Anxiety–Amygdala Associations: Novel Insights From the First Longitudinal Study of Autistic Youth With Distinct Anxiety

Abstract

In the current issue of Biological Psychiatry, Andrews et al. ( 1 Andrews D.S. Aksman L. Kerns C.M. Lee J.K. Winder-Patel B.M. Harvey D.J. et al. Association of amygdala development with different forms of anxiety in autism spectrum disorder. Biol Psychiatry. 2022; 91: 977-987 Abstract Full Text Full Text PDF PubMed Scopus (2) Google Scholar ) offer novel and important insights into how the amygdala is associated with anxiety in autism. Despite much theoretical rationale for a role of the amygdala in anxiety in individuals diagnosed with autism spectrum disorder (ASD) ( 1 Andrews D.S. Aksman L. Kerns C.M. Lee J.K. Winder-Patel B.M. Harvey D.J. et al. Association of amygdala development with different forms of anxiety in autism spectrum disorder. Biol Psychiatry. 2022; 91: 977-987 Abstract Full Text Full Text PDF PubMed Scopus (2) Google Scholar , 2 Yarger H.A. Nordahl C.W. Redcay E. Examining associations between amygdala volumes and anxiety symptoms in autism spectrum disorder [published online ahead of print Oct 21]. Biol Psychiatry Cogn Neurosci Neuroimaging. 2021; PubMed Google Scholar , 3 Herrington J.D. Maddox B.B. Kerns C.M. Rump K. Worley J.A. Bush J.C. et al. Amygdala volume differences in autism spectrum disorder are related to anxiety. J Autism Dev Disord. 2017; 47: 3682-3691 Crossref PubMed Scopus (41) Google Scholar , 4 Juranek J. Filipek P.A. Berenji G.R. Modahl C. Osann K. Spence M.A. Association between amygdala volume and anxiety level: Magnetic resonance imaging (MRI) study in autistic children. J Child Neurol. 2006; 21: 1051-1058 Crossref PubMed Scopus (94) Google Scholar , 5 Yarger H.A. Redcay E. A conceptual model of risk and protective factors associated with internalizing symptoms in autism spectrum disorder: A scoping review, synthesis, and call for more research. Dev Psychopathol. 2020; 32: 1254-1272 Crossref PubMed Scopus (5) Google Scholar ), previous empirical studies have yielded mixed results on the magnitude (or presence), direction, and laterality of the association between anxiety and amygdala volumes. Measurement of anxiety has varied across studies, with differing assessment tools, as well as the use of dimensional versus categorical approaches to evaluating the presence of anxiety. In addition, recent research ( 2 Yarger H.A. Nordahl C.W. Redcay E. Examining associations between amygdala volumes and anxiety symptoms in autism spectrum disorder [published online ahead of print Oct 21]. Biol Psychiatry Cogn Neurosci Neuroimaging. 2021; PubMed Google Scholar , 6 Kerns C.M. Winder-Patel B. Iosif A.M. Nordahl C.W. Heath B. Solomon M. et al. Clinically significant anxiety in children with autism spectrum disorder and varied intellectual functioning. J Clin Child Adolesc Psychol. 2021; 50: 780-795 Crossref PubMed Scopus (32) Google Scholar ) has argued that traditional, “DSM” anxiety disorders as operationalized in the DSM-5 ( 7 American Psychiatric A. Diagnostic and Statistical Manual of Mental Disorders: DSM-5. 5th ed. American Psychiatric Association, Washington, D.C.2013 Crossref Google Scholar ) (e.g., generalized anxiety disorder, separation anxiety, specific phobia, and social phobia—referred to as “DSM anxiety” in the remainder of the commentary) do not capture all types of anxiety that individuals with ASD experience ( 6 Kerns C.M. Winder-Patel B. Iosif A.M. Nordahl C.W. Heath B. Solomon M. et al. Clinically significant anxiety in children with autism spectrum disorder and varied intellectual functioning. J Clin Child Adolesc Psychol. 2021; 50: 780-795 Crossref PubMed Scopus (32) Google Scholar ). Instead, researchers have posited that individuals with ASD experience “distinct anxiety,” which includes anxieties such as idiosyncratic fears (e.g., fears of toilets), social anxiety without the fear of evaluation by others (required criterion for diagnosis of DSM social anxiety), or fear of change. The diverse methods used to assess anxiety and the failure to evaluate the presence of anxiety experienced specifically by those with ASD (i.e., distinct anxiety) may be contributing to these mixed results. Andrews et al. ( 1 Andrews D.S. Aksman L. Kerns C.M. Lee J.K. Winder-Patel B.M. Harvey D.J. et al. Association of amygdala development with different forms of anxiety in autism spectrum disorder. Biol Psychiatry. 2022; 91: 977-987 Abstract Full Text Full Text PDF PubMed Scopus (2) Google Scholar ) address these limitations in the first published study to investigate and report associations between amygdala volumes and DSM anxiety and distinct anxiety in autistic youth and, notably, is the first to look at developmental trajectories in amygdala growth over time with relation to distinct and DSM anxiety in autistic youth. SEE CORRESPONDING ARTICLE ON PAGE 977 SEE CORRESPONDING ARTICLE ON PAGE 977 Association of Amygdala Development With Different Forms of Anxiety in Autism Spectrum DisorderBiological PsychiatryVol. 91Issue 11PreviewThe amygdala is widely implicated in both anxiety and autism spectrum disorder. However, no studies have investigated the relationship between co-occurring anxiety and longitudinal amygdala development in autism. Here, the authors characterize amygdala development across childhood in autistic children with and without traditional DSM forms of anxiety and anxieties distinctly related to autism. Full-Text PDF