Journal of Autism and Developmental Disorders

, Volume 40, Issue 8, pp 1006–1016

Anxiety Symptoms in Boys with Autism Spectrum Disorder, Attention-Deficit Hyperactivity Disorder, or Chronic Multiple Tic Disorder and Community Controls

  • Sarit Guttmann-Steinmetz
  • Kenneth D. Gadow
  • Carla J. DeVincent
  • Judy Crowell
Original Paper

Abstract

We compared symptoms of generalized anxiety disorder (GAD) and separation anxiety disorder (SAD) in 5 groups of boys with neurobehavioral syndromes: attention-deficit/hyperactivity disorder (ADHD) plus autism spectrum disorder (ASD), ADHD plus chronic multiple tic disorder (CMTD), ASD only, ADHD only, and community Controls. Anxiety symptoms were assessed using parent and teacher versions of a DSM-IV-referenced rating scale. All three groups of boys with co-morbid ADHD evidenced more severe anxiety than Controls. Group differences in anxiety varied as a function of symptom, disorder, informant, and co-morbidity supporting the notion that co-morbid neurobehavioral syndromes differentially impact clinical features of co-occurring anxiety symptoms. Findings also suggest that GAD and SAD are phenomenologically unique, even in children with ASD. Implications for nosology are discussed.

Keywords

Autism Autism spectrum disorder Generalized anxiety disorder Separation anxiety disorder Attention-deficit/hyperactivity disorder Chronic tic disorder 

References

  1. American Psychiatric Association. (1987). Diagnostic and statistical manual of mental disorders, 3rd edition, revised (DSM-III-R). Washington, DC: American Psychiatric Association.Google Scholar
  2. American Psychiatric Association. (1994). Diagnostic and statistical manual of mental disorders, 4th ed. (DSM-IV). Washington, DC: American Psychiatric Association.Google Scholar
  3. Belzung, C., & Philippot, P. (2007). Anxiety from a phylogenetic perspective: Is there a qualitative difference between human and animal anxiety? Neural Plasticity, 59676.Google Scholar
  4. Bracha, H. S. (2006). Human brain evolution and the ‘neuroevolutionary time-depth principle’. Progress in Neuro-Psychopharmacology & Behavioral Psychiatry, 30, 827–853.CrossRefGoogle Scholar
  5. Cohen, I. L., Liu, X., Schultz, C., White, B. N., Jenkins, E. C., Brown, W. T., et al. (2003). Association of autism severity with a monoamine oxidase A functional polymorphism. Clinical Genetics, 64, 190–197.CrossRefPubMedGoogle Scholar
  6. Comings, D. E. (1990). Tourette syndrome and human behavior. Duarte, CA: Hope Press.Google Scholar
  7. Comings, D. E., Wu, S., Chiu, C., Ring, R. H., Gade, R., Ahn, C., et al. (1996). Polygenetic inheritance of Tourette syndrome, stuttering, attention deficit hyperactivity, conduct, and oppositional defiant disorder. American Journal of Medical Genetics. Part B, Neuropsychiatric Genetics, 67B, 264–288.Google Scholar
  8. Darwin, C. (1872). The expression of emotions in man and animals. London: John Murray.CrossRefGoogle Scholar
  9. de Bruin, E. I., Ferdinand, R. F., Meester, S., de Nijs, P. F., & Verheij, F. (2007). High rates of psychiatric co-morbidity in PDD-NOS. Journal of Autism and Developmental Disorders, 37, 877–886.CrossRefPubMedGoogle Scholar
  10. DeVincent, C. J., & Gadow, K. D. (2009). Relative clinical utility of three Child Symptom Inventory-4 scoring algorithms for differentiating children with autism spectrum disorder versus attention-deficit hyperactivity disorder. Autism Research, 2, 312–321.PubMedGoogle Scholar
  11. Feise, R. J. (2002). Do multiple outcome measures require p-value adjustment? BMC Medical Research Methodology, 2, 8–11.CrossRefPubMedGoogle Scholar
  12. Gadow, K. D., & DeVincent, C. J. (2005). Clinical significance of tics and attention-deficit hyperactivity disorder (ADHD) in children with pervasive developmental disorder. Journal of Child Neurology, 20, 481–488.PubMedGoogle Scholar
  13. Gadow, K. D., DeVincent, C. J., Olvet, D. M., & Hatchwell, E. (2009a). Association of DRD4 polymorphism with severity oppositional defiant, separation anxiety, and repetitive behaviors in children with autism spectrum disorder. Manuscript submitted for publication.Google Scholar
  14. Gadow, K. D., DeVincent, C. J., & Pomeroy, J. (2006). ADHD symptom subtypes in children with pervasive developmental disorder. Journal of Autism and Developmental Disorders, 36, 271–283.CrossRefPubMedGoogle Scholar
  15. Gadow, K. D., DeVincent, C. J., Pomeroy, J., & Azizian, A. (2005). Comparison of DSM-IV symptoms in elementary school-aged children with ASD versus clinic and community samples. Autism, 9, 392–415.CrossRefPubMedGoogle Scholar
  16. Gadow, K. D., DeVincent, C. J., & Schneider, J. (2008a). Predictors of psychiatric symptoms in children with an autism spectrum disorder. Journal of Autism and Developmental Disorders, 38, 1710–1720.CrossRefPubMedGoogle Scholar
  17. Gadow, K. D., DeVincent, C. J., & Schneider, J. (2009b). Comparative study of children with ADHD only, autism spectrum disorder + ADHD, and chronic multiple tic disorder + ADHD. Journal of Attention Disorders, 12, 474–485.CrossRefPubMedGoogle Scholar
  18. Gadow, K. D., Drabick, D. A. G., Loney, J., Sprafkin, J., Salisbury, H., Azizian, A., et al. (2004). Comparison of ADHD symptom subtypes as source-specific syndromes. Journal of Child Psychology and Psychiatry, 45, 1135–1149.CrossRefPubMedGoogle Scholar
  19. Gadow, K. D., Nolan, E. E., Sprafkin, J., & Schwartz, J. (2002). Tics and psychiatric comorbidity in children and adolescents. Developmental Medicine and Child Neurology, 44, 330–338.PubMedGoogle Scholar
  20. Gadow, K. D., Roohi, J., DeVincent, C. J., & Hatchwell, E. (2008b). Association of ADHD, tics, and anxiety with dopamine transporter (DAT1) genotype in autism spectrum disorder. Journal of Child Psychology and Psychiatry, 49, 1331–1338.CrossRefPubMedGoogle Scholar
  21. Gadow, K. D., Roohi, J., DeVincent, C. J., Kirsch, S., & Hatchwell, E. (2009c). Association of COMT (Val158Met) and BDNF (Val66Met) gene polymorphisms with anxiety, ADHD and tics in children with autism spectrum disorder. Journal of Autism and Developmental Disorders, 39, 1542–1551. doi:10.1007/s10803-009-0794-4.CrossRefPubMedGoogle Scholar
  22. Gadow, K. D., Schwartz, J., DeVincent, C., Strong, G., & Cuva, S. (2008c). Clinical utility of autism spectrum disorder scoring algorithms for the Child Symptom Inventory. Journal of Autism and Developmental Disorders, 38, 419–427.CrossRefPubMedGoogle Scholar
  23. Gadow, K. D., & Sprafkin, J. (1986). Stony Brook child psychiatric checklist-3. Stony Brook: Department of Psychiatry, State University of New York.Google Scholar
  24. Gadow, K. D., & Sprafkin, J. (1994). Child symptom inventories manual. Stony Brook, NY: Checkmate Plus.Google Scholar
  25. Gadow, K. D., & Sprafkin, J. (2002). Child Symptom Inventory-4 screening and norms manual. Stony Brook, NY: Checkmate Plus.Google Scholar
  26. Gadow, K. D., & Sprafkin, J. (2008). The symptom inventories: An annotated bibliography [on-line]. Available: www.checkmateplus.com.
  27. Gadow, K. D., Sverd, J., Nolan, E. E., Sprafkin, J., & Schneider, J. (2007). Immediate-release methylphenidate for ADHD in children with comorbid chronic multiple tic disorder. Journal of the American Academy of Child and Adolescent Psychiatry, 46, 840–848.CrossRefPubMedGoogle Scholar
  28. Happé, F., & Ronald, A. (2008). The ‘fractionable autism triad’: A review of evidence from behavioral, genetic, cognitive and neural research. Neuropsychology Review, 18, 287–304.CrossRefPubMedGoogle Scholar
  29. Lecavalier, L., Gadow, K. D., DeVincent, C. J., & Edwards, M. C. (2009). Validation of DSM-IV model of psychiatric syndromes in children with autism spectrum disorder. Journal of Autism and Developmental Disorders, 39, 278–289.CrossRefPubMedGoogle Scholar
  30. Leckman, J. F., Riddle, M. A., Hardin, M. T., Ort, S. I., Swartz, K. L., Stevenson, J., et al. (1989). The Yale global tic severity scale: Initial testing of a clinic-rated scale of tic severity. Journal of the American Academy of Child and Adolescent Psychiatry, 28, 566–573.CrossRefPubMedGoogle Scholar
  31. Lord, C., Risi, S., Lambrecht, L., Cook, E. H., Jr, Leventhal, B. L., DiLavore, P. C., et al. (2000). The autism diagnostic observation schedule-generic: A standard measure of social and communication deficits associated with the spectrum of autism. Journal of Autism and Developmental Disorders, 30, 205–223.CrossRefPubMedGoogle Scholar
  32. Myles, B., Barnhill, G., Hagiwara, T., Griswold, D., & Simpson, R. (2001). A synthesis of studies on the intellectual, academic, social/emotional and sensory characteristics of children with asperger syndrome. Education and Training in Mental Retardation and Developmental Disabilities, 36, 304–311.Google Scholar
  33. Nesse, R. M. (1999). Proximate and evolutionary studies of anxiety, stress and depression: Synergy at the interface. Neuroscience and Behavioral Reviews, 23, 895–903.Google Scholar
  34. Nolan, E. E., Gadow, K. D., & Sverd, J. (1994). Observations and ratings of tics in school settings. Journal of Abnormal Child Psychology, 22, 579–593.CrossRefPubMedGoogle Scholar
  35. Olatunji, B. O., & Cole, D. A. (2009). The longitudinal structure of general and specific anxiety dimensions in children: Testing a latent trait-state-occasion model. Psychological Assessment, 21, 412–424.CrossRefPubMedGoogle Scholar
  36. Perneger, T. V. (1998). What’s wrong with Bonferroni adjustments. BMJ, 316, 1236–1238.PubMedGoogle Scholar
  37. Pierre, C. B., Nolan, E. E., Gadow, K. D., Sverd, J., & Sprafkin, J. (1999). Comparison of internalizing and externalizing symptoms in children with attention-deficit hyperactivity disorder with and without comorbid tic disorder. Journal of Developmental and Behavioral Pediatrics, 20, 170–176.PubMedGoogle Scholar
  38. Reich, W. (2000). Diagnostic interview for children and adolescents (DICA). Journal of the American Academy of Child and Adolescent Psychiatry, 39, 59–66.CrossRefPubMedGoogle Scholar
  39. Roessner, V., Becker, A., Banaschewski, T., & Rothenberger, A. (2007). Psychological profile in children with chronic tic disorder and co-existing ADHD: Additive effects. Journal of Abnormal Child Psychology, 35, 79–85.CrossRefPubMedGoogle Scholar
  40. Rothman, K. (1990). No adjustments are needed for multiple comparisons. Epidemiology, 1, 43–46.CrossRefPubMedGoogle Scholar
  41. Rowe, D. C., Stever, C., Gard, J. M. C., Cleveland, H. H., Sanders, M. L., Abramowitz, A., et al. (1998). The relation of the dopamine transporter gene (DAT1) to symptoms of internalizing disorders in children. Behavior Genetics, 28, 215–225.CrossRefPubMedGoogle Scholar
  42. Schneider, J., Gadow, K. D., Crowell, J. A., & Sprafkin, J. (2009). Anxiety in boys with ADHD with and without chronic multiple tic disorder. Journal of Child and Adolescent Psychopharmacology, 19, 1–12. doi:10.1089/cap.2009.0013.CrossRefGoogle Scholar
  43. Sherrington, C. S. (1900). Experimentation in emotion. Nature, 62(1065), 328–331.CrossRefGoogle Scholar
  44. 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 and Adolescent Psychiatry, 47, 921–929.CrossRefPubMedGoogle Scholar
  45. Sprafkin, J., Volpe, R. J., Gadow, K. D., Nolan, E. E., & Kelly, K. (2002). A DSM-IV-referenced screening instrument for preschool children: The Early Childhood Inventory-4. Journal of the American Academy of Child and Adolescent Psychiatry, 41, 604–612.CrossRefPubMedGoogle Scholar
  46. Sukhodolsky, D. G., Scahill, L., Zhang, H., Peterson, B. S., King, R. A., Lombroso, P. J., et al. (2003). Disruptive behavior in children with Tourette’s syndrome: Association with ADHD co-morbidity, tic severity, and functional impairment. Journal of the American Academy of Child and Adolescent Psychiatry, 42, 98–105.CrossRefPubMedGoogle Scholar
  47. 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 and Adolescent Psychopharmacology, 15, 477–496.CrossRefPubMedGoogle Scholar
  48. 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.CrossRefPubMedGoogle Scholar
  49. Zhang, J., Quan, H., Ng, J., & Stepanavage, M. E. (1997). Some statistical methods for multiple endpoints in clinical trials. Controlled Clinical Trials, 18, 204–221.CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2010

Authors and Affiliations

  • Sarit Guttmann-Steinmetz
    • 1
  • Kenneth D. Gadow
    • 2
  • Carla J. DeVincent
    • 3
  • Judy Crowell
    • 2
  1. 1.New School of PsychologyInterdisciplinary Center Herzliya (IDC)HerzliyaIsrael
  2. 2.Department of Psychiatry and Behavioral Science, Putnam Hall-South CampusStony Brook UniversityStony BrookUSA
  3. 3.Department of PediatricsStony Brook UniversityStony BrookUSA

Personalised recommendations