Anxiety Disorders and Obsessive-Compulsive Disorder in Individuals with Autism Spectrum Disorder
- 657 Downloads
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.
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.
KeywordsAnxiety Obsessive-compulsive disorder Autism spectrum disorder Repetitive behaviors
Compliance with Ethical Standards
Conflict of Interest
Valentina Postorino, Giacomo Vivanti, Jessica Bradshaw, Martina Siracusano, and Luigi Mazzone declare that they have no conflicts of interest.
Connor Kerns receives book royalties from Elsevier. Dr. Kerns is owner of Connor M. Kerns, PhD, LCC, which provides training in the ADIS/ASA.
Human and Animal Rights and Informed Consent
This article does not contain any studies with human or animal subjects performed by any of the authors.
Papers of particular interest, published recently, have been highlighted: • Of importance •• Of major importance
- 2.• van Steensel FJ, Bögels SM, Perrin S. Anxiety disorders in children and adolescents with autistic spectrum disorders: a meta-analysis. Clin Child Fam Psychol Rev. 2011;14(3):302–17. An important systematic review and meta-analysis of 31 studies involving 2121 young people with ASD evaluating the presence of anxiety disorders in this clinical population using standardized questionnaire or diagnostic interviews CrossRefPubMedPubMedCentralGoogle Scholar
- 4.•• Mazzone L, Vitiello B: Psychiatric symptoms and comorbidities in autism spectrum disorder. Springer Eds, 2016. This is an important book that explains in detail the diagnosis, management, and treatment of comorbid disorders in patients with autism spectrum disorders . Google Scholar
- 8.• Lecavalier L, Wood JJ, Halladay AK, Jones NE, Aman MG, Cook EH, et al. Measuring anxiety as a treatment endpoint in youth with autism spectrum disorder. J Autism Dev Disord. 2014;44(5):1128–43. This is a systematic review performed by a panel of expert in the field assembled by Autism Speaks to examine strengths and weaknesses of available instruments for measuring anxiety in youth with ASD CrossRefPubMedPubMedCentralGoogle Scholar
- 9.• Kerns CM, Kendall PC, Zickgraf H, Franklin ME, Miller J, Herrington J. Not to be overshadowed or overlooked: functional impairments associated with comorbid anxiety disorders in youth with ASD. Behav Ther. 2015;46(1):29–39. This study examines associations between comorbid anxiety disorders and difficulties commonly attributed to both anxiety and ASD in a well-characterized sample of youth with ASD CrossRefPubMedGoogle Scholar
- 16.Scahill L, Dimitropoulos A, McDougle CJ, Aman MG, Feurer ID, McCracken JT, et al. Children’s Yale-Brown obsessive compulsive scale in autism spectrum disorder: component structure and correlates of symptom checklist. J Am Acad Child Adolesc Psychiatry. 2014;53(1):97–107.e1.CrossRefPubMedGoogle Scholar
- 17.• Scahill L, Challa SA. Repetitive behavior in children with autism spectrum disorder: similarities and differences with obsessive-compulsive disorder. In: Mazzone L, Vitiello B, editors. Psychiatric symptoms and comorbidities in autism spectrum disorder: Springer Eds; 2016. An important book chapter that examines the similarities and differences of repetitive behavior in children with ASD and OCD and help clinicians disentangle the repetitive behaviors attributable to OCD from those attributable to ASD.Google Scholar
- 21.American Psychiatric Association. Diagnostic and statistical manual of mental disorders. 4th ed. Washington, DC: American Psychiatric Association; 1994.Google Scholar
- 23.Sukhodolsky DG, Scahill L, Gadow KD, Arnold LE, Aman MG, McDougle CJ, et al. Parent-rated anxiety symptoms in children with pervasive developmental disorders: frequency and association with core autism symptoms and cognitive functioning. J Abnorm Child Psychol. 2008;36(1):117–28.CrossRefPubMedGoogle Scholar
- 24.van Steensel FJ, Heeman EJ. Anxiety levels in children with autism spectrum disorder: a meta-analysis. J Child Fam Stud. 2017:1–15.Google Scholar
- 25.• Simonoff E, Pickles A, Charman T, Chandler S, Loucas T, Baird G. Psychiatric disorders in children with autism spectrum disorders: prevalence, comorbidity, and associated factors in a population-derived sample. J Am Acad Child Adolesc Psychiatry. 2008;47(8):921–9. This study identifies the rates and type of psychiatric comorbidity associated with ASD and reports that one of the most common diagnoses in this sample was social anxiety disorder (29.2%) CrossRefPubMedGoogle Scholar
- 31.Magiati I, Ozsivadjian A, Kerns C. Phenomenology and presentation of anxiety in autism spectrum disorder. anxiety in children and adolescents with autism spectrum disorder: evidence-based assessment and treatment. 2017: 33–54.Google Scholar
- 35.Wu MS, Rudy BM, Storch EA. Obsessions, compulsions, and repetitive behavior: autism and/or OCD. In: Handbook of autism and anxiety: Springer International Publishing; 2014. p. 107–20.Google Scholar
- 39.• Uljarevic M, Nuske H, Vivanti G. Anxiety in autism spectrum disorder. In: Mazzone L, Vitiello B, editors. Psychiatric symptoms and comorbidities in autism spectrum disorder: Springer International Publishing; 2016. p. 21–38. This book chapter critically evaluate the current state of knowledge on the nature of anxiety issues in individuals with ASD, provide an overview of clinical management issues and best practices, and discuss current and future research directions.Google Scholar
- 42.Vivanti G, Dawson G, Rogers SJ. Early learning in autism. 2017: 1–12. In Vivanti et al. Implementing the Group-Based Early Start Denver Model for Preschoolers with Autism. Springer International Publishing.Google Scholar
- 46.Wehmeyer ML, Shogren K. Self-determination and learners with autism spectrum disorders. 2008: 433-476. In R. Simpson & B. Myles (Eds.), Educating children and youth with autism: strategies for effective practice (2nd Ed.) Austin, TX: Pro-Ed Publishers, Inc.Google Scholar
- 50.Developmental Disabilities Monitoring Network Surveillance Year 2010 Principal Investigators; Centers for Disease Control and Prevention (CDC). Prevalence of autism spectrum disorder among children aged 8 years - autism and developmental disabilities monitoring network, 11 sites, United States, 2010. MMWR Surveill Summ. 2014;63(2):1–21.Google Scholar
- 51.Moskowitz L, Rosen T, Lerner M, Levine K. Assessment of anxiety in youth with autism spectrum disorder. In: Kerns CM, Renno P, Storch EA, Kendall PC, Wood JJ, editors. Anxiety in children and adolescents with autism spectrum disorder: evidence based assessment and treatment. London: Elsevier Academic Press; 2017.Google Scholar
- 54.Bearss K, Taylor CA, Aman MG, Whittemore R, Lecavalier L, Miller J, et al. Using qualitative methods to guide scale development for anxiety in youth with autism spectrum disorder. Autism 2015: 1362361315601012.Google Scholar
- 64.Turner M. Repetitive behaviour and cognitive functioning in autism. Unpublished PhD thesis, University of Cambridge 1995.Google Scholar
- 65.Turner MA. Towards an executive dysfunction account of repetitive behavior in autism. In: Russell J, editor. Autism as an executive disorder. Oxford: Oxford University Press; 1997. p. 57–100.Google Scholar
- 70.•• Kerns CM, Wood JJ, Kendall PC, Renno P, Crawford EA, Mercado RJ, et al. The Treatment of Anxiety in Autism Spectrum Disorder (TAASD) study: rationale, design and methods. J Child Fam Stud. 2016;25(6):1889–902. This is a study protocol paper describing the Treatment of Anxiety in Autism Spectrum Disorder study, an ongoing three-site randomized controlled trial investigating the relative efficacy of a modular CBT protocol for anxiety in ASD versus standard CBT for pediatric anxiety and a treatment-as-usual control. CrossRefPubMedPubMedCentralGoogle Scholar
- 74.Baldwin DS, Anderson IM, Nutt DJ, Allgulander C, Bandelow B, den Boer JA, et al. Evidence-based pharmacological treatment of anxiety disorders, post-traumatic stress disorder and obsessive-compulsive disorder: a revision of the 2005 guidelines from the British Association for Psychopharmacology. J Psychopharmacol. 2014;28(5):403–39.CrossRefPubMedGoogle Scholar
- 76.King BH, Hollander E, Sikich L, McCracken JT, Scahill L, Bregman JD, et al. Lack of efficacy of citalopram in children with autism spectrum disorders and high levels of repetitive behavior: citalopram ineffective in children with autism. Arch Gen Psychiatry. 2009;66(6):583.CrossRefPubMedPubMedCentralGoogle Scholar
- 80.Guy L, Souders M, Bradstreet L, DeLussey C, Herrington JD. Brief report: emotion regulation and respiratory sinus arrhythmia in autism spectrum disorder. J Autism Dev Disord. 2014:1–7.Google Scholar
- 81.•• Häge A, Banaschewski T, Buitelaar JK, Dijkhuizen RM, Franke B, Lythgoe DJ, et al. Glutamatergic medication in the treatment of obsessive compulsive disorder (OCD) and autism spectrum disorder (ASD) - study protocol for a randomised controlled trial. Trials 2016: 17(1):141. This is a study protocol describing an ongoing randomised, double-blind, placebo-controlled design of treatment with memantine in patients with OCD and ASD and is part of the large, translational project TACTICS that is funded by the European Union and investigates the neural, genetic, and molecular factors involved in the pathogenesis of compulsivity.Google Scholar
- 83.Hill TL, Gray SA, Baker CN, Boggs K, Carey E, Johnson C, et al. A pilot study examining the effectiveness of the PEERS program on social skills and anxiety in adolescents with autism spectrum disorder. J Autism Dev Disord. 2017:1–12.Google Scholar
- 86.Wallace GL, Kenworthy L, Pugliese CE, Popal HS, White EI, Brodsky E, et al. Real-world executive functions in adults with autism spectrum disorder: profiles of impairment and associations with adaptive functioning and co-morbid anxiety and depression. J Autism Dev Disord. 2016;46(3):1071–83.CrossRefPubMedPubMedCentralGoogle Scholar
- 88.Green J, Pickles A, Pasco G, Bedford R, Wan MW, Elsabbagh M, et al. Randomised trial of a parent-mediated intervention for infants at high risk for autism: longitudinal outcomes to age 3 years. J Child Psychol Psychiatry. 2017;Google Scholar
- 90.Vivanti G, Dissanayake C, Victorian ASELCC Team. Outcome for children receiving the Early Start Denver Model before and after 48 months. J Autism Dev Disord. 2016:1–9.Google Scholar