Anxiety In Autism Spectrum Disorder Research Articles

Autistic traits predict social avoidance and distress: The chain mediating role of perceived stress and interpersonal alienation.

Social avoidance and distress are the primary aspects of social anxiety. Nonautistic people with high levels of autistic traits are more likely to exhibit social avoidance and distress. However, research has yet to reveal how autistic traits induce social avoidance and distress. To fill this gap, the present study recruited 708 participants to complete the 25-item Autism Spectrum Quotient, Social Avoidance and Distress Scale, Chinese Perceived Stress Scale, and Interpersonal Alienation Subscale. The results indicated that autistic traits significantly predicted social avoidance and distress in nonautistic people. In addition, autistic traits induced social avoidance and distress through perceived stress and interpersonal alienation, respectively. Importantly, perceived stress and interpersonal alienation (including the subdimensions of interpersonal alienation: sense of loneliness, sense of social isolation, and alienation between family members) partially mediated the relationships between autistic traits and social avoidance and distress. Overall, autistic traits predict social avoidance and distress via perceived stress and interpersonal alienation. This finding extends the hypothetical model of clinical anxiety in autism spectrum disorders. Furthermore, reducing perceived stress and interpersonal alienation in nonautistic people with high levels of autistic traits may be a valid intervention method to prevent and eliminate their social avoidance and distress.

Editorial introductions.

Current Opinion in Psychiatry was launched in 1988. It is one of a successful series of review journals whose unique format is designed to provide a systematic and critical assessment of the literature as presented in the many primary journals. The field of psychiatry is divided into 13 sections that are reviewed once a year. Each section is assigned a Section Editor, a leading authority in the area, who identifies the most important topics at that time. Here we are pleased to introduce the Journal's Section Editors for this issue. SECTION EDITORS Perminder S. SachdevPerminder S. SachdevPerminder S. Sachdev AM, MBBS, MD, FRANZCP, PhD, FAHMS, is Scientia Professor of Neuropsychiatry, Co-Director of the Centre for Healthy Brain Ageing (CHeBA) in the School of Psychiatry, UNSW Sydney, Australia, and Clinical Director of the Neuropsychiatric Institute (NPI) at the Prince of Wales Hospital, Sydney, Australia. He is co-chair of the Australian Dementia Network (ADNeT), and director of the Centre of Research Excellence in Vascular Contributions to Dementia. His major areas of research are drug-induced movement disorders, brain imaging, cognitive ageing and dementia. He has published over 700 peer-reviewed journal papers and six books, including one for lay readers (The Yipping Tiger and Other Tales from the Neuropsychiatric Clinic) and a book of poems (A Migrant's Musings). He was named NSW Scientist of the Year for Biomedical Sciences in 2010. In 2011, he was appointed Member of the Order of Australia (AM) for services to medical research. In 2018, he won the DARF-Yulgilbar Innovation Award for dementia research. In 2022, he was awarded the Ryman Prize for research concept or initiative that has enhanced quality of life for older people. Roma VasaRoma VasaDr Roma Vasa is an internationally recognized developmental neuropsychiatrist and the Director of Psychiatric Services at the Center for Autism and Related Disorders at the Kennedy Krieger Institute. She is an Associate Professor of Psychiatry and Behavioral Sciences at the Johns Hopkins University School of Medicine. Dr Vasa is co-chair of the Autism and Intellectual Disability Committee of American Academy of Child and Adolescent Psychiatry. Within the field of developmental neuropsychiatry, Dr Vasa specializes in the assessment and treatment of neurodevelopmental disorders and their associated psychiatric conditions, as well as neuropsychiatric outcomes after pediatric traumatic brain injury. Her research focuses on investigating the phenotype and underlying transdiagnostic constructs of anxiety in autism spectrum disorder, notably intolerance of uncertainty. Dr Vasa is committed to training the next generation of psychiatrists, students, and other professionals in developmental neuropsychiatry and has developed innovative educational models in this area. She recently launched the Developmental Neuropsychiatry Scholar Program at the Kennedy Krieger Institute, which provides advanced specialty training to child and adolescent psychiatrists.

Anxiety in Autism Spectrum Disorder: Clinical Characteristics and the Role of the Family.

Anxiety Disorder (AD) is among the most common psychiatric comorbidity in children and adolescents with Autism Spectrum Disorder (ASD). Likewise, parental psychological distress (PPD) was linked to anxiety symptoms in children and adolescents with ASD. The aim of this study was to characterise, in a sample of children and adolescents with ASD, anxiety symptoms, the functional impairment associated and the presence of PPD. Participants were divided into three groups based on their diagnosis: children and adolescents with a diagnosis of ASD + AD, others with a diagnosis of AD but without a diagnosis of ASD, and others with a diagnosis of ASD but without a diagnosis of AD. Group ASD + AD showed lower global functioning than Group ASD and Group AD. Generalised Anxiety Disorder, Separation Anxiety Disorder and Specific Phobias were more frequent in Group ASD + AD. Our findings also showed higher depressive symptoms in Group ASD + AD, both in the child and parent reports. Finally, parents of the Group ASD + AD revealed higher levels of PPD. Our findings suggest that early assessment of AD with functional impairment associated with the role of PPD could define individualised treatments and consequently mean a better prognosis in children and adolescents with ASD and AD.

Anxiety in children and youth with autism spectrum disorder and the association with amygdala subnuclei structure.

Autism spectrum disorder (ASD) is clinically characterized by social communication difficulties as well as restricted and repetitive patterns of behavior. In addition, children with ASD are more likely to experience anxiety compared with their peers who do not have ASD. Recent studies suggest that atypical amygdala structure, a brain region involved in emotions, may be related to anxiety in children with ASD. However, the amygdala is a complex structure composed of heterogeneous subnuclei, and few studies to date have focused on how amygdala subnuclei relate to in anxiety in this population. The current sample consisted of 95 children with ASD and 139 non-autistic children, who underwent magnetic resonance imaging (MRI) and assessments for anxiety. The amygdala volumes were automatically segmented. Results indicated that children with ASD had elevated anxiety scores relative to peers without ASD. Larger basal volumes predicted greater anxiety in children with ASD, and this association was not seen in non-autistic children. Findings converge with previous literature suggesting ASD children suffer from higher levels of anxiety than non-autistic children, which may have important implications in treatment and interventions. Our results suggest that volumetric estimation of amygdala's subregions in MRI may reveal specific anxiety-related associations in children with ASD.

Relation between Restricted and Repetitive Behaviors and Anxiety in Autism Spectrum Disorder: A Meta-Analysis

Background Restricted and repetitive behaviors (RRBs) are increasingly being reported to limit the social adaptability of children with autism. Method Three databases (PubMed, PsycINFO, & Web of Science) were selected to conduct a systematic review to examine the consistency in which theoretical frameworks and instruments have been used to evaluate the presence and impact of RRBs in young children who may have ASD. Results Among the 36 articles examined in this review, young males represented 78.5% of the totality of participants (n = 62,339). Approximately one-third of the studies (n = 11) provided an explanation of RRBs through utilizing a theoretical framework. With respect to instrument utility, of the 35 instruments recorded, the Autism Diagnostic Observation Schedule (ADOS) was most frequently used. Conclusions The ADOS and the Autism Diagnostic Interview – Revised (ADI-R) are highly revered as they both are consistently referenced as “a gold standard.” However, due to the expensiveness of those assessments, they are underutilized, likely among vulnerable populations (e.g., economically disadvantaged, ethnic minorities, LGBTQ+), as many practitioners and parents cannot afford access to them.

An Exploratory Study Using the Anti-Anxiety Medication Buspirone for Driving Anxiety in Autism Spectrum Disorder

Background: The literature documents that intellectually capable autism spectrum disorder (ASD) is frequently associated with driving avoidance. Because ASD is associated with high levels of comorbid anxiety and our previous work suggested heightened anxiety during driving simulation, we evaluated whether driving behavior assessed through a driving simulator would improve with antianxiety medication. Objective: This was an open label, proof of concept study testing the usefulness and tolerability of the nonsedating, short acting anti-anxiety medication buspirone, using a randomly assigned crossover design. Methods: The sample consisted of 24 adult drivers (5 female) with DSM-V ASD (mean age 28.4 years) who completed two simulated driving sessions, one while taking the anti-anxiety medication buspirone and one without it. Results: Treatment with buspirone was associated with significantly improved driving performance as measured by less variability in lane positioning, a proxy for safer driving, lower self-report anxiety scores on items involving physical sensations, and better self-report scores on the ability to concentrate while driving. Conclusions: These preliminary, proof of concept findings suggest that mitigating anxiety may improve driving performance in individuals with intellectually capable ASD, supporting the need to conduct larger controlled studies assessing this important issue.

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

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

Assessing anxiety in youth with autism spectrum disorder

AbstractAnxiety is now recognized as one of the most common co‐occurring conditions in youth diagnosed with autism spectrum disorder (ASD). Despite the prevalence of this comorbid condition, accurate assessment and diagnosis of anxiety in ASD has proven difficult. This paper will address the considerable research literature on assessing anxiety in youth with ASD, including difficulties related to assessment and differential diagnosis. In addition, this paper will describe relevant tools and methods for assessing anxiety in this complex population.

Association of Amygdala Development With Different Forms of Anxiety in Autism Spectrum Disorder

BackgroundThe 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. MethodsLongitudinal magnetic resonance imaging scans were acquired at up to four time points for 71 autistic and 55 typically developing (TD) children (∼2.5–12 years, 411 time points). Traditional DSM anxiety and anxieties distinctly related to autism were assessed at study time 4 (∼8–12 years) using a diagnostic interview tailored to autism: the Anxiety Disorders Interview Schedule-IV with the Autism Spectrum Addendum. Mixed-effects models were used to test group differences at study time 1 (3.18 years) and time 4 (11.36 years) and developmental differences (age-by-group interactions) in right and left amygdala volume between autistic children with and without DSM or autism-distinct anxieties and TD children. ResultsAutistic children with DSM anxiety had significantly larger right amygdala volumes than TD children at both study time 1 (5.10% increase) and time 4 (6.11% increase). Autistic children with autism-distinct anxieties had significantly slower right amygdala growth than TD, autism–no anxiety, and autism–DSM anxiety groups and smaller right amygdala volumes at time 4 than the autism–no anxiety (−8.13% decrease) and autism–DSM anxiety (−12.05% decrease) groups. ConclusionsDisparate amygdala volumes and developmental trajectories between DSM and autism-distinct forms of anxiety suggest different biological underpinnings for these common, co-occurring conditions in autism.

From Clinic to Classroom: Two Case Studies of Youth With ASD and Anxiety From the School-Based Facing Your Fears Program.

Cognitive behavioral therapy (CBT) is considered best practice for treating anxiety in youth with autism spectrum disorder (ASD) in clinic settings. However, there is significant need to translate CBT into school settings. This paper presents two case illustrations of students who participated in the Facing Your Fears: School-Based program (FYF-SB), a manualized, group CBT intervention for anxiety in ASD, adapted for delivery in schools by interdisciplinary school providers. Students showed improvement in anxiety across multiple domains following intervention, according to clinical interview and parent- and self-report. These outcomes suggest that anxious youth with ASD can benefit from CBT delivered by interdisciplinary school providers. Importantly, decreases in anxiety symptoms were evident in domains that were not explicitly targeted during intervention. Overall, these case illustrations help frame areas of future research, including examining how treatment gains may generalize across anxiety domains as well as whether corresponding improvement in school functioning occurs.

Novel treatments in autism spectrum disorder.

There are currently no approved medications for the core symptoms of autism spectrum disorder (ASD), and only limited data on the management of co-occurring mental health and behavioural symptoms. The purpose of this review is to synthesize recent trials on novel treatments in ASD, with a focus on research trends in the past 2 years. No new pharmacologic agents received regulatory approval for use in ASD. Several large randomized controlled trials (RCTs) had negative or ambiguous results (e.g. fluoxetine, oxytocin). A cross-over RCT of an oral cannabinoid suggested possible benefits for disruptive behaviours. Two large-scale multicentre trials of bumetanide were terminated early for lack of efficacy. Multicenter trials using repetitive transcranial magnetic stimulation are underway. Recent meta-analyses indicate that specific behavioural and psychological interventions can support social communication and treat anxiety. Numerous novel treatment targets informed by biological mechanisms are under investigation. Recent data support the use of behavioural and psychological interventions for social communication and anxiety in ASD; data are more limited regarding pharmacotherapy for core and associated symptoms. Next steps include replication of early findings, trials of new molecular targets, and the identification of novel biomarkers, including genetic predictors, of treatment response.

Vagus Nerve Stimulation as a Treatment for Fear and Anxiety in Individuals with Autism Spectrum Disorder.

Anxiety disorders affect a large percentage of individuals who have an autism spectrum disorder (ASD). In children with ASD, excessive anxiety is also linked to gastrointestinal problems, self-injurious behaviors, and depressive symptoms. Exposure-based cognitive behavioral therapies are effective treatments for anxiety disorders in children with ASD, but high relapse rates indicate the need for additional treatment strategies. This perspective discusses evidence from preclinical research, which indicates that vagus nerve stimulation (VNS) paired with exposure to fear-provoking stimuli and situations could offer benefits as an adjuvant treatment for anxiety disorders that coexist with ASD. Vagus nerve stimulation is approved for use in the treatment of epilepsy, depression, and more recently as an adjuvant in rehabilitative training following stroke. In preclinical models, VNS shows promise in simultaneously enhancing consolidation of extinction memories and reducing anxiety. In this review, we will present potential mechanisms by which VNS could treat fear and anxiety in ASD. We also discuss potential uses of VNS to treat depression and epilepsy in the context of ASD, and noninvasive methods to stimulate the vagus nerve.

Repetitive and restricted behaviours and anxiety in autism spectrum disorder: protocol for a systematic review and meta-analysis

BackgroundAutism spectrum disorder (ASD) is a neurodevelopmental disorder defined by persistent deficits in social functioning and the presence of restricted and repetitive behaviours (RRBs). RRBs refer to four subtypes of behaviour including repetitive movements, speech, or use of objects; insistence on sameness; restricted interests; and sensory processing abnormalities. Many individuals with ASD also experience anxiety, which compounds ASD-related difficulties and inhibits daily functioning. RRBs have been found to be positively associated with anxiety; however, our understanding of the interplay between RRB subtypes and anxiety remains unclear. Thus, the current review aims to clarify the association between RRBs and anxiety by conducting a systematic review and meta-analysis.MethodsTo identify relevant studies, we will search five databases: CINAHL Plus, Cochrane Central Register of Controlled Trials, Ovid MEDLINE, PsycINFO, and Scopus. Articles included in the review will have their titles, abstracts, and full texts reviewed by two independent authors and their methodological quality assessed via the modified Newcastle-Ottawa Scale. Random-effects meta-analyses will then be conducted to calculate the pooled association between RRB subtypes and anxiety. Sensitivity analyses will also be conducted to assess the potential impact of bias, missing data, outliers, and methodological differences on this relationship. Additionally, this review will collate the factors which may influence the anxiety-RRB relationship to help identify who is most vulnerable to developing anxiety.DiscussionThis will be the first review to examine the association between the four subtypes of RRBs and anxiety in individuals with ASD. Understanding this relationship, and the factors associated with this, may help clinicians understand the different underpinnings and presentations of anxiety within this population with potential implications for assessment and treatment.Systematic review registrationPROSPERO CRD42020185434

59.2 ANXIETY DISORDERS IN AUTISM SPECTRUM DISORDER

Children with autism spectrum disorder (ASD) are often anxious related to their challenges with functioning in the world. Children with ASD are also at risk for the development of a comorbid anxiety disorder. A review of the literature will provide a historical review of anxiety in ASD. Medication and therapy for anxiety disorders in typically developing children and children with ASD will be reviewed. Strategies to differentiate appropriate, expectable anxiety related to the developmental challenges faced by children with ASD and the presentation of separation, social, and generalized anxiety disorders in children with ASD will be presented. Importantly, the phenotype of the pediatric anxiety disorders are distinct and discernable in typically developing children, but to date the field has not demonstrated strategies to readily identify the phenotypic features of anxiety disorders as they present in children with ASD. Anxiety disorders often respond well to therapy and medication. Children with ASD can develop anxiety disorders similar to typically developing children. Clinicians familiar with the phenotypic features of the anxiety disorders in typically developing children can bring the promise of successful treatment to the population of children with ASD and an anxiety disorder.

Functional connectivity within an anxiety network and associations with anxiety symptom severity in middle-aged adults with and without autism.

Anxiety is highly prevalent in autism spectrum disorders (ASDs). However, few functional magnetic resonance imaging (fMRI) studies of ASDs have focused on anxiety (and fewer still on anxiety in middle-aged adults). Thus, relationships between atypical connectivity and anxiety in this population are poorly understood. The current study contrasted functional connectivity within anxiety network regions across adults (40-64 years) with and without autism, and tested for group by functional connectivity interactions on anxiety. Twenty-two adults with ASDs (16 males) and 26 typical control (TC) adults (22 males) completed the Beck Anxiety Inventory and a resting-state fMRI scan. An anxiety network consisting of 12 regions of interest was defined, based on a meta-analysis in TC individuals and two studies on anxiety in ASDs. We tested for main effects of group and group by anxiety interactions on connectivity within this anxiety network, controlling for head motion using ANCOVA. Results are reported at an FDR adjusted threshold of q < 0.1 (corrected) and p < 0.05 (uncorrected). Adults with ASDs showed higher anxiety and underconnectivity within the anxiety network, mostly involving bilateral insula. Connectivity within the anxiety network in the ASD group showed distinct relationships with anxiety symptoms that did not relate to ASD symptom severity. Functional connectivity involving the bilateral posterior insula was positively correlated with anxiety in the ASD (but not the TC) group. Increased anxiety in middle-aged adults with ASD is associated with atypical functional connectivity, predominantly involving bilateral insula. Results were not related to ASD symptom severity suggesting independence of anxiety-related effects. LAY SUMMARY: Anxiety is very common in adults with autism but the brain basis of this difference is not well understood. We compared functional connectivity between anxiety-related brain regions in middle-aged adults with and without autism. Adults with autism were more anxious and showed weaker functional connections between these regions. Some relationships between functional connectivity and higher anxiety were specific to the autism group. Results suggest that anxiety functions differently in autism.

Treating obsessive‐compulsive disorder in the presence of autism spectrum disorders

Obsessive‐compulsive disorder (OCD) is a frequent comorbidity (about 17%) for children and adolescents with autism spectrum disorder (ASD). Despite this, clear modifications and utilization of evidence‐based techniques for the treatment of comorbid OCD have not been widely disseminated; to date, there have been no randomized controlled trials (RCTs) of modifications in OCD treatment for children and adolescents with comorbid ASD and only one RCT for modifications of a targeted OCD treatment in adults with ASD. Adapted approaches to CBT for anxiety in ASD are not always appropriate; indeed, some modified therapies for comorbid anxiety and ASD specifically advise against using those treatments for comorbid OCD. This article seeks to elucidate methods or modifications, founded in evidence‐based principles, for treating OCD in children and adolescents with ASD.

Conceptualization of comorbid anxiety in autism spectrum disorder: An integrative literature review

Conceptualization of comorbid anxiety in autism spectrum disorder: An integrative literature review

Neuroanatomical correlates of social anxiety in autism spectrum disorder: A preliminary study with voxel-based morphometry analysis

Neuroanatomical correlates of social anxiety in autism spectrum disorder: A preliminary study with voxel-based morphometry analysis

Increased pain sensitivity and pain-related anxiety in individuals with autism

Individuals with autism spectrum disorder (ASD) often exhibit differences in pain responsivity. This altered responsivity could be related to ASD-related social communication difficulties, sensory differences, or altered processing of pain stimuli. Previous neuroimaging work suggests altered pain evaluation could contribute to pain-related anxiety in ASD. We hypothesized that individuals with ASD would report increased pain sensitivity and endorse more pain-related anxiety, compared to typically developing controls. We recruited 43 adults (ASD, n = 24; typically developing, n = 19) for 3 heat pain tasks (applied to the calf). We measured heat pain thresholds using a method of limits approach, a pain-rating curve (7 temperatures between 40 and 48°C, 5 seconds, 5 trials each), and a sustained heat pain task with alternating low (42°C) and high (46°C) temperatures (21 seconds, 6 trials each). Individual differences in pain-related anxiety, fear of pain, situational pain catastrophizing, depressive symptoms, and autism-related social communication were assessed by self-report. There were no group differences in pain thresholds. For suprathreshold tasks, mean pain ratings were higher in ASD across both the pain-rating curve and the sustained heat pain tasks, but responses in the ASD group were more varied. Pain anxiety (PASS-Total) and pain-related fear (FOP-III-Total) were higher in the ASD group and were positively associated with pain ratings. Our results suggest that both sensory and cognitive experiences of pain are heightened and interact reciprocally in adults with ASD. Future studies are needed to evaluate the impact of pain-related anxiety on treatment-seeking and pain behaviors, given higher levels of pain-related anxiety in ASD.

Anxiety in autism spectrum disorder: Diagnosis and therapy

Autism spectrum disorder (ASD) affects approximately one in 59 new births in the United States. This neurodevelopmental condition is associated with increased risk for comorbid psychiatric conditions. Anxiety is particularly common, with a prevalence rate of nearly 40% for children and teens with ASD. In contrast, the Centers for Disease Control and Prevention estimates that 7.1% of children aged 3–17 in the general population have been diagnosed with anxiety. There is evidence that anxiety in individuals with ASD tends to be characterized by more significant symptom presentation than community populations. Further, findings suggest that anxiety may persist as the most common comorbid condition in adults with ASD. Here, we summarize diagnostic issues and characteristics of ASD that can complicate the diagnosis and psychotherapeutic treatment of anxiety in this population.