symptoms by age 11, compared to 41% of those with moderate, and 20% of those with mild restricted/repetitive behavior, respectively. Moderate and severe restricted/repetitive behavior were both associated with increased odds of elevated anxiety (moderate aOR: 2.5 [1.2-5.3]; severe aOR: 3.2 (1.4-7.5]). CONCLUSION Restricted/repetitive behavior severity at time of ASD diagnosis indicates risk for future anxiety symptoms. This finding increases our understanding of which children with ASD will develop anxiety disorders and may guide research concerning early interventions and etiological mechanisms.
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Affiliation(s)
| | - Simone Vigod
- University of Toronto, Ontario, Canada; Institute of Health Policy, Management and Evaluation, University of Toronto, Ontario, Canada; Women's College Hospital and Women's College Research Institute, Toronto, Ontario, Canada
| | - Eleanor Pullenayegum
- Child Health Evaluative Sciences, The Hospital for Sick Children Research Institute, Toronto, Ontario, Canada; Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario Canada
| | | | - Pat Mirenda
- University of British Columbia, Vancouver, Canada
| | - Isabel M Smith
- Dalhousie University, Halifax, Nova Scotia, Canada; Autism Research Centre, IWK Health Centre, Halifax, Nova Scotia, Canada
| | - Tracy Vaillancourt
- Counselling Psychology, Faculty of Education, University of, Ottawa, Ontario, Canada
| | - Joanne Volden
- Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, Canada
| | - Charlotte Waddell
- Children's Health Policy Centre, Faculty of Health Sciences, Simon Fraser University, Vancouver, British Columbia, Canada
| | | | - Teresa Bennett
- Offord Centre for Child Studies, Hamilton, Ontario, Canada; McMaster University, Hamilton, Ontario, Canada
| | - Eric Duku
- Offord Centre for Child Studies, Hamilton, Ontario, Canada; McMaster University, Hamilton, Ontario, Canada
| | - Mayada Elsabbagh
- Montreal Neurological Institute, McGill University, Montreal, Quebec, Canada
| | - Stelios Georgiades
- Offord Centre for Child Studies, Hamilton, Ontario, Canada; McMaster University, Hamilton, Ontario, Canada
| | - Wendy J Ungar
- Institute of Health Policy, Management and Evaluation, University of Toronto, Ontario, Canada; Child Health Evaluative Sciences, The Hospital for Sick Children Research Institute, Toronto, Ontario, Canada
| | - Anat Zaidman-Zait
- Constantine School of Education, Tel Aviv University, Israel; The School of Population and Public Health, Faculty of Medicine, University of British Columbia, Canada
| | - Peter Szatmari
- University of Toronto, Ontario, Canada; Centre for Addiction and Mental Health and The Hospital for Sick Children, Toronto, Ontario, Canada.
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14
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Maddox BB, Lecavalier L, Miller JS, Pritchett J, Hollway J, White SW, Gillespie S, Evans AN, Schultz RT, Herrington JD, Bearss K, Scahill L. Reliability and validity of the Pediatric Anxiety Rating Scale modified for autism spectrum disorder. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2020; 24:1773-1782. [PMID: 32476441 DOI: 10.1177/1362361320922682] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
LAY ABSTRACT Many youth with autism spectrum disorder have anxiety, but it can be difficult to assess anxiety with existing measures. We modified the Pediatric Anxiety Rating Scale for youth with autism spectrum disorder and tested the new measure in a group of 116 youth (age: 5-17 years) with autism spectrum disorder. The Pediatric Anxiety Rating Scale for youth with autism spectrum disorder is an interview that a clinician usually completes with the child and parent together. We modified the interview questions and scoring instructions based on feedback from parents of children with autism spectrum disorder and from a panel of experts in autism spectrum disorder and anxiety. Unlike many other anxiety measures, the Pediatric Anxiety Rating Scale for youth with autism spectrum disorder relies less on a child's verbal expression of anxiety and more on signs that a parent can easily observe. Training clinicians to administer and score the Pediatric Anxiety Rating Scale for youth with autism spectrum disorder was uncomplicated, and raters showed excellent agreement on video-recorded interviews. Youth who were not currently in treatment for anxiety had stable Pediatric Anxiety Rating Scale for youth with autism spectrum disorder scores with repeat measurement over a 1-month period. The Pediatric Anxiety Rating Scale for youth with autism spectrum disorder is a useful clinician-rated measure of anxiety in youth with autism spectrum disorder and fills a gap for assessing anxiety in this population.
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Affiliation(s)
| | | | - Judith S Miller
- University of Pennsylvania, USA.,Children's Hospital of Philadelphia, USA
| | | | | | | | | | - Andrea N Evans
- Emory University, USA.,University of California, Los Angeles, USA
| | - Robert T Schultz
- University of Pennsylvania, USA.,Children's Hospital of Philadelphia, USA
| | - John D Herrington
- University of Pennsylvania, USA.,Children's Hospital of Philadelphia, USA
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15
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Hillman K, Dix K, Ahmed K, Lietz P, Trevitt J, O'Grady E, Uljarević M, Vivanti G, Hedley D. Interventions for anxiety in mainstream school-aged children with autism spectrum disorder: A systematic review. CAMPBELL SYSTEMATIC REVIEWS 2020; 16:e1086. [PMID: 37131419 PMCID: PMC8356281 DOI: 10.1002/cl2.1086] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Affiliation(s)
- Kylie Hillman
- Australian Council for Educational ResearchCamberwellVictoriaAustralia
| | - Katherine Dix
- Australian Council for Educational ResearchAdelaideSouth AustraliaAustralia
| | - Kashfee Ahmed
- Australian Council for Educational ResearchAdelaideSouth AustraliaAustralia
| | - Petra Lietz
- Australian Council for Educational ResearchAdelaideSouth AustraliaAustralia
| | - Jenny Trevitt
- Australian Council for Educational ResearchCamberwellVictoriaAustralia
| | - Elizabeth O'Grady
- Australian Council for Educational ResearchCamberwellVictoriaAustralia
| | - Mirko Uljarević
- Division of Child and Adolescent Psychiatry, Stanford Autism Center, Department of Psychiatry and Behavioral Sciences, School of MedicineStanford UniversityPalo AltoCalifornia
| | - Giacomo Vivanti
- A. J. Drexel Autism InstituteDornsife School of Public Health, Drexel UniversityPhiladelphiaPennsylvania
| | - Darren Hedley
- Olga Tennison Autism Research Centre, School of Psychology and Public Health, College of Science, Health and EngineeringLaTrobe UniversityBundooraVictoriaAustralia
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Wood JJ, Kendall PC, Wood KS, Kerns CM, Seltzer M, Small BJ, Lewin AB, Storch EA. Cognitive Behavioral Treatments for Anxiety in Children With Autism Spectrum Disorder: A Randomized Clinical Trial. JAMA Psychiatry 2020; 77:474-483. [PMID: 31755906 PMCID: PMC6902190 DOI: 10.1001/jamapsychiatry.2019.4160] [Citation(s) in RCA: 95] [Impact Index Per Article: 23.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
IMPORTANCE Anxiety is common among youth with autism spectrum disorder (ASD), often interfering with adaptive functioning. Psychological therapies are commonly used to treat school-aged youth with ASD; their efficacy has not been established. OBJECTIVE To compare the relative efficacy of 2 cognitive behavioral therapy (CBT) programs and treatment as usual (TAU) to assess treatment outcomes on maladaptive and interfering anxiety in children with ASD. The secondary objectives were to assess treatment outcomes on positive response, ASD symptom severity, and anxiety-associated adaptive functioning. DESIGN, SETTING, AND PARTICIPANTS This randomized clinical trial began recruitment in April 2014 at 3 universities in US cities. A volunteer sample of children (7-13 years) with ASD and maladaptive and interfering anxiety was randomized to standard-of-practice CBT, CBT adapted for ASD, or TAU. Independent evaluators were blinded to groupings. Data were collected through January 2017 and analyzed from December 2018 to February 2019. INTERVENTIONS The main features of standard-of-practice CBT were affect recognition, reappraisal, modeling/rehearsal, in vivo exposure tasks, and reinforcement. The CBT intervention adapted for ASD was similar but also addressed social communication and self-regulation challenges with perspective-taking training and behavior-analytic techniques. MAIN OUTCOMES AND MEASURES The primary outcome measure per a priori hypotheses was the Pediatric Anxiety Rating Scale. Secondary outcomes included treatment response on the Clinical Global Impressions-Improvement scale and checklist measures. RESULTS Of 214 children initially enrolled, 167 were randomized, 145 completed treatment, and 22 discontinued participation. Those who were not randomized failed to meet eligibility criteria (eg, confirmed ASD). There was no significant difference in discontinuation rates across conditions. Randomized children had a mean (SD) age of 9.9 (1.8) years; 34 were female (20.5%). The CBT program adapted for ASD outperformed standard-of-practice CBT (mean [SD] Pediatric Anxiety Rating Scale score, 2.13 [0.91] [95% CI, 1.91-2.36] vs 2.43 [0.70] [95% CI, 2.25-2.62]; P = .04) and TAU (2.93 [0.59] [95% CI, 2.63-3.22]; P < .001). The CBT adapted for ASD also outperformed standard-of-practice CBT and TAU on parent-reported scales of internalizing symptoms (estimated group mean differences: adapted vs standard-of-practice CBT, -0.097 [95% CI, -0.172 to -0.023], P = .01; adapted CBT vs TAU, -0.126 [95% CI, -0.243 to -0.010]; P = .04), ASD-associated social-communication symptoms (estimated group mean difference: adapted vs standard-of-practice CBT, -0.115 [95% CI, -0223 to -0.007]; P = .04; adapted CBT vs TAU: -0.235 [95% CI,-0.406 to -0.065]; P = .01); and anxiety-associated social functioning (estimated group mean difference: adapted vs standard-of-practice CBT, -0.160 [95% CI, -0.307 to -0.013]; P = .04; adapted CBT vs TAU: -0.284 [95% CI, -0.515 to -0.053]; P = .02). Both CBT conditions achieved higher rates of positive treatment response than TAU (BIACA, 61 of 66 [92.4%]; Coping Cat, 47 of 58 [81.0%]; TAU, 2 of 18 [11.1%]; P < .001 for each comparison). CONCLUSIONS AND RELEVANCE In this study, CBT was efficacious for children with ASD and interfering anxiety, and an adapted CBT approach showed additional advantages. It is recommended that clinicians providing psychological treatments to school-aged children with ASD consider developing CBT expertise. TRIAL REGISTRATION ClinicalTrials.gov identifier: NCT02028247.
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Affiliation(s)
- Jeffrey J. Wood
- Department of Education, University of California, Los Angeles, Los Angeles,Department of Psychiatry, University of California, Los Angeles, Los Angeles
| | - Philip C. Kendall
- Department of Psychology, Temple University, Philadelphia, Pennsylvania
| | - Karen S. Wood
- Department of Psychiatry, University of California, Los Angeles, Los Angeles
| | - Connor M. Kerns
- Department of Psychology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Michael Seltzer
- Department of Education, University of California, Los Angeles, Los Angeles
| | - Brent J. Small
- University of South Florida School of Aging Studies, Tampa
| | - Adam B. Lewin
- Departments of Pediatrics and Psychiatry, University of South Florida, Tampa
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17
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Family-Centered Cognitive Behavioral Therapy for Anxiety in Very Young Children with Autism Spectrum Disorder. J Autism Dev Disord 2020; 50:3905-3920. [PMID: 32146598 DOI: 10.1007/s10803-020-04446-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
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18
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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 2020; 50:780-795. [DOI: 10.1080/15374416.2019.1703712] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Affiliation(s)
| | | | - 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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19
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Hyman SL, Levy SE, Myers SM. Identification, Evaluation, and Management of Children With Autism Spectrum Disorder. Pediatrics 2020; 145:peds.2019-3447. [PMID: 31843864 DOI: 10.1542/peds.2019-3447] [Citation(s) in RCA: 464] [Impact Index Per Article: 116.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Autism spectrum disorder (ASD) is a common neurodevelopmental disorder with reported prevalence in the United States of 1 in 59 children (approximately 1.7%). Core deficits are identified in 2 domains: social communication/interaction and restrictive, repetitive patterns of behavior. Children and youth with ASD have service needs in behavioral, educational, health, leisure, family support, and other areas. Standardized screening for ASD at 18 and 24 months of age with ongoing developmental surveillance continues to be recommended in primary care (although it may be performed in other settings), because ASD is common, can be diagnosed as young as 18 months of age, and has evidenced-based interventions that may improve function. More accurate and culturally sensitive screening approaches are needed. Primary care providers should be familiar with the diagnostic criteria for ASD, appropriate etiologic evaluation, and co-occurring medical and behavioral conditions (such as disorders of sleep and feeding, gastrointestinal tract symptoms, obesity, seizures, attention-deficit/hyperactivity disorder, anxiety, and wandering) that affect the child's function and quality of life. There is an increasing evidence base to support behavioral and other interventions to address specific skills and symptoms. Shared decision making calls for collaboration with families in evaluation and choice of interventions. This single clinical report updates the 2007 American Academy of Pediatrics clinical reports on the evaluation and treatment of ASD in one publication with an online table of contents and section view available through the American Academy of Pediatrics Gateway to help the reader identify topic areas within the report.
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Affiliation(s)
- Susan L Hyman
- Golisano Children's Hospital, University of Rochester, Rochester, New York;
| | - Susan E Levy
- Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; and
| | - Scott M Myers
- Geisinger Autism & Developmental Medicine Institute, Danville, Pennsylvania
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20
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Varela RE, DuPont R, Kamps JL, Weems CF, Niditch L, Beaton EA, Pucci G. Age Differences in Expression of Generalized and Social Anxiety Among Youth with Autism Spectrum Disorder. J Autism Dev Disord 2019; 50:730-740. [DOI: 10.1007/s10803-019-04289-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
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Abstract
Youth with ASD are more likely to experience bullying than their typically developing peers. This risk has not been studied in youth with ASD transitioning to college. We examined the occurrence of bullying in 35 high functioning youth with ASD who were preparing to attend college. We also examined youth anxiety and ASD symptoms. Fifty-one percent of the sample reported being recent victims of bullying; 31% of parents reported their child was a victim of bullying. Parent report of bullying correlated significantly with ratings of youth social anxiety symptoms. These findings suggest that bullying is an issue of concern for higher functioning, older adolescents with ASD, and that their own reports may be particularly important in identifying its occurrence.
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22
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Wan B, Wang Z, Jung M, Lu Y, He H, Chen Q, Jin Y. Effects of the Co‐occurrence of Anxiety and Attention‐Deficit/Hyperactivity Disorder on Intrinsic Functional Network Centrality among Children with Autism Spectrum Disorder. Autism Res 2019; 12:1057-1068. [DOI: 10.1002/aur.2120] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2018] [Revised: 04/15/2019] [Accepted: 04/20/2019] [Indexed: 12/28/2022]
Affiliation(s)
- Bin Wan
- Department of Maternal and Child Health, School of Public HealthSun Yat‐sen University Guangzhou China
| | - Zengjian Wang
- Department of Maternal and Child Health, School of Public HealthSun Yat‐sen University Guangzhou China
| | - Minyoung Jung
- Department of NeuropsychiatryUniversity of Fukui Fukui Japan
| | - Yanchun Lu
- Department of Medical Radiology, Sun Yat‐sen University Cancer Center, State Key Laboratory of Oncology in South ChinaCollaborative Innovation Center for Cancer Medicine Guangzhou China
| | - Haoqiang He
- Department of Medical Radiology, Sun Yat‐sen University Cancer Center, State Key Laboratory of Oncology in South ChinaCollaborative Innovation Center for Cancer Medicine Guangzhou China
| | - Qi Chen
- Department of Maternal and Child Health, School of Public HealthSun Yat‐sen University Guangzhou China
| | - Yu Jin
- Department of Maternal and Child Health, School of Public HealthSun Yat‐sen University Guangzhou China
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23
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Anxiety in Children with Autism at School: a Systematic Review. REVIEW JOURNAL OF AUTISM AND DEVELOPMENTAL DISORDERS 2019. [DOI: 10.1007/s40489-019-00172-z] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
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24
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Yerys BE, Tunç B, Satterthwaite TD, Antezana L, Mosner MG, Bertollo JR, Guy L, Schultz RT, Herrington JD. Functional Connectivity of Frontoparietal and Salience/Ventral Attention Networks Have Independent Associations With Co-occurring Attention-Deficit/Hyperactivity Disorder Symptoms in Children With Autism. BIOLOGICAL PSYCHIATRY. COGNITIVE NEUROSCIENCE AND NEUROIMAGING 2019; 4:343-351. [PMID: 30777604 PMCID: PMC6456394 DOI: 10.1016/j.bpsc.2018.12.012] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/17/2018] [Revised: 12/17/2018] [Accepted: 12/17/2018] [Indexed: 01/01/2023]
Abstract
BACKGROUND Children with autism spectrum disorder (ASD) and co-occurring attention-deficit/hyperactivity disorder (ADHD) symptoms have worse functional outcomes and treatment response than those without ADHD symptoms. There is limited knowledge of the neurobiology of ADHD symptoms in ASD. Here, we test the hypothesis that aberrant functional connectivity of two large-scale executive brain networks implicated in ADHD-the frontoparietal and salience/ventral attention networks-also play a role in ADHD symptoms in ASD. METHODS We compared resting-state functional connectivity of the two executive brain networks in children with ASD (n = 77) and typically developing control children (n = 82). These two executive brain networks comprise five subnetworks (three frontoparietal, two salience/ventral attention). After identifying aberrant functional connections among subnetworks, we examined dimensional associations with parent-reported ADHD symptoms. RESULTS Weaker functional connectivity in ASD was present within and between the frontoparietal and salience/ventral attention subnetworks. Decreased functional connectivity within a single salience/ventral attention subnetwork, as well as between two frontoparietal subnetworks, significantly correlated with ADHD symptoms. Furthermore, follow-up linear regressions demonstrated that the salience/ventral attention and frontoparietal subnetworks explain unique variance in ADHD symptoms. These executive brain network-ADHD symptom relationships remained significant after controlling for ASD symptoms. Finally, specificity was also demonstrated through the use of a control brain network (visual) and a control co-occurring symptom domain (anxiety). CONCLUSIONS The present findings provide novel evidence that both frontoparietal and salience/ventral attention networks' weaker connectivities are linked to ADHD symptoms in ASD. Moreover, co-occurring ADHD in the context of ASD is a source of meaningful neural heterogeneity in ASD.
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Affiliation(s)
- Benjamin E Yerys
- Center for Autism Research and Department of Child and Adolescent Psychiatry and Behavioral Sciences, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.
| | - Birkan Tunç
- Center for Autism Research and Department of Child and Adolescent Psychiatry and Behavioral Sciences, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; Department of Biomedical and Health Information, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Theodore D Satterthwaite
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Ligia Antezana
- Department of Psychology, Virginia Polytechnic Institute and State University, Blacksburg, Virginia
| | - Maya G Mosner
- Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill, North Carolina
| | - Jennifer R Bertollo
- Center for Autism Research and Department of Child and Adolescent Psychiatry and Behavioral Sciences, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; Department of Psychology, Virginia Polytechnic Institute and State University, Blacksburg, Virginia
| | - Lisa Guy
- Department of Psychiatry, School of Medicine, University of North Carolina at Chapel Hill, North Carolina
| | - Robert T Schultz
- Center for Autism Research and Department of Child and Adolescent Psychiatry and Behavioral Sciences, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - John D Herrington
- Center for Autism Research and Department of Child and Adolescent Psychiatry and Behavioral Sciences, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
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25
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McVey AJ. The neurobiological presentation of anxiety in autism spectrum disorder: A systematic review. Autism Res 2019; 12:346-369. [DOI: 10.1002/aur.2063] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2018] [Revised: 10/31/2018] [Accepted: 11/20/2018] [Indexed: 12/28/2022]
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26
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Associations Between Family Member BMI and Obesity Status of Children with Autism Spectrum Disorder. J Dev Behav Pediatr 2018; 38:690-696. [PMID: 28834788 DOI: 10.1097/dbp.0000000000000491] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
OBJECTIVE To determine whether there is an association between parent and sibling obesity status and obesity status in children with autism spectrum disorder (ASD). METHODS We examined predictors of obesity in children with ASD with body mass index data for the proband, 1 sibling, and 2 parents using data from the multisite Simons Simplex Collection. RESULTS In a stepwise logistic regression model, proband obesity status was associated with obesity status of the sibling (odds ratio [OR] 2.66; 95% confidence interval [CI], 1.92-3.70), mother (OR 2.10; 95% CI, 1.59-2.77), and father (OR 1.51; 95% CI, 1.15-1.98). Proband obesity was also related to somatic complaints (OR 1.60; 95% CI, 1.006-2.53), mood stabilizers (OR 1.80; 95% CI, 1.19-2.72), internalizing problems (OR 1.60; 95% CI, 1.14-2.30), age (OR 1.01; 95% CI, 1.00-1.01), and some adaptive functioning domains (OR 0.987; 95% CI, 0.977-0.997). Race, ethnicity, income, sex, and maternal education were not significant predictors. CONCLUSION Familial factors were generally the strongest predictors of obesity rather than medication use, demographics, or psychological characteristics. Results support a family-centered approach to treatment of obesity in children with ASD.
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27
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The Stability of Self-Reported Anxiety in Youth with Autism Versus ADHD or Typical Development. J Autism Dev Disord 2018; 47:3756-3764. [PMID: 28593597 DOI: 10.1007/s10803-017-3184-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Children with autism spectrum disorder (ASD) are at risk for anxiety symptoms. Few anxiety measures are validated for individuals with ASD, and the nature of ASD raises questions about reliability of self-reported anxiety. This study examined longitudinal stability and change of self-reported anxiety in higher functioning youth with ASD (HFASD) compared to youth with symptoms of attention deficit hyperactivity disorder and typical development (TD) using the Multidimensional Anxiety Scale for Children (March, 2012; March et al. J Am Acad Child Adolesc Psychiatry 36(4):554-565, 1997). Diagnostic groups demonstrated comparable evidence of stability for most dimensions of anxiety. The HFASD group displayed higher anxiety than both comparison groups, especially physical symptoms. These findings have implications for identification and measurement of anxiety in ASD.
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28
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Oswald TM, Winder-Patel B, Ruder S, Xing G, Stahmer A, Solomon M. A Pilot Randomized Controlled Trial of the ACCESS Program: A Group Intervention to Improve Social, Adaptive Functioning, Stress Coping, and Self-Determination Outcomes in Young Adults with Autism Spectrum Disorder. J Autism Dev Disord 2018; 48:1742-1760. [PMID: 29234931 PMCID: PMC5889958 DOI: 10.1007/s10803-017-3421-9] [Citation(s) in RCA: 44] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
The purpose of this pilot randomized controlled trial was to investigate the acceptability and efficacy of the Acquiring Career, Coping, Executive control, Social Skills (ACCESS) Program, a group intervention tailored for young adults with autism spectrum disorder (ASD) to enhance critical skills and beliefs that promote adult functioning, including social and adaptive skills, self-determination skills, and coping self-efficacy. Forty-four adults with ASD (ages 18-38; 13 females) and their caregivers were randomly assigned to treatment or waitlist control. Compared to controls, adults in treatment significantly improved in adaptive and self-determination skills, per caregiver report, and self-reported greater belief in their ability to access social support to cope with stressors. Results provide evidence for the acceptability and efficacy of the ACCESS Program.
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Affiliation(s)
- Tasha M Oswald
- MIND Institute, U.C. Davis Medical Center, 2825 50th Street, Sacramento, CA, 95817, USA.
- Department of Psychiatry and Behavioral Sciences, U.C. Davis Medical Center, 2230 Stockton Blvd., Sacramento, CA, 95817, USA.
- Portia Bell Hume Behavioral Health and Training Center, 5776 Stoneridge Mall Rd, Pleasanton, CA, 94588, USA.
| | - Breanna Winder-Patel
- MIND Institute, U.C. Davis Medical Center, 2825 50th Street, Sacramento, CA, 95817, USA
- Department of Pediatrics, U.C. Davis Medical Center, 2516 Stockton Blvd, Sacramento, CA, 95817, USA
| | - Steven Ruder
- MIND Institute, U.C. Davis Medical Center, 2825 50th Street, Sacramento, CA, 95817, USA
| | - Guibo Xing
- Center for Healthcare Policy and Research, U.C. Davis Medical Center, 2103 Stockton Blvd., Sacramento, CA, 95817, USA
| | - Aubyn Stahmer
- MIND Institute, U.C. Davis Medical Center, 2825 50th Street, Sacramento, CA, 95817, USA
- Department of Psychiatry and Behavioral Sciences, U.C. Davis Medical Center, 2230 Stockton Blvd., Sacramento, CA, 95817, USA
| | - Marjorie Solomon
- MIND Institute, U.C. Davis Medical Center, 2825 50th Street, Sacramento, CA, 95817, USA
- Department of Psychiatry and Behavioral Sciences, U.C. Davis Medical Center, 2230 Stockton Blvd., Sacramento, CA, 95817, USA
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29
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Vasa RA, Kreiser NL, Keefer A, Singh V, Mostofsky SH. Relationships between autism spectrum disorder and intolerance of uncertainty. Autism Res 2018; 11:636-644. [PMID: 29316350 PMCID: PMC5903967 DOI: 10.1002/aur.1916] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2017] [Revised: 11/08/2017] [Accepted: 12/06/2017] [Indexed: 12/21/2022]
Abstract
Intolerance of uncertainty (IU) is a dispositional risk factor involving maladaptive responding under conditions of uncertainty. Recent data indicate that IU is likely elevated in youth with autism spectrum disorder (ASD) and is positively correlated with anxiety. This study examined whether IU may be associated with ASD independent of anxiety. Relationships between anxiety, ASD, and IU were examined in 57 children with ASD without co-occurring intellectual disability and 32 control participants, ages 7-16 years. Hierarchal linear regressions were run to examine whether ASD variables, including emotion dysregulation, were predictive of IU when controlling for anxiety. Severity of social communication deficits, repetitive behaviors, and emotion dysregulation were each related to IU when controlling for the effects of anxiety. When these variables were entered into the regression model together, emotion dysregulation was the only significant predictor of IU. These findings suggest that IU is directly related to features of ASD possibly due to shared genetic, neurological, or psychological underpinnings. Autism Res 2018, 11: 636-644. © 2018 International Society for Autism Research, Wiley Periodicals, Inc. LAY SUMMARY Youth with ASD without co-occurring intellectual disability experience high levels of intolerance of uncertainty (IU), which is related to anxiety. This study found that IU may also have a relationship with certain aspects of ASD, particularly emotion dysregulation.
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Affiliation(s)
- Roma A. Vasa
- Center for Autism and Related Disorders, Kennedy Krieger Institute, 3901 Greenspring Avenue, Baltimore, Maryland, 21211
- Center for Neurodevelopmental and Imaging Research, Kennedy Krieger Institute, 707 North Broadway, Baltimore, Maryland, 21205
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, 1800 Orleans Street, Baltimore, Maryland, 21287
| | - Nicole L. Kreiser
- Department of Psychiatry and Behavioral Sciences, Eastern Virginia Medical School, 825 Fairfax Avenue, Suite 710, Norfolk, Virginia, 23507
| | - Amy Keefer
- Center for Autism and Related Disorders, Kennedy Krieger Institute, 3901 Greenspring Avenue, Baltimore, Maryland, 21211
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, 1800 Orleans Street, Baltimore, Maryland, 21287
| | - Vini Singh
- Center for Autism and Related Disorders, Kennedy Krieger Institute, 3901 Greenspring Avenue, Baltimore, Maryland, 21211
| | - Stewart H. Mostofsky
- Center for Neurodevelopmental and Imaging Research, Kennedy Krieger Institute, 707 North Broadway, Baltimore, Maryland, 21205
- Department of Psychiatry and Behavioral Sciences, Eastern Virginia Medical School, 825 Fairfax Avenue, Suite 710, Norfolk, Virginia, 23507
- Department of Neurology, Johns Hopkins University School of Medicine, 601 N. Caroline Street, Baltimore, Maryland, 21205
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Crane L, Adams F, Harper G, Welch J, Pellicano E. ‘Something needs to change’: Mental health experiences of young autistic adults in England. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2018; 23:477-493. [DOI: 10.1177/1362361318757048] [Citation(s) in RCA: 109] [Impact Index Per Article: 18.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
There is a high incidence and prevalence of mental health problems among young people, with several barriers to help-seeking noted in this group. High rates of mental health problems have also been reported in children and adults on the autism spectrum. Taken together, young autistic people may be a particularly vulnerable group when it comes to mental health. Yet, there has been remarkably little work on the mental health needs and experiences of young autistic adults (16–25 years). Adopting a community-based participatory research (CBPR) approach – in which academic researchers and young autistic adults collaborated in an equitable research partnership – we explored young autistic people’s experiences of mental health problems and their perspectives on the support they sought, if any, for these problems. A total of 130 young autistic adults took part in the research: 109 completed an online survey and 21 took part in detailed interviews. The results highlight how young autistic people find it difficult to evaluate their mental health, experience high levels of stigma and often face severe obstacles when trying to access mental health support. The findings also demonstrate how listening to – and learning from – young autistic people is crucial in ensuring that their mental health needs are met.
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Does the Presence of Anxiety and ADHD Symptoms Add to Social Impairment in Children with Autism Spectrum Disorder? J Autism Dev Disord 2017; 47:1122-1134. [PMID: 28132125 DOI: 10.1007/s10803-016-3025-9] [Citation(s) in RCA: 51] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Children with autism spectrum disorder (ASD) experience internalizing and externalizing problems at higher rates than typically developing children, which could worsen social impairment. The present study compared impairment scores (social responsiveness scale, 2nd edition; SRS-2 scores) in 57 children (3-17 years, 82.5% male) with ASD, either with or without heightened levels of anxiety or ADHD symptoms, all per parent report. Children with heightened anxiety problems showed higher scores on four SRS-2 subscales (Social Cognition, Social Communication, Social Motivation, and Restricted Interests and Repetitive Behavior). Children with heightened ADHD traits showed higher scores on two subscales (Social Communication and Social Awareness). These findings suggest similarities and differences in how social deficits in ASD may worsen with anxiety or ADHD symptoms.
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Uljarević M, Richdale AL, McConachie H, Hedley D, Cai RY, Merrick H, Parr JR, Le Couteur A. The Hospital Anxiety and Depression scale: Factor structure and psychometric properties in older adolescents and young adults with autism spectrum disorder. Autism Res 2017; 11:258-269. [PMID: 28922575 DOI: 10.1002/aur.1872] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2017] [Accepted: 08/25/2017] [Indexed: 12/17/2022]
Abstract
Despite the high frequency of anxiety and depression symptoms in individuals with Autism Spectrum Disorder (ASD) and a significant impact of these comorbidities on both individuals with ASD and their families, research on the validity of anxiety and depression measures in the ASD population is currently lacking. The aim of this study was to explore the psychometric properties of the Hospital Anxiety and Depression Scale [HADS; Zigmond & Snaith, ] in a sample of older adolescents and young adults with ASD. One hundred and fifty one participants (UK Transition longitudinal study: N = 106; 75 males, Mage = 16.04 years, SD = 1.28; Longitudinal Study of Australian Schools Leavers with ASD: N = 45, 30 males; Mage = 18.35 years, SD = 2.55) completed the HADS and a range of mental health and well-being measures. Combination of the Principal Component Analysis and Parallel Analysis indicated two factors as an optimal solution in our sample, accounting for 43.77% of variance with factors being identical in terms of content with the structure found in the general population. Internal consistency was good for the HADS anxiety scale (HADS-A; .82-.84) and acceptable for the HADS depression scale (HADS-D; .60-.72). Convergent validity of both HADS-A and HADS-D scales was excellent and divergent validity was acceptable. Our study represents a significant contribution to the literature by providing an initial validation of the HADS in older adolescents and younger adults with ASD. Autism Res 2018, 11: 258-269. © 2017 International Society for Autism Research, Wiley Periodicals, Inc. LAY SUMMARY Research on the validity of measurement of anxiety and depression in ASD is currently lacking. The aim of this study was to explore the properties of the Hospital Anxiety and Depression Scale (HADS) in a sample of 151 young people with ASD. Participants completed HADS and a range of mental health and well-being measures. Encouragingly, our findings suggest that HADS provides a reliable and valid assessment of anxiety and depression in ASD.
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Affiliation(s)
- Mirko Uljarević
- Olga Tennison Autism Research Centre, School of Psychological Science, La Trobe University, Melbourne, Victoria, Australia.,Cooperative Research Centre for Living with Autism (Autism CRC), Long Pocket, Brisbane, Queensland, Australia
| | - Amanda L Richdale
- Olga Tennison Autism Research Centre, School of Psychological Science, La Trobe University, Melbourne, Victoria, Australia.,Cooperative Research Centre for Living with Autism (Autism CRC), Long Pocket, Brisbane, Queensland, Australia
| | - Helen McConachie
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
| | - Darren Hedley
- Olga Tennison Autism Research Centre, School of Psychological Science, La Trobe University, Melbourne, Victoria, Australia
| | - Ru Ying Cai
- Olga Tennison Autism Research Centre, School of Psychological Science, La Trobe University, Melbourne, Victoria, Australia.,Cooperative Research Centre for Living with Autism (Autism CRC), Long Pocket, Brisbane, Queensland, Australia
| | - Hannah Merrick
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
| | - Jeremy R Parr
- Institute of Neuroscience, Newcastle University, Newcastle upon Tyne, UK
| | - Ann Le Couteur
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK.,Complex Neurodevelopmental Disorders Service, Northumberland Tyne and Wear NHS Foundation Trust, Newcastle upon Tyne, UK
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Brookman-Frazee L, Stadnick N, Chlebowski C, Baker-Ericzén M, Ganger W. Characterizing psychiatric comorbidity in children with autism spectrum disorder receiving publicly funded mental health services. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2017; 22:938-952. [PMID: 28914082 DOI: 10.1177/1362361317712650] [Citation(s) in RCA: 90] [Impact Index Per Article: 12.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Publicly funded mental health programs play a significant role in serving children with autism spectrum disorder. Understanding patterns of psychiatric comorbidity for this population within mental health settings is important to implement appropriately tailored interventions. This study (1) describes patterns of psychiatric comorbidity in children with autism spectrum disorder who present to mental health services with challenging behaviors and (2) identifies child characteristics associated with comorbid conditions. Data are drawn from baseline assessments from 201 children with autism spectrum disorder who participated in a community effectiveness trial across 29 publicly funded mental health programs. Non-autism spectrum disorder diagnoses were assessed using an adapted Mini-International Neuropsychiatric Interview, parent version. Approximately 92% of children met criteria for at least one non-autism spectrum disorder diagnosis (78% attention deficit hyperactivity disorder, 58% oppositional defiant disorder, 56% anxiety, 30% mood). Logistic regression indicated that child gender and clinical characteristics were differentially associated with meeting criteria for attention deficit hyperactivity disorder, oppositional defiant disorder, an anxiety, or a mood disorder. Exploratory analyses supported a link between challenging behaviors and mood disorder symptoms and revealed high prevalence of these symptoms in this autism spectrum disorder population. Findings provide direction for tailoring intervention to address a broad range of clinical issues for youth with autism spectrum disorder served in mental health settings.
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Affiliation(s)
- Lauren Brookman-Frazee
- 1 University of California, San Diego, USA.,2 Rady Children's Hospital, San Diego, USA.,3 Child and Adolescent Services Research Center, USA
| | - Nicole Stadnick
- 1 University of California, San Diego, USA.,3 Child and Adolescent Services Research Center, USA
| | - Colby Chlebowski
- 1 University of California, San Diego, USA.,3 Child and Adolescent Services Research Center, USA
| | - Mary Baker-Ericzén
- 2 Rady Children's Hospital, San Diego, USA.,3 Child and Adolescent Services Research Center, USA
| | - William Ganger
- 3 Child and Adolescent Services Research Center, USA.,4 San Diego State University, USA
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Amygdala Volume Differences in Autism Spectrum Disorder Are Related to Anxiety. J Autism Dev Disord 2017; 47:3682-3691. [DOI: 10.1007/s10803-017-3206-1] [Citation(s) in RCA: 47] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
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Magiati I, Lerh JW, Hollocks MJ, Uljarevic M, Rodgers J, McConachie H, Ozsivadjian A, South M, Van Hecke A, Hardan A, Libove R, Leekam S, Simonoff E. The measurement properties of the spence children's anxiety scale-parent version in a large international pooled sample of young people with autism spectrum disorder. Autism Res 2017; 10:1629-1652. [DOI: 10.1002/aur.1809] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2016] [Revised: 02/03/2017] [Accepted: 04/07/2017] [Indexed: 12/27/2022]
Affiliation(s)
- Iliana Magiati
- Department of Psychology; National University of Singapore, 9 Arts Link; Singapore 117570
| | - Jian Wei Lerh
- Department of Psychology; National University of Singapore, 9 Arts Link; Singapore 117570
| | - Matthew J. Hollocks
- Department of Child and Adolescent Psychiatry; Institute of Psychiatry, Psychology & Neuroscience, King's College London, DeCrespigny Park, Denmark Hill; London SE5 8AF UK
- Department of Clinical Psychology; Faculty of Medicine and Health Sciences, Norwich Medical School, University of East Anglia; Norwich UK
| | - Mirko Uljarevic
- Olga Tennison Autism Research Centre; School of Psychological Science, La Trobe University; Victoria 3086 Australia
- Cooperative Research Centre for Living with Autism (Autism CRC), Long Pocket; Brisbane Queensland Australia
| | - Jacqui Rodgers
- Clinical Psychology; Ridley Building, Institute of Neuroscience, Newcastle University; Newcastle NE1 7RU UK
| | - Helen McConachie
- Institute of Health and Society, Newcastle University, Sir James Spence Institute, Royal Victoria Infirmary, Queen Victoria Road; Newcastle upon Tyne NE1 4LP UK
| | - Ann Ozsivadjian
- Evelina London Children's Hospital, St Thomas' Hospital; London UK
| | - Mikle South
- Department of Psychology; College of Family, Home and Social Sciences, Brigham Young University; Provo Utah
| | - Amy Van Hecke
- Department of Psychology; College of Arts and Sciences, Marquette University, Cramer Hall; Milwaukee Wisconsin 53201-1881
| | - Antonio Hardan
- Department of Psychiatry and Behavioral Sciences; Stanford University School of Medicine, Stanford University; Stanford California 94305
| | - Robin Libove
- Department of Psychiatry and Behavioral Sciences; Stanford University School of Medicine, Stanford University; Stanford California 94305
| | - Susan Leekam
- Wales Autism Research Centre; School of Psychology, Cardiff University; Cardiff CF10 3AT UK
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Souders MC, Zavodny S, Eriksen W, Sinko R, Connell J, Kerns C, Schaaf R, Pinto-Martin J. Sleep in Children with Autism Spectrum Disorder. Curr Psychiatry Rep 2017; 19:34. [PMID: 28502070 PMCID: PMC5846201 DOI: 10.1007/s11920-017-0782-x] [Citation(s) in RCA: 132] [Impact Index Per Article: 18.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
The purposes of this paper are to provide an overview of the state of the science of sleep in children with autism spectrum disorder (ASD), present hypotheses for the high prevalence of insomnia in children with ASD, and present a practice pathway for promoting optimal sleep. Approximately two thirds of children with ASD have chronic insomnia, and to date, the strongest evidence on promoting sleep is for sleep education, environmental changes, behavioral interventions, and exogenous melatonin. The Sleep Committee of the Autism Treatment Network (ATN) developed a practice pathway, based on expert consensus, to capture best practices for screening, identification, and treatment for sleep problems in ASD in 2012. An exemplar case is presented to integrate key constructs of the practice pathway and address arousal and sensory dysregulation in a child with ASD and anxiety disorder. This paper concludes with next steps for dissemination of the practice pathway and future directions for research of sleep problems in ASD.
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Affiliation(s)
- Margaret C Souders
- University of Pennsylvania School of Nursing, 418 Curie Blvd, Philadelphia, PA, 19104, USA.
| | - Stefanie Zavodny
- University of Pennsylvania School of Nursing, 418 Curie Blvd, Philadelphia, PA, 19104, USA
| | - Whitney Eriksen
- University of Pennsylvania School of Nursing, 418 Curie Blvd, Philadelphia, PA, 19104, USA
| | - Rebecca Sinko
- Thomas Jefferson University, 130 S. 9th St, Philadelphia, PA, 19107, USA
| | - James Connell
- AJ Drexel Autism Institute, 3020 Market St #560, Philadelphia, PA, 19104, USA
| | - Connor Kerns
- AJ Drexel Autism Institute, 3020 Market St #560, Philadelphia, PA, 19104, USA
| | - Roseann Schaaf
- Thomas Jefferson University, 130 S. 9th St, Philadelphia, PA, 19107, USA
| | - Jennifer Pinto-Martin
- University of Pennsylvania School of Nursing, 418 Curie Blvd, Philadelphia, PA, 19104, USA
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Kerns CM, Renno P, Kendall PC, Wood JJ, Storch EA. Anxiety Disorders Interview Schedule-Autism Addendum: Reliability and Validity in Children With Autism Spectrum Disorder. JOURNAL OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY : THE OFFICIAL JOURNAL FOR THE SOCIETY OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY, AMERICAN PSYCHOLOGICAL ASSOCIATION, DIVISION 53 2017; 46:88-100. [PMID: 27925775 PMCID: PMC5441235 DOI: 10.1080/15374416.2016.1233501] [Citation(s) in RCA: 73] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Assessing anxiety in autism spectrum disorder (ASD) is inherently challenging due to overlapping (e.g., social avoidance) and ambiguous symptoms (e.g., fears of change). An ASD addendum to the Anxiety Disorders Interview Schedule-Child/Parent, Parent Version (ADIS/ASA) was developed to provide a systematic approach for differentiating traditional anxiety disorders from symptoms of ASD and more ambiguous, ASD-related anxiety symptoms. Interrater reliability and convergent and discriminant validity were examined in a sample of 69 youth with ASD (8-13 years, 75% male, IQ = 68-143) seeking treatment for anxiety. The parents of participants completed the ADIS/ASA and a battery of behavioral measures. A second rater independently observed and scored recordings of the original interviews. Findings suggest reliable measurement of comorbid (intraclass correlation = 0.85-0.98, κ = 0.67-0.91) as well as ambiguous anxiety-like symptoms (intraclass correlation = 0.87-95, κ = 0.77-0.90) in children with ASD. Convergent and discriminant validity were supported for the traditional anxiety symptoms on the ADIS/ASA, whereas convergent and discriminant validity were partially supported for the ambiguous anxiety-like symptoms. Results provide evidence for the reliability and validity of the ADIS/ASA as a measure of traditional anxiety categories in youth with ASD, with partial support for the validity of the ambiguous anxiety-like categories. Unlike other measures, the ADIS/ASA differentiates comorbid anxiety disorders from overlapping and ambiguous anxiety-like symptoms in ASD, allowing for more precise measurement and clinical conceptualization. Ambiguous anxiety-like symptoms appear phenomenologically distinct from comorbid anxiety disorders and may reflect either symptoms of ASD or a novel variant of anxiety in ASD.
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Affiliation(s)
- Connor Morrow Kerns
- a A. J. Drexel Autism Institute and Community Health & Prevention , Drexel University
| | - Patricia Renno
- b Center for Autism Research and Treatment , University of California Los Angeles
| | | | - Jeffrey J Wood
- b Center for Autism Research and Treatment , University of California Los Angeles
- d Division of Child Psychiatry and Division of Psychological Studies in Education , University of California Los Angeles
| | - Eric A Storch
- e Departments of Pediatrics, Psychiatry & Behavioral Neurosciences, and Psychology , University of South Florida
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Lohr WD, Daniels K, Wiemken T, Williams PG, Kelley RR, Kuravackel G, Sears L. The Screen for Child Anxiety-Related Emotional Disorders Is Sensitive but Not Specific in Identifying Anxiety in Children with High-Functioning Autism Spectrum Disorder: A Pilot Comparison to the Achenbach System of Empirically Based Assessment Scales. Front Psychiatry 2017; 8:138. [PMID: 28824469 PMCID: PMC5539181 DOI: 10.3389/fpsyt.2017.00138] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2017] [Accepted: 07/17/2017] [Indexed: 12/28/2022] Open
Abstract
Validated brief screening instruments are needed to improve the detection of anxiety disorders in autism spectrum disorder (ASD). The Screen for Child Anxiety-Related Emotional Disorders (SCARED), a 41-item parent- and self-reported scale measuring anxiety, was compared to the Achenbach System of Empirically Based Assessment (ASEBA) scales. One hundred participants with a clinical diagnosis of high-functioning ASD, aged 8-18 years, and their parents completed the above scales. We hypothesized that the SCARED would be useful in screening for anxiety and its results for total scores of anxiety would converge with ASEBA syndrome scales for anxiety and internalizing disorders. Significant correlations were shown between the SCARED and the Child Behavior Checklist (CBCL) and Youth Self-Report (YSR) across a broad spectrum of scales. The CBCL syndrome scale for anxious/depressed showed the highest correlation and predicted anxiety scores on the SCARED. While many of the YSR scales significantly correlated with child ratings of anxiety, none of the scales predicted the SCARED child scores. Differences in self and parent reports suggest that parents interpret externalizing behaviors as signs of anxiety in ASD, whereas youth may describe internalized symptoms as anxiety. Females were more likely to self-report anxiety than males. Results support the use of the SCARED as a screening tool for anxiety in high-functioning ASD, but it should be supplemented with other tools to increase the specificity of its results.
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Affiliation(s)
- W David Lohr
- Department of Pediatrics, University of Louisville School of Medicine, Louisville, KY, United States
| | - Katherine Daniels
- School of Psychology, Spalding University, Louisville, KY, United States
| | - Tim Wiemken
- University of Louisville School of Public Health and Information Sciences, Louisville, KY, United States
| | - P Gail Williams
- Department of Pediatrics, University of Louisville School of Medicine, Louisville, KY, United States
| | - Robert R Kelley
- St. Mary's College of Maryland, St. Mary's City, MD, United States
| | - Grace Kuravackel
- Department of Pediatrics, University of Louisville School of Medicine, Louisville, KY, United States
| | - Lonnie Sears
- Department of Pediatrics, University of Louisville School of Medicine, Louisville, KY, United States
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Kerns CM, Rump K, Worley J, Kratz H, McVey A, Herrington J, Miller J. The Differential Diagnosis of Anxiety Disorders in Cognitively-Able Youth With Autism. COGNITIVE AND BEHAVIORAL PRACTICE 2016. [DOI: 10.1016/j.cbpra.2015.11.004] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
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Kerns CM, Newschaffer CJ, Berkowitz SJ. Traumatic Childhood Events and Autism Spectrum Disorder. J Autism Dev Disord 2016; 45:3475-86. [PMID: 25711547 DOI: 10.1007/s10803-015-2392-y] [Citation(s) in RCA: 119] [Impact Index Per Article: 14.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Traumatic childhood events are associated with a wide range of negative physical, psychological and adaptive outcomes over the life course and are one of the few identifiable causes of psychiatric illness. Children with autism spectrum disorder (ASD) may be at increased risk for both encountering traumatic events and developing traumatic sequelae; however, this topic has been understudied. This review considers the rationale for examining traumatic events and related symptomology in individuals with ASD and summarizes the limited research on this topic. A conceptual framework for understanding the interplay of ASD, trauma and traumatic sequelae is proposed and recommendations for future research presented.
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Affiliation(s)
- Connor Morrow Kerns
- A.J. Drexel Autism Institute, Drexel University, 3020 Market Street, Suite 560, Philadelphia, PA, 19104, USA.
| | - Craig J Newschaffer
- A.J. Drexel Autism Institute, Drexel University, 3020 Market Street, Suite 560, Philadelphia, PA, 19104, USA
| | - Steven J Berkowitz
- Department of Psychiatry, University of Pennsylvania, Pennsylvania, PA, USA
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41
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Zamzow RM, Ferguson BJ, Stichter JP, Porges EC, Ragsdale AS, Lewis ML, Beversdorf DQ. Effects of propranolol on conversational reciprocity in autism spectrum disorder: a pilot, double-blind, single-dose psychopharmacological challenge study. Psychopharmacology (Berl) 2016; 233:1171-8. [PMID: 26762378 DOI: 10.1007/s00213-015-4199-0] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2015] [Accepted: 12/21/2015] [Indexed: 10/22/2022]
Abstract
RATIONALE Pharmacological intervention for autism spectrum disorder (ASD) is an important addition to treatment, yet currently available agents target co-morbid psychiatric concerns, such as aggression and irritability. Propranolol, a beta-adrenergic antagonist with anxiolytic effects, has been shown to improve verbal fluency and working memory in adults and adolescents with ASD in single-dose challenges. OBJECTIVES The present pilot study explores the acute effects of propranolol on a measure of conversational reciprocity in this population. We also examined whether autonomic activity and anxiety moderate or mediate response to the drug, given relationships between these variables and ASD, as well as the drug's effects. METHODS In a within-subject crossover design, 20 individuals with ASD received a single dose of propranolol or placebo during two sessions in a double-blinded, counterbalanced manner. After drug administration, participants performed a conversational reciprocity task by engaging in a short conversation with the researcher. Measurements of autonomic activity and anxiety were obtained before and after drug administration. RESULTS Propranolol significantly improved performance on the conversational reciprocity task total [d = 0.40] and nonverbal communication domain scores when compared to the placebo condition. However, neither autonomic activity nor anxiety was significantly associated with drug response. CONCLUSIONS Acute propranolol administration improved conversational reciprocity in ASD. Further exploration of these preliminary findings, as well as other potential treatment response predictors, with serial doses is warranted.
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Affiliation(s)
- Rachel M Zamzow
- Interdisciplinary Neuroscience Program, University of Missouri, Columbia, MO, USA
| | - Bradley J Ferguson
- Interdisciplinary Neuroscience Program, University of Missouri, Columbia, MO, USA
| | - Janine P Stichter
- Department of Special Education, University of Missouri, Columbia, MO, USA
| | - Eric C Porges
- Center for Cognitive Aging and Memory (CAM), Institute on Aging, McKnight Brain Institute, Department of Aging and Geriatric Research, University of Florida, Gainesville, FL, 32608, USA
| | | | - Morgan L Lewis
- Department of Biological Sciences, University of Missouri, Columbia, MO, USA
- Department of Psychological Sciences, University of Missouri, Columbia, MO, USA
| | - David Q Beversdorf
- Department of Psychological Sciences, University of Missouri, Columbia, MO, USA.
- William and Nancy Thompson Endowed Chair in Radiology, Departments of Radiology and Neurology, and the Thompson Center for Autism and Neurodevelopmental Disorders, University of Missouri, Columbia, MO, USA.
- Department of Radiology, DC069.10, University of Missouri Health Care, One Hospital Dr, Columbia, MO, 65212, USA.
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Herrington JD, Miller JS, Pandey J, Schultz RT. Anxiety and social deficits have distinct relationships with amygdala function in autism spectrum disorder. Soc Cogn Affect Neurosci 2016; 11:907-14. [PMID: 26865425 DOI: 10.1093/scan/nsw015] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2015] [Accepted: 01/28/2016] [Indexed: 11/13/2022] Open
Abstract
Current neural models of autism spectrum disorder (ASD) and anxiety disorders suggest hyperactivation of amygdala in anxiety, but hypoactivation of amygdala in ASD. The objectives of this study were to (i) test the hypothesis that amygdala activity measured by functional magnetic resonance imaging (fMRI) represents a hybrid signal of opposing social functions and anxiety symptoms, and (ii) determine whether longstanding findings of decreased amygdala activation in ASD apply only to those individuals with ASD and low levels of anxiety. During fMRI scanning, 81 youth with ASD and 67 non-ASD control participants completed a face recognition paradigm that elicits robust amygdala activation. Only individuals with ASD and low anxiety levels (a subsample of 28 participants) showed decreased amygdala activation relative to controls. In the ASD group, anxiety symptoms were positively correlated with amygdala activity across the full ASD group, whereas core ASD symptoms (including social deficits) were negatively correlated. Results indicate that hypoactivation of amygdala in ASD, a suggestive finding first reported nearly 20 years ago, can be masked by comorbid anxiety-thus bringing enhanced clarity to this line of work. Amygdala activity represents a hybrid signal of emotion and social processes that cannot be reduced to either alone.
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Affiliation(s)
- John D Herrington
- Center for Autism Research, The Children's Hospital of Philadelphia, Department of Child Psychiatry and Behavioral Science, Perelman School of Medicine, University of Pennsylvania, and
| | - Judith S Miller
- Center for Autism Research, The Children's Hospital of Philadelphia, Department of Child Psychiatry and Behavioral Science, Perelman School of Medicine, University of Pennsylvania, and
| | - Juhi Pandey
- Center for Autism Research, The Children's Hospital of Philadelphia
| | - Robert T Schultz
- Center for Autism Research, The Children's Hospital of Philadelphia, Department of Child Psychiatry and Behavioral Science, Perelman School of Medicine, University of Pennsylvania, and Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
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Vasa RA, Mazurek MO, Mahajan R, Bennett AE, Bernal MP, Nozzolillo AA, Arnold LE, Coury DL. Assessment and Treatment of Anxiety in Youth With Autism Spectrum Disorders. Pediatrics 2016; 137 Suppl 2:S115-23. [PMID: 26908467 DOI: 10.1542/peds.2015-2851j] [Citation(s) in RCA: 80] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES Anxiety is one of the most prevalent co-occurring symptoms in youth with autism spectrum disorder (ASD). The assessment and treatment recommendations proposed here are intended to help primary care providers with the assessment and treatment of anxiety in ASD. METHODS The Autism Speaks Autism Treatment Network/Autism Intervention Research on Physical Health Anxiety Workgroup, a multidisciplinary team of clinicians and researchers with expertise in ASD, developed the clinical recommendations. The recommendations were based on available scientific evidence regarding anxiety treatments, both in youth with ASD and typically developing youth, and clinical consensus of the workgroup where data were lacking. RESULTS Assessment of anxiety requires a systematic approach to evaluating symptoms and potential contributing factors across various developmental levels. Treatment recommendations include psychoeducation, coordination of care, and modified cognitive-behavioral therapy, particularly for children and adolescents with high-functioning ASD. Due to the limited evidence base in ASD, medications for anxiety should be prescribed cautiously with close monitoring of potential benefits and side effects. CONCLUSIONS Assessment and treatment of clinical anxiety in youth with ASD require a standardized approach to improve outcomes for youth with ASD. Although this approach provides a framework for clinicians, clinical judgment is recommended when making decisions about individual patients.
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Affiliation(s)
- Roma A Vasa
- Kennedy Krieger Institute and Department of Psychiatry and Behavioral Sciences at the Johns Hopkins University School of Medicine, Baltimore, Maryland;
| | - Micah O Mazurek
- Department of Health Psychology at the University of Missouri and Thompson Center for Autism and Neurodevelopmental Disorders, Columbia, Missouri
| | - Rajneesh Mahajan
- Kennedy Krieger Institute and Department of Psychiatry and Behavioral Sciences at the Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Amanda E Bennett
- Division of Developmental and Behavioral Pediatrics, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | | | - Alixandra A Nozzolillo
- Center for Child and Adolescent Health Research and Policy, Massachusetts General Hospital for Children and Harvard Medical School, Boston, Massachusetts; and
| | - L Eugene Arnold
- Nisonger Center of Excellence in Developmental Disabilities and
| | - Daniel L Coury
- Department of Developmental and Behavioral Pediatrics, The Ohio State University, Columbus, Ohio
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Johnco CJ, De Nadai AS, Lewin AB, Ehrenreich-May J, Wood JJ, Storch EA. Defining treatment response and symptom remission for anxiety disorders in pediatric autism spectrum disorders using the Pediatric Anxiety Rating Scale. J Autism Dev Disord 2015; 45:3232-42. [PMID: 26031924 PMCID: PMC4574290 DOI: 10.1007/s10803-015-2483-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
This study examined optimal guidelines to assess treatment response and remission for anxiety in youth with autism spectrum disorders (ASD) using the Pediatric Anxiety Rating Scale (PARS). Data was collected for 108 children aged 7-16 years with comorbid anxiety and ASD before and after receiving cognitive behavior therapy. Optimal cut-offs on the PARS were assessed using signal detection analyses using receiver operating characteristic methods. Maximum agreement with response criteria was achieved at 15 % reduction in symptoms on the PARS. Maximum agreement with remission criteria was achieved at 40 % reduction in symptoms, or at a score of 10 or below at post-treatment. Results have implications for standardizing criteria used in research trials and clinical practice.
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Affiliation(s)
- Carly J Johnco
- Department of Pediatrics, University of South Florida, St. Petersburg, FL, USA.
- Rothman Center for Pediatric Neuropsychiatry, Child Development and Rehabilitation Center, 880 6th Street South Suite 460, Box 7523, St. Petersburg, FL, 33701, USA.
| | | | - Adam B Lewin
- Department of Pediatrics, University of South Florida, St. Petersburg, FL, USA
- Department of Psychology, University of South Florida, Tampa, FL, USA
- Department of Psychiatry and Behavioral Neurosciences, University of South Florida, Tampa, FL, USA
| | | | - Jeffrey J Wood
- Division of Child Psychiatry, University of California, Los Angeles, CA, USA
- Division of Psychological Studies in Education, University of California, Los Angeles, CA, USA
| | - Eric A Storch
- Department of Pediatrics, University of South Florida, St. Petersburg, FL, USA
- Department of Psychology, University of South Florida, Tampa, FL, USA
- Department of Psychiatry and Behavioral Neurosciences, University of South Florida, Tampa, FL, USA
- Department of Health Policy and Management, University of South Florida, Tampa, FL, USA
- Rogers Behavioral Health - Tampa Bay, Tampa, FL, USA
- All Children's Hospital - Johns Hopkins Medicine, St. Petersburg, FL, USA
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