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Smith JV, McQuaid GA, Wallace GL, Neuhaus E, Lopez A, Ratto AB, Jack A, Khuu A, Webb SJ, Verbalis A, Pelphrey KA, Kenworthy L. Time is of the essence: Age at autism diagnosis, sex assigned at birth, and psychopathology. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2024:13623613241249878. [PMID: 38725306 DOI: 10.1177/13623613241249878] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/25/2024]
Abstract
LAY ABSTRACT Previous research has shown that girls/women are diagnosed later than boys/men with autism. Individuals who are diagnosed later in life, especially girls/women, have greater anxious and depressive symptoms. Previous research has been limited due to narrow inclusionary criteria for enrollment in studies. The present study uses two samples-one clinic-based, large "real-world" sample and another research-based sample with strict criteria for autism diagnosis-to understand the relationships between diagnostic age, sex assigned at birth, and symptoms of anxiety/depression. In both samples, those who were diagnosed later had greater anxious/depressive symptoms, and anxiety was not predicted by sex. In the clinic-based but not research-based sample, those assigned female at birth were diagnosed later than those assigned male at birth. In the clinic-based sample only, individuals assigned female at birth and who were later diagnosed experienced greater symptoms of anxiety/depression compared to those assigned male who benefited from earlier diagnostic timing. Within the research-based sample, those assigned female at birth had greater depressive symptoms than those assigned male. These findings highlight the importance of timely identification of autism, especially for girls/women who are often diagnosed later. Community-based samples are needed to better understand real-world sex-based and diagnostic age-based disparities in mental health.
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Affiliation(s)
- Jessica V Smith
- Children's Research Institute, Children's National Hospital, USA
| | | | - Gregory L Wallace
- Department of Speech, Language, and Hearing Sciences, The George Washington University, USA
| | - Emily Neuhaus
- Center on Child Health, Behavior, and Development, Seattle Children's Research Institute, USA
| | - Andrea Lopez
- Children's Research Institute, Children's National Hospital, USA
| | - Allison B Ratto
- Children's Research Institute, Children's National Hospital, USA
| | - Allison Jack
- Department of Psychology, George Mason University, USA
| | - Alexis Khuu
- Children's Research Institute, Children's National Hospital, USA
| | - Sara J Webb
- Center on Child Health, Behavior, and Development, Seattle Children's Research Institute, USA
| | - Alyssa Verbalis
- Children's Research Institute, Children's National Hospital, USA
| | | | - Lauren Kenworthy
- Children's Research Institute, Children's National Hospital, USA
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2
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Spackman E, Lerh JW, Rodgers J, Hollocks MJ, South M, McConachie H, Ozsivadjian A, Vaughan Van Hecke A, Libove R, Hardan AY, Leekam SR, Simonoff E, Frazier TW, Alvares GA, Schwartzman JM, Magiati I, Uljarević M. Understanding the heterogeneity of anxiety in autistic youth: A person-centered approach. Autism Res 2022; 15:1742-1754. [PMID: 35642170 DOI: 10.1002/aur.2744] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Accepted: 04/18/2022] [Indexed: 11/10/2022]
Abstract
The present study aimed to examine anxiety profiles among children and adolescents on the autism spectrum. It further aimed to characterize the association between the identified anxiety profiles and key clinical and developmental variables. The Spence Children's Anxiety Scale-Parent Version (SCAS-P) data from a large international pooled sample of 870 caregivers of autistic children and adolescents (Mage = 11.6 years, SDage = 2.77; 107 females) was used. Latent profile analysis identified a three-anxiety profile solution exhibiting high entropy (0.80) and high latent profile probabilities, with good classification accuracy. Identified profiles fell along the severity spectrum and were named as the mild (n = 498), moderate (n = 272) and severe (n = 100) anxiety profiles. There were no statistically significant differences between the three anxiety profiles in terms of sex distribution. Participants in the mild profile were significantly younger than those in the severe profile, had significantly fewer social communication difficulties than youth in the moderate anxiety profile group and had significantly fewer restricted and repetitive behaviors and lower cognitive functioning scores compared to participants in moderate and severe anxiety profiles. This is the first study to move beyond identifying associations and group-level differences to exploring and identifying characteristics of anxiety-based subgroups at an individual level that differ on key clinical and developmental variables. The subgroups identified in this study are a preliminary, yet important, first step towards informing future assessment and individualized interventions aiming to support young people on the autism spectrum to reduce and manage anxiety. LAY SUMMARY: This study tried to understand if there are subgroups of autistic young people who may have similar anxiety profiles. We found that we could meaningfully group young people into three groups based on how severe the anxiety symptoms their caregivers reported were: a group with low levels of anxiety, those with moderate anxiety, and those with more severe anxiety. We also found that the young people in the mild group were younger, had fewer autism traits and lower levels of intellectual functioning than young people in the other two groups.
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Affiliation(s)
- Emily Spackman
- Melbourne School of Psychological Sciences, University of Melbourne, Melbourne, Victoria, Australia
| | - Jian Wei Lerh
- Department of Psychology, National University of Singapore, Singapore, Singapore
| | - Jacqui Rodgers
- Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
| | - Matthew J Hollocks
- Department of Child & Adolescent Psychiatry, King's College London, London, UK.,Central and North West London NHS Foundation Trust, London, UK
| | - Mikle South
- Emory University School of Medicine, Emory University, Atlanta, Georgia, USA
| | - Helen McConachie
- Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
| | - Ann Ozsivadjian
- Evelina London Children's Hospital, Guys and St Thomas' NHS Foundation Trust, London, UK
| | | | - Robin Libove
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford University, Stanford, California, USA
| | - Antonio Y Hardan
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford University, Stanford, California, USA
| | - Susan R Leekam
- Wales Autism Research Centre, School of Psychology, Cardiff University, Cardiff, UK
| | - Emily Simonoff
- Department of Child & Adolescent Psychiatry, King's College London, London, UK
| | - Thomas W Frazier
- Department of Psychology, John Carroll University, University Heights, Ohio, USA
| | - Gail A Alvares
- School of Psychological Science, University of Western Australia, Perth, Western Australia, Australia
| | - Jessica M Schwartzman
- Vanderbilt Child and Adolescent Psychiatry, Vanderbilt University, Nashville, Tennessee, USA
| | - Iliana Magiati
- School of Psychological Science, University of Western Australia, Perth, Western Australia, Australia
| | - Mirko Uljarević
- Melbourne School of Psychological Sciences, University of Melbourne, Melbourne, Victoria, Australia
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3
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Carter M, Casey S, O'Keeffe GW, Gibson L, Gallagher L, Murray DM. Maternal Immune Activation and Interleukin 17A in the Pathogenesis of Autistic Spectrum Disorder and Why It Matters in the COVID-19 Era. Front Psychiatry 2022; 13:823096. [PMID: 35250672 PMCID: PMC8891512 DOI: 10.3389/fpsyt.2022.823096] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2021] [Accepted: 01/21/2022] [Indexed: 11/30/2022] Open
Abstract
Autism spectrum disorder (ASD) is the commonest neurodevelopmental disability. It is a highly complex disorder with an increasing prevalence and an unclear etiology. Consensus indicates that ASD arises as a genetically modulated, and environmentally influenced condition. Although pathogenic rare genetic variants are detected in around 20% of cases of ASD, no single factor is responsible for the vast majority of ASD cases or that explains their characteristic clinical heterogeneity. However, a growing body of evidence suggests that ASD susceptibility involves an interplay between genetic factors and environmental exposures. One such environmental exposure which has received significant attention in this regard is maternal immune activation (MIA) resulting from bacterial or viral infection during pregnancy. Reproducible rodent models of ASD are well-established whereby induction of MIA in pregnant dams, leads to offspring displaying neuroanatomical, functional, and behavioral changes analogous to those seen in ASD. Blockade of specific inflammatory cytokines such as interleukin-17A during gestation remediates many of these observed behavioral effects, suggesting a causative or contributory role. Here, we review the growing body of animal and human-based evidence indicating that interleukin-17A may mediate the observed effects of MIA on neurodevelopmental outcomes in the offspring. This is particularly important given the current corona virus disease-2019 (COVID-19) pandemic as severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection during pregnancy is a potent stimulator of the maternal immune response, however the long-term effects of maternal SARS-CoV-2 infection on neurodevelopmental outcomes is unclear. This underscores the importance of monitoring neurodevelopmental outcomes in children exposed to SARS-CoV-2-induced MIA during gestation.
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Affiliation(s)
- Michael Carter
- INFANT Research Centre, University College Cork, Cork, Ireland.,Department of Paediatrics and Child Health, University College Cork, Cork, Ireland.,National Children's Research Centre, Dublin, Ireland
| | - Sophie Casey
- INFANT Research Centre, University College Cork, Cork, Ireland.,Department of Anatomy and Neuroscience, University College Cork, Cork, Ireland
| | - Gerard W O'Keeffe
- INFANT Research Centre, University College Cork, Cork, Ireland.,Department of Anatomy and Neuroscience, University College Cork, Cork, Ireland
| | - Louise Gibson
- INFANT Research Centre, University College Cork, Cork, Ireland.,Department of Paediatrics and Child Health, University College Cork, Cork, Ireland
| | - Louise Gallagher
- Department of Psychiatry, School of Medicine, Trinity College Dublin, Dublin, Ireland.,Trinity Translational Medicine Institute, St. James's Hospital, Dublin, Ireland
| | - Deirdre M Murray
- INFANT Research Centre, University College Cork, Cork, Ireland.,Department of Paediatrics and Child Health, University College Cork, Cork, Ireland
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4
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Carter M, Casey S, O’Keeffe GW, Gibson L, Murray DM. Mid-gestation cytokine profiles in mothers of children affected by autism spectrum disorder: a case-control study. Sci Rep 2021; 11:22315. [PMID: 34785716 PMCID: PMC8595633 DOI: 10.1038/s41598-021-01662-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2021] [Accepted: 10/15/2021] [Indexed: 12/28/2022] Open
Abstract
Autism Spectrum disorder is one of the commonest and most important neurodevelopmental conditions affecting children today. With an increasing prevalence and an unclear aetiology, it is imperative we find early markers of autism, which may facilitate early identification and intervention. Alterations of gestational cytokine profiles have been reported in mothers of autistic children. Increasing evidence suggests that the intrauterine environment is an important determinant of autism risk. This study aims to examine the mid-gestational serum cytokine profiles of the mothers of autistic children from a well-characterised birth cohort. A nested sub-cohort within a large mother-child birth cohort were identified based on a confirmed multi-disciplinary diagnosis of autism before the age 10 years and neuro-typical matched controls in a 2:1 ratio. IFN-γ, IL-1β, IL-4, IL-6, IL-8, IL-17A, GMCSF and TNFα were measured in archived maternal 20-week serum using MesoScale Diagnostics multiplex technology and validation of our IL-17A measurements was performed using an ultrasensitive assay. From a cohort of 2137 children, 25 had confirmed autism before 10 years and stored maternal serum from mid-gestation. We examined the sera of these 25 cases and 50 matched controls. The sex ratio was 4:1 males to females in each group, and the mean age at diagnosis was 5.09 years (SD 2.13). We found that concentrations of IL-4 were significantly altered between groups. The other analytes did not differ significantly using either multiplex or ultra-sensitive assays. In our well-characterised prospective cohort of autistic children, we confirmed mid-gestational alterations in maternal IL-4 concentrations in autism affected pregnancies versus matched controls. These findings add to promising evidence from animal models and retrospective screening programmes and adds to the knowledge in this field.
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Affiliation(s)
- Michael Carter
- The Irish Centre for Maternal and Child Health Research, University College Cork, Cork, Ireland. .,National Children's Research Centre, Crumlin, Dublin 12, Ireland. .,Department of Paediatrics and Child Health, University College Cork (UCC), Cork, Ireland.
| | - Sophie Casey
- grid.7872.a0000000123318773The Irish Centre for Maternal and Child Health Research, University College Cork, Cork, Ireland ,grid.7872.a0000000123318773Department of Anatomy and Neuroscience, University College Cork (UCC), Cork, Ireland
| | - Gerard W. O’Keeffe
- grid.7872.a0000000123318773The Irish Centre for Maternal and Child Health Research, University College Cork, Cork, Ireland ,grid.7872.a0000000123318773Department of Anatomy and Neuroscience, University College Cork (UCC), Cork, Ireland
| | - Louise Gibson
- grid.7872.a0000000123318773The Irish Centre for Maternal and Child Health Research, University College Cork, Cork, Ireland ,grid.7872.a0000000123318773Department of Paediatrics and Child Health, University College Cork (UCC), Cork, Ireland
| | - Deirdre M. Murray
- grid.7872.a0000000123318773The Irish Centre for Maternal and Child Health Research, University College Cork, Cork, Ireland ,grid.7872.a0000000123318773Department of Paediatrics and Child Health, University College Cork (UCC), Cork, Ireland
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5
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Maternal Mid-Gestation Cytokine Dysregulation in Mothers of Children with Autism Spectrum Disorder. J Autism Dev Disord 2021; 52:3919-3932. [PMID: 34505185 PMCID: PMC9349096 DOI: 10.1007/s10803-021-05271-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/01/2021] [Indexed: 12/25/2022]
Abstract
Autism spectrum disorder (ASD) is a developmental disorder characterised by deficits in social interactions and communication, with stereotypical and repetitive behaviours. Recent evidence suggests that maternal immune dysregulation may predispose offspring to ASD. Independent samples t-tests revealed downregulation of IL-17A concentrations in cases, when compared to controls, at both 15 weeks (p = 0.02), and 20 weeks (p = 0.02), which persisted at 20 weeks following adjustment for confounding variables. This adds to the growing body of evidence that maternal immune regulation may play a role in foetal neurodevelopment.
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6
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Muris P, Monait N, Weijsters L, Ollendick TH. Symptoms of Selective Mutism in Non-clinical 3- to 6-Year-Old Children: Relations With Social Anxiety, Autistic Features, and Behavioral Inhibition. Front Psychol 2021; 12:669907. [PMID: 34135829 PMCID: PMC8201984 DOI: 10.3389/fpsyg.2021.669907] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Accepted: 05/05/2021] [Indexed: 11/26/2022] Open
Abstract
Selective mutism (SM) is a psychiatric condition that is characterized by a failure to speak in specific social situations (e. g., at school) despite speaking normally in other situations (e.g., at home). There is abundant evidence that anxiety, and social anxiety in particular, is a prominent feature of SM, which is the main reason why this condition is currently classified as an anxiety disorder. Meanwhile, there is increasing support for the notion that autism-related problems are also involved in SM. The present study examined the relations between SM and social anxiety, autistic features, and behavioral inhibition to the unfamiliar (i.e., the tendency to react with restraint and withdrawal when confronted with unfamiliar stimuli and situations). Parents of 172 3- to 6-year-old preschool children completed an online survey for measuring the relevant constructs. Results showed that there were positive and statistically significant correlations between SM and social anxiety, autistic features, and behavioral inhibition. Regression analyses revealed that (1) both social anxiety and autistic features accounted for a significant and unique proportion of the variance in SM scores, and (2) that both of these variables no longer made a significant contribution once behavioral inhibition was added to the model. It can be concluded that while the involvement of social anxiety is unambiguous in SM, autism-related problems are also implicated. Furthermore, behavioral inhibition seems to play a key role in the non-speaking behavior of non-clinical young children.
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Affiliation(s)
- Peter Muris
- Department of Clinical Psychological Science, Maastricht University, Maastricht, Netherlands.,Departement of Sielkunde, Stellenbosch University, Stellenbosch, South Africa
| | - Nona Monait
- Department of Clinical Psychological Science, Maastricht University, Maastricht, Netherlands
| | - Lotte Weijsters
- Department of Clinical Psychological Science, Maastricht University, Maastricht, Netherlands
| | - Thomas H Ollendick
- Department of Psychology, Virginia Polytechnic and State University, Blacksburg, VA, United States.,Department of Psychology, Roehampton University, London, United Kingdom
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7
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Abstract
Individuals with autism experience substantially higher rates of mood problems compared to the general population, which contribute to reduced quality of life and increased mortality through suicide. Here, we reviewed evidence for the clinical presentation, aetiology and therapeutic approaches for mood problems in autism. We identified a lack of validated tools for accurately identifying mood problems in individuals with autism, who may present with 'atypical' features (e.g. severe irritability). Risk factors for mood problems in autism appear to be largely overlapping with those identified in the general population, including shared genetic, environmental, cognitive, physiological/neurobiological mechanisms. However, these mechanisms are exacerbated directly/indirectly by lived experiences of autism, including increased vulnerability for chronic stress - often related to social-communication difficulties(/bullying) and sensory sensitivities. Lastly, current therapeutic approaches are based on recommendations for primary mood disorders, with little reference to the neurobiological/cognitive differences associated with autism. Thus, we recommend: 1) the development and validation of (objective) tools to identify mood problems in autism and measure therapeutic efficacy; 2) an interactive approach to investigating aetiologies in large-scale longitudinal studies, integrating different levels of analysis (e.g. cognitive, neurobiological) and lived experience; 3) testing potential treatments through high-quality (e.g. sufficiently powered, blinded) clinical trials, specifically for individuals with autism.
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Affiliation(s)
- Bethany Oakley
- Department of Forensic and Neurodevelopmental Sciences, Institute of Psychiatry, Psychology & Neuroscience, King's College London, De Crespigny Park, UK
| | - Eva Loth
- Department of Forensic and Neurodevelopmental Sciences, Institute of Psychiatry, Psychology & Neuroscience, King's College London, De Crespigny Park, UK
| | - Declan G Murphy
- Department of Forensic and Neurodevelopmental Sciences, Institute of Psychiatry, Psychology & Neuroscience, King's College London, De Crespigny Park, UK.,South London and Maudsley NHS Foundation Trust (SLaM), London, UK.,Sackler Institute for Translational Neurodevelopment, Institute of Psychiatry, Psychology & Neuroscience, King's College London, De Crespigny Park, UK
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8
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Hastings SE, Hastings RP, Swales MA, Hughes JC. Emotional and behavioural problems of children with autism spectrum disorder attending mainstream schools. INTERNATIONAL JOURNAL OF DEVELOPMENTAL DISABILITIES 2021; 68:633-640. [PMID: 36210888 PMCID: PMC9542324 DOI: 10.1080/20473869.2020.1869414] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Revised: 12/18/2020] [Accepted: 12/20/2020] [Indexed: 05/30/2023]
Abstract
Emotional and behavioural problems occur more commonly in children with Autism Spectrum Disorder (ASD) compared to other children. Few studies have focused on these problems in children with ASD attending mainstream schools. We assessed via parent report the emotional and behavioural problems in 160 children aged 4-17 years with ASD attending mainstream schools and investigated differences between the primary and secondary aged children. Children with ASD had higher levels of problems across all domains of the Strengths and Difficulties Questionnaire (SDQ) compared to UK norms. Within the ASD sample, SDQ scores were associated with male sex, living in a household with more children, more severe autism symptoms and fewer adaptive skills, and higher levels of family socio-economic risk. No robust primary-secondary school differences were found. Implications for future research and the support of children with ASD in mainstream school settings are discussed.
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Affiliation(s)
| | | | | | - J Carl Hughes
- School of Education and Human Development, Bangor University, Bangor, Gwynedd, UK
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9
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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. Co-occurring trajectories of anxiety and insistence on sameness behaviour in autism spectrum disorder. Br J Psychiatry 2021; 218:20-27. [PMID: 32641181 DOI: 10.1192/bjp.2020.127] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
BACKGROUND Children with autism spectrum disorder (ASD) have increased susceptibility to anxiety disorders. Variation in a common ASD symptom, insistence on sameness behaviour, may predict future anxiety symptoms. AIMS To describe the joint heterogeneous longitudinal trajectories of insistence on sameness and anxiety in children with ASD and to characterise subgroups at higher risk for anxiety. METHOD In a longitudinal ASD cohort (n = 421), insistence on sameness behaviour was measured using the Autism Diagnostic Interview-Revised at approximately ages 3, 6 and 11 years. Anxiety was quantified at 8 time points between ages 3 and 11 years using the Child Behavior Checklist (CBCL) (parent report). Clusters of participants following similar trajectories were identified using group-based and joint trajectory modelling. RESULTS Three insistence on sameness trajectories were identified: (a) 'low-stable' (41.7% of participants), (b) 'moderate-increasing' (52.0%) and (c) 'high-peaking' (i.e. increasing then stabilising/decreasing behaviour) (6.3%). Four anxiety trajectories were identified: (a) 'low-increasing' (51.0%), (b) 'moderate-decreasing' (16.2%), (c) 'moderate-increasing' (19.6%) and (d) 'high-stable' (13.1%). Of those assigned to the 'high-peaking' insistence on sameness trajectory, 95% jointly followed an anxiety trajectory that surpassed the threshold for clinical concern (T-score >65) by middle childhood (anxiety trajectories 3 or 4). Insistence on sameness and anxiety trajectories were similar in severity and direction for 64% of the sample; for 36%, incongruous patterns were seen (e.g. decreasing anxiety and increasing insistence on sameness). CONCLUSIONS The concurrent assessment of insistence on sameness behaviour and anxiety in ASD may help in understanding current symptom profiles and anticipating future trajectories. High preschool insistence on sameness in particular may be associated with elevated current or future anxiety symptoms.
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Affiliation(s)
| | - Simone Vigod
- Department of Psychiatry, Women's College Hospital; and Women's College Research Institute; and Department of Psychiatry and Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada
| | - Eleanor Pullenayegum
- Child Health Evaluative Sciences, The Hospital for Sick Children Research Institute; and Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Connor M Kerns
- Department of Psychology, University of British Columbia, Vancouver, Canada
| | - Pat Mirenda
- Department of Educational and Counselling Psychology and Special Education, University of British Columbia, Vancouver, Canada
| | - Isabel M Smith
- Department of Pediatrics, Dalhousie University; and Autism Research Centre, Dalhousie University and IWK Health Centre, Halifax, 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, Canada
| | - Lonnie Zwaigenbaum
- Department of Pediatrics, University of Alberta; and Autism Research Centre, Edmonton, Canada
| | - Teresa Bennett
- Offord Centre for Child Studies; and Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Canada
| | - Eric Duku
- Offord Centre for Child Studies; and Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Canada
| | - Mayada Elsabbagh
- Montreal Neurological Institute, McGill University, Montreal, Canada
| | - Stelios Georgiades
- Department of Psychiatry and Behavioural Neurosciences, McMaster University; and Offord Centre for Child Studies, Hamilton, Canada
| | - Wendy J Ungar
- Child Health Evaluative Sciences, The Hospital for Sick Children Research Institute; and Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada
| | - Anat Zaidman Zait
- Department of School Counseling and Special Education, Constantiner School of Education, Tel Aviv University, Israel; and School of Population and Public Health, Faculty of Medicine, University of British Columbia, Vancouver, Canada
| | - Peter Szatmari
- Centre for Addiction and Mental Health; and The Hospital for Sick Children; and Department of Psychiatry, University of Toronto, Toronto, Canada
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10
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Characterization and Prediction of Anxiety in Adolescents with Autism Spectrum Disorder: A Longitudinal Study. JOURNAL OF ABNORMAL CHILD PSYCHOLOGY 2020; 48:1239-1249. [PMID: 32617732 DOI: 10.1007/s10802-020-00673-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Anxiety is one of the most common comorbidities in youth with autism spectrum disorder (ASD). The current study's aims were: To examine the frequency of elevated anxiety symptoms in adolescents diagnosed with ASD in toddlerhood; To explore the impact of comorbid anxiety in adolescents on clinical presentation; To evaluate variables in toddlerhood that associate with anxiety symptom severity in adolescence. The study included 61 adolescents (mean age = 13:8y) diagnosed with ASD in toddlerhood (T1). Participants underwent a comprehensive assessment of cognitive ability, adaptive skills and autism severity at T1 and again as adolescents (T2), and an evaluation of anxiety symptoms at T2. For the first aim, the most prevalent anxiety subtypes noted in adolescence were separation (39.3%), social (27.9%) and generalized anxiety (18.0%). For the second aim, cognitive ability, autism severity and adaptive skills in adolescents with and without elevated anxiety symptoms scores of any type did not differ significantly. For the third aim, younger age at adolescence was associated with more severe separation and generalized anxiety symptoms. Higher cognitive ability and adaptive skills in toddlerhood were associated with elevated generalized anxiety symptoms in adolescence. Lower adaptive behaviors and repetitive behaviors (RRBs) correlated with elevated social anxiety symptoms. Lower cognitive abilities and more severe RRBs in toddlerhood predicted separation anxiety in adolescence. The study sheds light on early characteristics in ASD that associate with anxiety symptom severity in adolescence. The type of elevated anxiety symptoms presented in adolescence associated with the level of cognitive ability, adaptive skills and RRBs in toddlerhood.
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11
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Kuzminskaite E, Begeer S, Hoekstra RA, Grove R. Short report: Social communication difficulties and restricted repetitive behaviors as predictors of anxiety in adults with autism spectrum disorder. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2020; 24:1917-1923. [PMID: 32615779 PMCID: PMC7543028 DOI: 10.1177/1362361320934218] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Autism spectrum disorder and anxiety are highly comorbid conditions. Understanding the underlying traits of anxiety in autism spectrum disorder is crucial to prevent and treat it efficiently. Hence, this study determined whether social communication difficulties or restricted repetitive behaviors are stronger risk factors for anxiety symptoms in autistic adults in a large cohort. Data on 742 autistic adults from the Netherlands Autism Register were included in the study. Hierarchical regression was implemented to evaluate whether social communication difficulties (Autism-Spectrum Quotient social behavior factor) and restricted repetitive behaviors (Adult Routines Inventory) were predictive of anxiety (Hospital Anxiety and Depression Scale) controlling for age and sex. When considered together, restricted repetitive behaviors stood out as significant positive predictors of anxiety symptoms (lower-order restricted repetitive behaviors, β = 0.32, p < 0.001; higher-order restricted repetitive behaviors, β = 0.15, p = 0.001), whereas social communication difficulties did not (β = 0.06, p = 0.11). Sex did not moderate these associations (p > 0.05). Non-social autistic traits are stronger predictors of anxiety symptoms than social traits in autistic adults. Increased attention to restricted repetitive behaviors should be given to improve current support programs for autistic adults with anxiety and to identify autistic individuals at risk.
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12
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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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13
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Abstract
Purpose
Mental health conditions are known to be more common amongst autistic than non-autistic people. To date, there is little work exploring gender differences in mental health amongst autistic people and no work including non-binary/trans people. This paper aims to address this gap.
Design/methodology/approach
This was a large-scale online study, with 948 participants between 18 and 81 years old. Participants self-reported autism, anxiety, depression and eating disorder status. Analyses were run examining gender differences in the rates of these conditions in each group.
Findings
Autistic people are more likely to have anxiety and depression than non-autistic people of all genders. Autistic women and non-binary people experienced mental health issues at higher rates than men and at similar rates to each other. Autistic people were twice as likely as non-autistic people to have all eating disorders. Further, gendered patterns of eating disorders seen in the non-autistic population are also present in the autistic population.
Research limitations/implications
There are inherent issues with self-report of diagnoses online, but this study showed that using screening questionnaires is effective.
Originality/value
This is the first paper to look at gender differences in common mental health issues amongst autistic and non-autistic adults. It highlights that there are significant gendered patterns in the prevalence of mental health issues in both the autistic and non-autistic population and that these have an impact for how treatment should be approached to be effective.
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14
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Briot K, Jean F, Jouni A, Geoffray MM, Ly-Le Moal M, Umbricht D, Chatham C, Murtagh L, Delorme R, Bouvard M, Leboyer M, Amestoy A. Social Anxiety in Children and Adolescents With Autism Spectrum Disorders Contribute to Impairments in Social Communication and Social Motivation. Front Psychiatry 2020; 11:710. [PMID: 32793002 PMCID: PMC7393242 DOI: 10.3389/fpsyt.2020.00710] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2020] [Accepted: 07/06/2020] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Recognition of symptoms of Social anxiety (SA) may be difficult among individuals with Autism Spectrum Disorders (ASD) because of overlap between social anxiety and autistic symptomatology. The main aim of our study was thus to explore the association between symptoms of social anxiety and clinical characteristics of ASD in order to identify individuals experiencing concomitant ASD and social anxiety disorder. We also described the prevalence of SA in a sample of children and adolescents with ASD. METHOD 79 children and adolescents with ASD (with and without intellectual disability) and 28-matched control participants were recruited in two French Expert Centers for ASD, coordinated by the Fundation FondaMental. Psychiatric comorbidities, anxiety disorders and depression were screened with standard tools (Liebowitz social anxiety scale, Hamilton Depression and Anxiety Rating Scale) and correlated to autistic features and social skills assessed with the social responsiveness scale 2 (SRS-2) and the repetitive behavior scale (RBS-R). We performed bivariate analysis between the social anxiety level and the scores measured with different clinical scales. We then adjusted the observed relationships with the alterations of SRS-2 and RBS-R scores. RESULTS After adjustment, the level of social anxiety appeared as significantly associated with alterations in social reciprocity and particularly with the SRS-2 "social communication" and "social motivation" sub-scores, but not with RBS-R score. CONCLUSIONS We confirm previous reports showing that individuals with ASD are at high risk for specific anxiety disorders. In particular, high levels of impairments in social motivation and social communication (SRS-2) are indicative of comorbid disorders namely, social anxiety and ASD. Our findings clearly inform diagnostic assessment in ASD and stress the need to take comorbid anxiety disorders into consideration to improve treatment of ASD. To further clarify the impact of social anxiety on social competences and socio-adaptive handicap, longitudinal studies and cluster analysis will be needed in the future.
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Affiliation(s)
- Kellen Briot
- University of Bordeaux, Medical Sciences Department, Bordeaux, France.,Centre Hospitalier Charles-Perrens, Pôle Universitaire de Psychiatrie de l'Enfant et de l'Adolescent, Bordeaux, France
| | - François Jean
- Centre Hospitalier Dr Jean Eric Techer, Pôle de Psychiatrie de l'enfant et de l'adolescent, Calais, France
| | - Ali Jouni
- Centre Hospitalier Charles-Perrens, Pôle Universitaire de Psychiatrie de l'Enfant et de l'Adolescent, Bordeaux, France
| | - Marie-Maude Geoffray
- Department of Child and Adolescent Psychiatry, Centre Hospitalier le Vinatier, Bron, France
| | - Myriam Ly-Le Moal
- Institut Roche, Tour Horizons- Bureau 18M3, Boulogne-Billancourt, France
| | - Daniel Umbricht
- Roche Pharma Research and Early Development, Roche Innovation Center Basel, F. Hoffmann-La Roche Ltd., Basel, Switzerland
| | - Christopher Chatham
- Roche Pharma Research and Early Development, Roche Innovation Center Basel, F. Hoffmann-La Roche Ltd., Basel, Switzerland
| | - Lorraine Murtagh
- Roche Pharma Research and Early Development, Roche Innovation Center Basel, F. Hoffmann-La Roche Ltd., Basel, Switzerland
| | - Richard Delorme
- Fondation FondaMental, Créteil, France.,Institut Pasteur, Human Genetics and Cognitive Functions Unit, Paris, France.,Université Paris Est Créteil, AP-HP, DMU IMPACT, Psychiatry and Addictology Department, Mondor University Hospital, Créteil, France
| | - Manuel Bouvard
- University of Bordeaux, Medical Sciences Department, Bordeaux, France.,Centre Hospitalier Charles-Perrens, Pôle Universitaire de Psychiatrie de l'Enfant et de l'Adolescent, Bordeaux, France.,Fondation FondaMental, Créteil, France.,Aquitaine Institute for Cognitive and Integrative Neuroscience, INCIA UMR 5287, Bordeaux, France
| | - Marion Leboyer
- Fondation FondaMental, Créteil, France.,Université Paris Est Créteil, AP-HP, DMU IMPACT, Psychiatry and Addictology Department, Mondor University Hospital, Créteil, France.,INSERM, U955, IMRB, Laboratoire de NeuroPsychiatrie translationnelle, Créteil, France
| | - Anouck Amestoy
- University of Bordeaux, Medical Sciences Department, Bordeaux, France.,Centre Hospitalier Charles-Perrens, Pôle Universitaire de Psychiatrie de l'Enfant et de l'Adolescent, Bordeaux, France.,Fondation FondaMental, Créteil, France.,Aquitaine Institute for Cognitive and Integrative Neuroscience, INCIA UMR 5287, Bordeaux, France
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15
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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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16
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Prevalence and Predictors of Anxiety Disorders in Adolescent and Adult Males with Autism Spectrum Disorder and Fragile X Syndrome. J Autism Dev Disord 2019; 49:1131-1141. [PMID: 30430320 DOI: 10.1007/s10803-018-3804-6] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Anxiety disorders affect ~ 15-20% of youths without neurodevelopmental disorders, with persons having autism spectrum disorder (ASD) and fragile X syndrome (FXS) at elevated risk for anxiety disorders. Few studies have compared rates and predictors of anxiety disorders in adolescents with FXS or ASD. This study directly compares rates, predictors, and medication of anxiety disorders between age-matched, male adolescents with FXS (n = 31) or ASD (n = 20). Results indicate that 51.6% of FXS and 50.0% of ASD adolescents met criteria for an anxiety disorder. Cognitive scores and ASD severity did not predict anxiety. Of those with anxiety, ~ 40% of the FXS and 20% of the ASD participants were prescribed medications for anxiety.
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17
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Adams D, Simpson K, Keen D. School-related anxiety symptomatology in a community sample of primary-school-aged children on the autism spectrum. J Sch Psychol 2018; 70:64-73. [DOI: 10.1016/j.jsp.2018.07.003] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2018] [Revised: 06/07/2018] [Accepted: 07/26/2018] [Indexed: 12/28/2022]
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18
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Duvekot J, van der Ende J, Verhulst FC, Greaves-Lord K. Examining bidirectional effects between the autism spectrum disorder (ASD) core symptom domains and anxiety in children with ASD. J Child Psychol Psychiatry 2018; 59:277-284. [PMID: 29076153 DOI: 10.1111/jcpp.12829] [Citation(s) in RCA: 46] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/08/2017] [Indexed: 12/28/2022]
Abstract
BACKGROUND Although a bidirectional relationship between autism spectrum disorder (ASD) and anxiety symptoms is assumed, few studies have investigated this. Moreover, little is known about potential differential relationships of the two core symptom domains of ASD - social communication impairment and restricted, repetitive behavior - with anxiety over time. METHOD Participants were 130 children with an ASD (M age 6.7 years, 81.5% boys) of whom 79 participated in a follow-up assessment 2 years later. We used cross-lagged models to test whether social communication impairment and restricted, repetitive behavior at T0 predicted anxiety at T2 and vice versa. RESULTS Crossed-lagged models showed that anxiety symptoms predicted social communication impairment over time (β = .22, p = .008), but not vice versa (β = -.07, p = .49). There were no significant paths from anxiety symptoms to later restricted, repetitive behavior (β = .11, p = .34) or vice versa (β = -.11, p = .27). CONCLUSIONS Our results do not support a bidirectional relationship between the ASD core symptom domains and anxiety, but suggest that higher levels of anxiety symptoms increase the risk of more social communication impairment over time in children with ASD. This underlines the importance of treating anxiety symptoms to improve both social and emotional functioning.
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Affiliation(s)
- Jorieke Duvekot
- Erasmus MC Sophia Children's Hospital, Rotterdam, The Netherlands
| | - Jan van der Ende
- Erasmus MC Sophia Children's Hospital, Rotterdam, The Netherlands
| | - Frank C Verhulst
- Erasmus MC Sophia Children's Hospital, Rotterdam, The Netherlands
| | - Kirstin Greaves-Lord
- Erasmus MC Sophia Children's Hospital, Rotterdam, The Netherlands.,Yulius Mental Health, Dordrecht, The Netherlands
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19
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Black KR, Stevenson RA, Segers M, Ncube BL, Sun SZ, Philipp-Muller A, Bebko JM, Barense MD, Ferber S. Linking Anxiety and Insistence on Sameness in Autistic Children: The Role of Sensory Hypersensitivity. J Autism Dev Disord 2018; 47:2459-2470. [PMID: 28540453 DOI: 10.1007/s10803-017-3161-x] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Sensory hypersensitivity and insistence on sameness (I/S) are common, co-occurring features of autism, yet the relationship between them is poorly understood. This study assessed the impact of sensory hypersensitivity on the clinical symptoms of specific phobia, separation anxiety, social anxiety and I/S for autistic and typically developing (TD) children. Parents of 79 children completed questionnaires on their child's difficulties related to sensory processing, I/S, and anxiety. Results demonstrated that sensory hypersensitivity mediated 67% of the relationship between symptoms of specific phobia and I/S and 57% of the relationship between separation anxiety and I/S. No relationship was observed between sensory hypersensitivity and social anxiety. These mediation effects of sensory hypersensitivity were found only in autistic children, not in TD children.
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Affiliation(s)
- Karen R Black
- Department of Psychology, University of Toronto, Toronto, ON, Canada.,Department of Psychology, York University, Toronto, ON, Canada
| | - Ryan A Stevenson
- Department of Psychology, Western University, London, ON, Canada. .,Brain and Mind Institute, Western University, London, ON, Canada. .,Neuroscience Program, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada. .,Department of Psychiatry, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada. .,Westminster Hall, University of Western Ontario, 361 Windermere Road, London, ON, N6G 2K3, Canada.
| | - Magali Segers
- Department of Psychology, York University, Toronto, ON, Canada
| | - Busiswe L Ncube
- Department of Psychology, York University, Toronto, ON, Canada
| | - Sol Z Sun
- Department of Psychology, University of Toronto, Toronto, ON, Canada
| | | | - James M Bebko
- Department of Psychology, York University, Toronto, ON, Canada
| | - Morgan D Barense
- Department of Psychology, University of Toronto, Toronto, ON, Canada.,Rotman Research Institute at Baycrest, Toronto, ON, Canada
| | - Susanne Ferber
- Department of Psychology, University of Toronto, Toronto, ON, Canada.,Rotman Research Institute at Baycrest, Toronto, ON, Canada
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20
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Maloret P, Scott T. Don't ask me what's the matter, ask me what matters: Acute mental health facility experiences of people living with autism spectrum conditions. J Psychiatr Ment Health Nurs 2018; 25:49-59. [PMID: 29078024 DOI: 10.1111/jpm.12438] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/23/2017] [Indexed: 12/16/2022]
Abstract
UNLABELLED WHAT IS KNOWN ON THE SUBJECT?: There is a growing body of evidence that many people with an autism spectrum condition suffer anxiety in their daily life and a realization among practitioners that admission to a mental health unit for this population is usually a negative anxiety-inducing experience. Anxiety is driven by the intolerance of uncertainty that is being unsure of what is going to happen, how long the uncertainty will exist and the insistence of sameness which, when compromised, can be anxiety provoking. Equally, confusion in understanding personal emotional responses and those of others is a source of anxiety. WHAT THIS PAPER ADDS TO EXISTING KNOWLEDGE?: This paper builds upon existing understanding of anxiety as a causative factor of mental ill-health for people with an autism spectrum condition. Specifically, this paper explores the potentially anxiety-inducing experience of mental health unit admission; how anxiety is felt, triggered, expressed and managed. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: As many different anxiety responses could be exhibited during hospitalization, including violent acts and self-harming, for mental health practitioners working in the inpatient units, it is essential that the thoughts, feelings and responses of the patient with an autistic spectrum condition (ASC) are better understood and that support offered during their stay in a mental health facility is from an informed position. ABSTRACT Background This qualitative study explored how mental health inpatients with autistic spectrum conditions (ASCs) experience and cope with anxiety when admitted to an acute mental health inpatient facility in the United Kingdom. Anxiety is a common characteristic for people who live with ASCs and whilst a plethora of studies on anxiety in this population is published which correlate anxiety with mental health service experience, little is known about the actual triggers of anxiety and its manifestations. This study adds to a body of evidence which considers anxiety experienced by people with autism. The rationale for this study includes the need to heighten mental health practitioners' understanding, of the responses, motivations to engage and support required to overcome fears and anxieties when admitted to a mental health inpatient unit. Method The study used a qualitative naturalistic research design, to explore the emotional and psychological experiences of being a mental health inpatient living with an ASC. During 2015-2017. audio-recorded semistructured interviews captured the experiences of 20 adults from the east of England who were former psychiatric inpatients with an established diagnosis of ASC. Interpretative phenomenological analysis enabled the identification of broad themes which explained in rich detail, participant reflections regarding the situations and events within the acute care mental health facility that triggered their anxiety, manifestations of anxiety and responses to their anxiety. Findings Broad response patterns were identified that could be associated with their anxiety that is isolating themselves from others, including patients and staff, ceasing to eat and sleep adequately and all too often self-harming or exhibiting aggressive and violent responses. Conclusions The anxiety caused by the physical environment appears to be overlooked by mental health practitioners so attention to anxiety-inducing encounters is needed when planning acute care mental health service improvement and research is required to clearly understand the experiences of this vulnerable group.
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Affiliation(s)
- P Maloret
- Nursing and Midwifery, School of Health and Social Work, University of Hertfordshire, Hatfield, UK
| | - T Scott
- Centre for Research in Primary and Community Care, University of Hertfordshire, Hatfield, UK
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21
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Anxiety-related symptomatology in young children on the autism spectrum. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2017; 23:350-358. [DOI: 10.1177/1362361317734692] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Anxiety symptomatology is frequently reported in autistic children, and the prevalence of anxiety disorder is estimated at around 40%. However, most studies have focused upon children of age 8 years or above, so little is known about early signs of anxiety in younger children with autism. This study sought to describe anxiety-related symptomatology in 95 5- to 6-year-old autistic children using the Anxiety Scale for Children with Autism Spectrum Disorder. Wide variability was found in levels of symptomatology with the most frequently reported items within the ‘uncertainty’ subscale and the least frequently reported items in the ‘anxious arousal’ subscale. Comparisons of those with scores less than or greater than 70 on adaptive behaviour suggests some influence of ability on presentation of anxiety-related symptomatology.
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22
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Abstract
PURPOSE OF REVIEW This review aims to synthesize the most recent research on anxiety disorders and obsessive-compulsive disorder (OCD) in individuals with autism spectrum disorder (ASD) and discuss the relationship between these conditions and challenges for assessment. Furthermore, implications for treatment and future directions are discussed. RECENT FINDINGS Research suggests that anxiety disorders and OCD are highly prevalent in individuals with ASD. However, the significant overlap of ASD features with anxiety and OCD symptomology makes differential diagnosis of these disorders particularly challenging. Though several treatments for anxiety have been adapted for youth with ASD (e.g., cognitive behavior therapy), pharmacological treatments and treatments for adults are still marked undeveloped. Despite the high prevalence of anxiety disorders and OCD in ASD and some recent advances in assessment and treatment, research is needed to clarify the multifaceted relationship of these conditions and develop tailored assessment and treatment approaches appropriate for a full range of individuals with ASD.
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23
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Uljarević M, Richdale AL, Evans DW, Cai RY, Leekam SR. Interrelationship between insistence on sameness, effortful control and anxiety in adolescents and young adults with autism spectrum disorder (ASD). Mol Autism 2017; 8:36. [PMID: 28736608 PMCID: PMC5521115 DOI: 10.1186/s13229-017-0158-4] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2017] [Accepted: 07/13/2017] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Both self-regulation and insistence on sameness (IS) are related to anxiety, which is a common feature of individuals with autism spectrum disorder (ASD). Here, we aimed to characterise the IS-self-regulation-anxiety interrelationship by investigating the potential contribution made by self-regulation, assessed via effortful control (EC), to the IS-anxiety relationship in a sample of adolescents and young adults with ASD. METHOD Seventy-one older adolescents and younger adults with ASD (49 males, 22 females; Mage = 18.71 years, SD = 2.51, range 14.42-24.81) completed the Adult Repetitive Behaviour Questionnaire-2, Effortful Control Scale of the Adult Temperament Questionnaire and the DSM-5 Dimensional Anxiety Scales. RESULTS IS was associated with both EC (r = -.39, p = .001) and anxiety (r = .45, p < .001), and anxiety was in turn associated with EC (r = -.44, p < .001). To characterise the nature of this interrelationship, two mediation analyses were performed using the serial mediation model in PROCESS with 5000 resamples in bootstrapping. There was a significant indirect effect of EC on anxiety, through IS (b = -.06; BCa 95% CI [-.13, -.02]), and indirect effect on anxiety through EC (b = 1.62; BCa 95% CI [.59, 3.24]) with the mediators accounting for 29.07 and 26.04% of the total effect, respectively. CONCLUSIONS Our study provides the first exploration of the IS-anxiety-self-regulation link in ASD. The finding that lower levels of self-regulation are related both to anxiety and IS behaviours points to self-regulation as a viable intervention target for both anxiety and IS behaviours.
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Affiliation(s)
- Mirko Uljarević
- Olga Tennison Autism Research Centre, School of Psychological Science, La Trobe University, Bundoora, VIC 3086 Australia
- Cooperative Research Centre for Living with Autism (Autism CRC), Level 3 Foxtail Building, Long Pocket, The University of Queensland, Brisbane, QLD 4072 Australia
| | - Amanda L. Richdale
- Olga Tennison Autism Research Centre, School of Psychological Science, La Trobe University, Bundoora, VIC 3086 Australia
- Cooperative Research Centre for Living with Autism (Autism CRC), Level 3 Foxtail Building, Long Pocket, The University of Queensland, Brisbane, QLD 4072 Australia
| | - David W. Evans
- Department of Psychology, Bucknell University, Lewisburg, PA USA
| | - Ru Ying Cai
- Olga Tennison Autism Research Centre, School of Psychological Science, La Trobe University, Bundoora, VIC 3086 Australia
- Cooperative Research Centre for Living with Autism (Autism CRC), Level 3 Foxtail Building, Long Pocket, The University of Queensland, Brisbane, QLD 4072 Australia
| | - Susan R. Leekam
- Wales Autism Research Centre, School of Psychology, Cardiff University, Cardiff, Wales UK
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24
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Bilbo SD, Block CL, Bolton JL, Hanamsagar R, Tran PK. Beyond infection - Maternal immune activation by environmental factors, microglial development, and relevance for autism spectrum disorders. Exp Neurol 2017; 299:241-251. [PMID: 28698032 DOI: 10.1016/j.expneurol.2017.07.002] [Citation(s) in RCA: 196] [Impact Index Per Article: 28.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2017] [Revised: 06/26/2017] [Accepted: 07/05/2017] [Indexed: 12/17/2022]
Abstract
Immune molecules such as cytokines and chemokines and the cells that produce them within the brain, notably microglia, are critical for normal brain development. This recognition has in recent years led to the working hypothesis that inflammatory events during pregnancy, e.g. in response to infection, may disrupt the normal expression of immune molecules during critical stages of neural development and thereby contribute to the risk for neurodevelopmental disorders such as autism spectrum disorder (ASD). This hypothesis has in large part been shepherded by the work of Dr. Paul Patterson and colleagues, which has elegantly demonstrated that a single viral infection or injection of a viral mimetic to pregnant mice significantly and persistently impacts offspring immune and nervous system function, changes that underlie ASD-like behavioral dysfunction including social and communication deficits. Subsequent studies by many labs - in humans and in non-human animal models - have supported the hypothesis that ongoing disrupted immune molecule expression and/or neuroinflammation contributes to at least a significant subset of ASD. The heterogeneous clinical and biological phenotypes observed in ASD strongly suggest that in genetically susceptible individuals, environmental risk factors combine or synergize to create a tipping or threshold point for dysfunction. Importantly, animal studies showing a link between maternal immune activation (MIA) and ASD-like outcomes in offspring involve different species and diverse environmental factors associated with ASD in humans, beyond infection, including toxin exposures, maternal stress, and maternal obesity, all of which impact inflammatory or immune pathways. The goal of this review is to highlight the broader implications of Dr. Patterson's work for the field of autism, with a focus on the impact that MIA by diverse environmental factors has on fetal brain development, immune system development, and the pathophysiology of ASD.
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Affiliation(s)
- Staci D Bilbo
- Pediatrics and Neuroscience, Harvard Medical School, Lurie Center for Autism, Massachusetts General Hospital for Children, Boston, MA 02126, United States.
| | - Carina L Block
- Psychology and Neuroscience, Duke University, Durham, NC 27708, United States
| | - Jessica L Bolton
- Pediatrics and Anatomy/Neurobiology, University of California-Irvine, Irvine, CA 92697, United States
| | - Richa Hanamsagar
- Pediatrics and Neuroscience, Harvard Medical School, Lurie Center for Autism, Massachusetts General Hospital for Children, Boston, MA 02126, United States
| | - Phuong K Tran
- Pediatrics and Neuroscience, Harvard Medical School, Lurie Center for Autism, Massachusetts General Hospital for Children, Boston, MA 02126, United States
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25
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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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Teh EJ, Chan DME, Tan GKJ, Magiati I. Continuity and Change in, and Child Predictors of, Caregiver Reported Anxiety Symptoms in Young People with Autism Spectrum Disorder: A Follow-Up Study. J Autism Dev Disord 2017; 47:3857-3871. [DOI: 10.1007/s10803-017-3136-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/26/2023]
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A Comparison Between Caregiver-Reported Anxiety and Other Emotional and Behavioral Difficulties in Children and Adolescents with Autism Spectrum Disorders Attending Specialist or Mainstream Schools. J Autism Dev Disord 2016; 49:2653-2663. [PMID: 27160302 DOI: 10.1007/s10803-016-2792-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Increasing numbers of students with Autism Spectrum Disorder (ASD) are attending mainstream schools. Nonetheless, concerns about their emotional well-being and mental health in these settings have also been raised. This study sought to compare caregiver-reported anxiety and other emotional and behavioural problems in youth with ASD attending mainstream or specialist schools. Caregivers of 27 youth with ASD in mainstream schools (age 10.91 ± 3.44 years) and 69 youth with ASD in special schools (age 10.93 ± 2.81 years) matched for gender, age, adaptive functioning and autism symptom severity scores participated. Caregivers completed the Spence Children's Anxiety Scale-Parent, a measure of adaptive functioning, and a checklist of other emotional and behavioral difficulties. Students with ASD attending mainstream schools experienced higher levels of social anxiety symptoms compared to their specialist school counterparts. No other statistically significant differences were found in other aspects of emotional and behavioural functioning examined, but some differences emerged in item-level analyses. Uncertainties in navigating more complex social environments and increased social relating difficulties in mainstream schools are discussed as probable environmental triggers for increased social phobia related symptomatology, although other explanations for this small effect size difference are also considered. Limitations of the present study and recommendations for future research focusing on exploring environmental socio-ecological factors influencing anxiety and mental health in young people with ASD are also discussed.
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