Abstract
The present chapter provides an overview of current research on the co-occurrence of anxiety and autism spectrum disorders (ASD). We first provide a brief history of the evolving conceptualization of these conditions and then summarize the research findings. Findings regarding the prevalence and presentation of anxiety in the context of ASD are offered. Similarities and differences in the quality, frequency, and developmental trajectory of anxiety symptoms in individuals with and without ASD, in particular, are discussed. We consider the methodological and theoretical challenges that have tempered the conclusions that can be drawn from existing studies, and address difficulties both differentiating and characterizing the relationship between anxiety and ASD. Finally, we offer future directions for the improved understanding and study of these conditions.
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References
American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders (4th ed.). Arlington: American Psychiatric Publishing, Inc.
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (4th ed.). Arlington: American Psychiatric Publishing, Inc.
Angold, A., Costello, E. J., & Erkanli, A. (1999). Comorbidity. Journal of Child Psychology and Psychiatry, 40, 57–87,
Asperger, H. (1944). "Die "Autistischen Psychopathen" im Kindesalter [Autistic psychopaths in childhood]". Archiv für Psychiatrie und Nervenkrankheiten, 177, 76–136. doi:10.1007/BF01837709 (in German).
Bakken, T. L., Helverschou, S. B., Eilertsen, D. E., Heggelund, T., Myrbakk, E., & Martinsen, H. (2010). Psychiatric disorders in adolescents and adults with autism and intellectual disability: A representative study in one county in Norway. Research in Developmental Disabilities, 31, 1669–1677. doi:10.1016/j.ridd.2010.04.009.
Baron-Cohen, S., & Belmonte, M. K. (2005). Autism: A window onto the development of the social and the analytic brain. Annual Review of Neuroscience, 28, 109–126. doi:10.1146/annurev.neuro.27.070203.144137.
Bellini, S. (2004). Social skill deficits and anxiety in high-functioning adolescents with autism spectrum disorders. Focus on Autism and Other Developmental Disabilities, 19, 78–86. doi:10.1177/10883576040190020201.
Bellini, S. (2006). The development of social anxiety in adolescents with autism spectrum disorders. Focus on Autism and Other Developmental Disabilities, 21, 138–145. doi:10.1177/1088357606021003020.
Benjamin, C. L., Puleo, C. M., & Kendall, P. C. (2011). Informant agreement in treatment gains for child anxiety. Child & Family Behavior Therapy, 33(3), 199–216. doi:10.1080/07317107.2011.595987.
Beesdo, K., Knappe, S., & Pine, D. S. (2009). Anxiety and anxiety disorders in children and adolescents: Developmental issues and implications for DSM-V. The Psychiatric Clinics of North America, 32(3), 483. doi:10.1016/j.psc.2009.06.002.
Bishop, S. L., Hus, V., Duncan, A., Huerta, M., Gotham, K., Pickles, A., & Lord, C. (2013). Subcategories of restricted and repetitive behaviors in children with autism spectrum disorders. Journal of autism and developmental disorders, 43, 1287–1297.
Bradley, E. A., Summers, J. A., Wood, H. L., & Bryson, S. E. (2004). Comparing rates of psychiatric and behavior disorders in adolescents and young adults with severe intellectual disability with and without autism. Journal of Autism and Developmental Disorders, 34, 151–161. doi:10.1023/B:JADD.0000022606.97580.19.
Brereton, A. V., Tonge, B. J., & Einfeld, S. L. (2006). Psychopathology in children and adolescents with autism compared to young people with intellectual disability. Journal of Autism and Developmental Disorders, 36, 863–870. doi:10.1007/s10803-006-0125-y.
Burnette, C. P., Mundy, P. C., Meyer, J. A., Sutton, S. K., Vaughan, A. E., & Charak, D. (2005). Weak central coherence and its relations to theory of mind and anxiety in autism. Journal of Autism and Developmental Disorders, 35, 63–73. doi:10.1007/s10803-004-1035-5.
Cath, D. C., Ran, N., Smit, J. H., Van Balkom, A., & Comijs, H. C. (2008). Symptom overlap between autism spectrum disorders, generalized social anxiety disorder and obsessive-compulsive disorder in adults: A preliminary case-controlled study. Psychopathology, 41, 101–110. doi:10.1159/000111555.
Cerdá, M., Sagdeo, A., & Galea, S. (2008). Comorbid forms of psychopathology: Key patterns and future research directions. Epidemiologic Reviews, 30, 155–177. doi:10.1093/epirev/mxn003.
Davis, T. E. III, Hess, J. A., Moree, B. N., Fodstad, J. C., Dempsey, T., Jenkins, W. S., & Matson, J. L. (2011a). Anxiety symptoms across the lifespan in people diagnosed with autistic disorder. Research in Autism Spectrum Disorders, 5, 112–118. doi:10.1016/j.rasd.2010.02.006.
Davis, T. E. III, Moree, B. N., Dempsey, T., Reuther, E. T., Fodstad, J. C., Hess, J. A., & Matson, J. L. (2011b). The relationship between autism spectrum disorders and anxiety: The moderating effect of communication. Research in Autism Spectrum Disorders, 5, 324–329. doi:10.1016/j.rasd.2010.04.015.
Davis, T. E. (2012). Where to from here for ASD and Anxiety? Lessons Learned from Child anxiety and the Issue of DSM-5. Clinical Psychology: Science and Practice, 19, 358–363.
Davis, T. E., & Ollendick, T. H. (2005). Empirically supported treatments for specific phobia in children: Do efficacious treatments address the components of a phobic response ?. Clinical Psychology: Science and Practice, 12(2), 144-160.
Davis, T. E., Moree, B. N., Dempsey, T., Hess, J. A., Jenkins, W. S., Fodstad, J. C., & Matson, J. L. (2012). The effect of communication deficits on anxiety symptoms in infants and toddlers with autism spectrum disorders. Behavior Therapy, 43(1), 142–152. doi:10.1016/j.beth.2011.05.003.
de Bruin, E. I., Ferdinand, R. F., Meester, S., de Nijs, P. F. A., & Verheij, F. (2007). High rates of psychiatric comorbidity in PDD-NOS. Journal of Autism and Developmental Disorders, 37, 877–886. doi:10.1007/s10803-006-0215-x.
Drabick, D. A. G., & Kendall, P. C. (2010). Developmental psychopathology and the diagnosis of mental health problems among youth. Clinical Psychology: Science and Practice, 17, 272–280. doi:10.1111/j.1468-2850.2010.01219.x.
Evans, D. W., Canavera, K., Kleinpeter, F. L., Maccubbin, E., & Taga, K. (2005). The fears, phobias and anxieties of children with autism spectrum disorders and Down syndrome: Comparisons with developmentally and chronologically age matched children. Child Psychiatry and Human Development, 36, 3–26. doi:10.1007/s10578-004-3619-x.
Farrugia, S., & Hudson, J. (2006). Anxiety in adolescents with Asperger syndrome: Negative thoughts, behavioral problems, and life interference. Focus on Autism and Other Developmental Disabilities, 21, 25–35. doi:10.1177/10883576060210010401.
Gadow, K. D., DeVincent, C. J., Pomeroy, J., & Azizian, A. (2004). Psychiatric symptoms in preschool children with PDD and clinic and comparison samples. Journal of Autism and Developmental Disorders, 34, 379–393. doi:10.1023/B:JADD.0000037415.21458.93.
Gadow, K. D., DeVincent, C. J., Pomeroy, J., & Azizian, A. (2005). Comparison of DSM-IV symptoms in elementary school-age children with PDD versus clinic and community samples. Autism: The International Journal of Research and Practice, 9, 392–415. doi:10.1177/1362361305056079.
Gillott, A., Furniss, F., & Walter, A. (2001). Anxiety in high-functioning children with autism. Autism: The International Journal of Research and Practice, 5(3), 277–286. doi:10.1177/1362361301005003005.
Guttmann-Steinmetz, S., Gadow, K. D., DeVincent, C. J., & Crowell, J. (2010). Anxiety symptoms in boys with autism spectrum disorder, attention-deficit hyperactivity disorder, or chronic multiple tic disorder and community controls. Journal of Autism and Developmental Disorders, 40, 1006–1016. doi:10.1007/s10803-010-0950-x.
Hartley, S. L., & Sikora, D. M. (2009). Which DSM-IV-TR criteria best differentiate high-functioning autism spectrum disorder from ADHD and anxiety disorders in older children? Autism: The International Journal of Research and Practice, 13, 485–509. doi:10.1177/1362361309335717.
Helverschou, S. B., & Martinsen, H. (2010). Anxiety in people diagnosed with autism and intellectual disability: Recognition and phenomenology. Research in Autism Spectrum Disorders, 5, 377–387. doi:10.1016/j.rasd.2010.05.003.
Hofvander, B., Delorme, R., Chaste, P., Nyden, A., Wentz, E., Stahlberg, O., et al. (2009). Psychiatric and psychosocial problems in adults with normal-intelligence autism spectrum disorders. BMC psychiatry, 9, 35. doi:10.1186/1471-244X-9-35.
Hurtig, T., Kuusikko, S., Mattila, M. L., Haapsamo, H., Ebeling, H., Jussila, K., et al. (2009). Multi-informant reports of psychiatric symptoms among high-functioning adolescents with Asperger syndrome or autism. Autism: The International Journal of Research and Practice, 13, 583–598. doi:10.1177/1362361309335719..
Kanai, C., Koyama, T., Kato, S., Miyamoto, Y., Osada, H., & Kurita, H. (2004). Comparison of high-functioning atypical autism and childhood autism by childhood autism rating scale-Tokyo version. Psychiatry and Clinical Neurosciences, 58, 217–221. doi:10.1111/j.1440-1819.2003.01220.x.
Kanner, L. (1943). Autistic disturbances of affective contact. Nervous Child, 2, 217–250.
Kendall, P. C., Compton, S. N., Walkup, J. T., Birmaher, B., Albano, A. M., Sherrill, J., et al. (2010). Clinical characteristics of anxiety disordered youth. Journal of Anxiety Disorders, 24, 360–365. doi:10.1016/j.janxdis.2010.01.009.
Kerns, C. M., & Kendall, P. C. (2012). The presentation and classification of anxiety in autism spectrum disorder. Clinical Psychology: Science & Practice, 19, 323–347. doi:10.1111/cpsp.12009.
Kerns, C. M., Kendall, P.C., Berry, L., Souders, M. C., Franklin, M. E., Schultz, R. T., Miller, J., Herrington, J. (in press). Traditional and atypical presentation of anxiety in youth with autism spectrum disorder. Journal of Autism and Developmental Disorders.
Kessler, R. C., Chiu, W. T., Demler, O., & Walters, E. E. (2005). Prevalence, severity, and comorbidity of 12-month DSM-IV disorders in the National Comorbidity Survey Replication. Archives of General Psychiatry, 62(6), 617. doi:10.1001/archpsyc.62.6.617.
Kim, J. A., Szatmari, P., Bryson, S. E., Streiner, D. L., & Wilson, F. J. (2000). The prevalence of anxiety and mood problems among children with autism and Asperger syndrome. Autism: The International Journal of Research and Practice, 4, 117–132. doi:10.1177/1362361300004002002.
Kuusikko, S., Pollock-Wurman, R., Jussila, K., Carter, A. S., Mattila, M. L., Ebeling, H., et al. (2008). Social anxiety in high-functioning children and adolescents with autism and Asperger syndrome. Journal of Autism and Developmental Disorders, 38, 1697–1709. doi:10.1007/s10803-008-0555-9.
Lecavalier, L. (2006). Behavioral and emotional problems in young people with pervasive developmental disorders: Relative prevalence, effects of subject characteristics, and empirical classification. Journal of Autism and Developmental Disorders, 36, 1101–1114. doi:10.1007/s10803-006-0147-5.
Leyfer, O. T., Folstein, S. E., Bacalman, S., Davis, N. O., Dinh, E., Morgan, J., & Lainhart, J. E. (2006). Comorbid psychiatric disorders in children with autism: Interview development and rates of disorders. Journal of Autism and Developmental Disorders, 36, 849–861. doi:10.1007/s10803-006-0123-0.
Lilienfeld, S. O., Waldman, I. D., & Israel, A. C. (1994). The critical examination of the use of the term and concept of comorbidity in psychopathology research. Clinical Psychology: Science and Practice, 1, 71–83. doi:10.1111/j.1468-2850.1994.tb00007.x.
MacNeil, B. M., Lopes, V. A., & Minnes, P. M. (2009). Anxiety in children and adolescents with autism spectrum disorders. Research in Autism Spectrum Disorders, 3(1), 1–21.doi:10.1016/j.rasd.2008.06.001.
Mandell, D. S., Walrath, C. M., Manteuffel, B., Sgro, G., & Pinto-Martin, J. A. (2005). The prevalence and correlates of abuse among children with autism served in comprehensive community-based mental health settings. Child Abuse & Neglect, 29(12), 1359–1372. doi:10.1016/j.chiabu.2005.06.006.
Mason, J. S., & Scior, J. (2004). ‘Diagnostic Overshadowing’ amongst clinicians working with people with intellectual disability in the UK. Journal of Applied Research in Intellectual Abilities, 17, 85–90. doi:10.1111/j.1360-2322.2004.00184.x.
Matson, J. L., Hess, J. A., & Boisjoli, J. A. (2010). Comorbid psychopathology in infants and toddlers with autism and pervasive developmental disorders-not otherwise specified (PDD-NOS). Research in Autism Spectrum Disorders, 4, 300–304. doi:10.1016/j.rasd.2009.10.001.
Mattila, M. L., Hurtig, T., Haapsamo, H., Jussila, K., Kuusikko-Gauffin, S., Kielinen, M., & Joskitt, L. (2010). Comorbid psychiatric disorders associated with Asperger syndrome/high-functioning autism: A community- and clinic-based study. Journal of Autism and Developmental Disorders, 40, 1080–1093. doi:10.1007/s10803-010-0958-2.
Mayes, S. D., Calhoun, S. L., Murray, M. J., Ahuja, M., & Smith, L. A. (2011). Anxiety, depression, and irritability in children with autism relative to other neuropsychiatric disorders and typical development. Research in Autism Spectrum Disorders, 5(1), 474–485. doi:10.1016/j.rasd.2010.06.012.
Mayes, S. D., Calhoun, S. L., Aggarwal, R., Baker, C., Mathapati, S., Molitoris, S., & Mayes, R. D. (2013). Unusual fears in children with autism. Research in Autism Spectrum Disorders, 7, 151–158. doi:10.1016/j.rasd.2012.08.002.
Mazefsky, C. A., Oswald, D. P., Day, T. N., Eack, S. M., Minshew, N. J., & Lainhart, J. E. (2012). ASD, a psychiatric disorder, or both? Psychiatric diagnoses in adolescents with high-functioning ASD. Journal of Clinical Child & Adolescent Psychology, 41, 516–523.
McDougle, C. J., Kresch, L. E., Goodman, W. K., Naylor, S. T., Volkmar, F. R., Cohen, D. J., & Price, L. H. (1995). A case-controlled study of repetitive thoughts and behavior in adults with autistic disorder and obsessive-compulsive disorder. American Journal of Psychiatry, 152, 772–777.
McNally, K. R. H., Lincoln, A. J., Brown, M. Z., & Chavira, D. A. (2013). The Coping Cat program for children with anxiety and autism spectrum disorder: A pilot randomized controlled trial. Journal of Autism and Developmental Disabilities, 43, 57–67. doi:10.1007/s10803-012-1541.
Mehtar, M., & Mukaddes, N. M. (2011). Posttraumatic stress disorder in individuals with diagnosis of autistic spectrum disorders. Research in Autism Spectrum Disorders, 5(1), 539–546. doi:10.1016/j.rasd.2010.06.020.
Muris, P., Steerneman, P., Merckelbach, H., Holdrinet, I., & Meesters, C. (1998). Comorbid anxiety symptoms in children with pervasive developmental disorders. Journal of Anxiety Disorders, 12, 387–393.doi:10.1016/S0887-6185(98)00022–X.
Ollendick, T. H., & White, S. W. (2012). The presentation and classification of anxiety in autism spectrum disorder: Where to from here? Clinical Psychology: Science and Practice, 19(4), 352–355. doi:10.1111/cpsp.12013.
Ooi, Y., Tan, W., Lim, C., Goh, T., & Sung, M. (2011). Prevalence of emotional and behavioral problems in children with high functioning autism spectrum disorders. Australian and New Zealand Journal of Psychiatry, 44, 370–375. doi:10.3109/00048674.2010.534071.
Puleo, C. M., & Kendall, P. C. (2011). Anxiety disorders in typically developing youth: Autism spectrum symptoms as a predictor of cognitive-behavioral treatment. Journal of Autism and Developmental Disorders, 41, 275–286. doi:10.1007/s10803-010-1047-2.
Rapee, R. M., Schniering, C. A., & Hudson, J. L. (2009). Anxiety disorders during childhood and adolescence: Origins and treatment. Annual Review of Clinical Psychology, 5, 311–341. doi:10.1146/annurev.clinpsy.032408.153628.
Regier, D. A., Narrow, W. E., Kuhl, E. A., & Kupfer, D. J. (2009). The conceptual development of DSM-V. American Journal of Psychiatry, 166, 645–650. doi:10.1176/appi.ajp.2009.09020279.
Renno, P., & Wood, J. J. (2013). Discriminant and convergent validity of the anxiety construct in children with autism spectrum disorders. Journal of Autism and Developmental Disorders, 43, 1–12. doi:10.1007/s10803-013-1767-1.
Rodgers, J., Riby, D. M., Janes, E., Connolly, B., & McConachie, H. (2012). Anxiety and repetitive behaviours in autism spectrum disorders and Williams syndrome: A cross-syndrome comparison. Journal of Autism and Developmental Disorders, 42(2), 175–180. doi:10.1007/s10803-011-1225-x.
Russell, A. J., Mataix-Cols, D., Anson, M., & Murphy, D. G. (2005). Obsessions and compulsions in Asperger syndrome and high-functioning autism. The British Journal of Psychiatry, 186(6), 525–528. doi:10.1192/bjp.186.6.525.
Russell, E., & Sofronoff, K. (2005). Anxiety and social worries in children with Asperger syndrome. Australian and New Zealand Journal of Psychiatry, 39, 633–638. doi:10.1111/j.1440-1614.2005.01637.x.
Scahill, L. (2012). Commentary on Kerns and Kendall. Clinical Psychology: Science and Practice, 19, 348–351. doi:10.1111/cpsp.12018.
Silverman, W. K., & Albano, A. M. (1996). Guide to the use of the Anxiety Disorders Interview Schedule for DSM-IV-Child and Parent Versions. London: Oxford University Press.
Simonoff, E., Pickles, A., Charman, T., Chandler, S., Loucas, T., & Baird, G. (2008). Psychiatric disorders in children with autism spectrum disorders: Prevalence, comorbidity, and associated factors in a population-derived sample. Journal of the American Academy of Child & Adolescent Psychiatry, 47, 921–929. doi:10.1097/CHI.0b013e318179964f.
Storch, E. A., Ehrenreich, J. M., Wood, J. L., Jones, A. M., De Nadai, A. A., Lewin, A. B., et al. (2012). Journal of Child and Adolescent Psychopharmacology, 22, 292–299. doi:10.1089/cap.2011.0114.
Sukhodolsky, D. G., Scahill, L., Gadow, K. D., Arnold, L. E., Aman, M. G., McDougle, C. J., et al. (2008). Parent-rated anxiety symptoms in children with pervasive developmental disorders: Frequency and association with core autism symptoms and cognitive functioning. Journal of Abnormal Child Psychology, 36, 117–128. doi:10.1007/s10802-007-9165-9.
Thede, L. L., & Coolidge, F. L. (2007). Psychological and neurobehavioral comparisonsof children with Asperger’s disorder versus high-functioning autism. Journal of Autismand Developmental Disorders, 37, 847–854.
Tonge, B. J., Brereton, A. V., Gray, K. M., & Einfeld, S. L. (1999). Behavioural and emotional disturbance in high-functioning autism and Asperger syndrome Autism, 3(2), 117–130.
Ung, D., Arnold, E. B., Lewin, A. B., Nadeau, J. M., Jones, A. M., De Nadai, A. S.,Storch, E. A., & Murphy, T. K. (2013). The effect of cognitive-behavioral therapy versus treatment as usual for anxiety in children with autism spectrum disorders: a randomized, controlled trial. Journal of the American Academy of Child & Adolescent Psychiatry, 52, 132–142.
van Steensel, F. J., Bogels, S. M., & Perrin, S. (2011). Anxiety disorders in children and adolescents with autistic spectrum disorders: A meta-analysis. Clinical Child and Family Psychology Review, 14, 302–317. doi:10.1007/s10567-011-0097-0.
Weisbrot, D. M., Gadow, K. D., DeVincent, C. J., & Pomeroy, J. (2005). The presentation of anxiety in children with pervasive developmental disorders. Journal of Child & Adolescent Psychopharmacology, 15, 477–496. doi:10.1089/cap.2005.15.477.
White, S. W., Oswald, D., Ollendick, T., & Scahill, L. (2009). Anxiety in children and adolescents with autism spectrum disorders. Clinical Psychology Review, 29, 216–229. doi:10.1016/j.cpr.2009.01.003.
White, S. W., & Roberson-Nay, R. (2009). Anxiety, social deficits, and loneliness in youth with autism spectrum disorders. Journal of Autism and Developmental Disorders, 39, 1006–1013. doi:10.1007/s10803-009-0713-8.
Wood, J. J., Drahota, A., Sze, K., Har, K., Chiu, A., & Langer, D. A. (2009). Cognitive behavioral therapy for anxiety in children with autism spectrum disorders: A randomized, controlled trial. Journal of Child Psychology and Psychiatry, 50, 224–234.
Wood, J. J., & Gadow, K. D. (2010). Exploring the nature and function of anxiety in youth with autism spectrum disorders. Clinical Psychology: Science and Practice, 17, 281–292. doi:10.1111/j.1468-2850.2010.01220.x.
Worley, J. A., Matson, J. L., Sipes, M., & Koziowski, A. M. (2010). Prevalence of autism spectrum disorders in toddlers receiving early intervention services. Research in Autism Spectrum Disorders, 5, 920–925. doi:10.1016/j.rasd.2010.10.007.
Zandt, F., Prior, M., & Kyrios, M. (2007). Repetitive behaviour in children with high functioning autism and obsessive compulsive disorder. Journal of Autism and Developmental Disabilities, 37, 251–259. doi:10.1007/s10803-006-0158-2.
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Kerns, C., Kendall, P. (2014). Autism and Anxiety: Overlap, Similarities, and Differences. In: Davis III, T., White, S., Ollendick, T. (eds) Handbook of Autism and Anxiety. Autism and Child Psychopathology Series. Springer, Cham. https://doi.org/10.1007/978-3-319-06796-4_6
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