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Developmental cascades between insistence on sameness behaviour and anxiety symptoms in autism spectrum disorder

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Abstract

Autistic children experience high rates of anxiety. Insistence on sameness behaviour (IS) is a core feature of autism that appears correlated with anxiety severity. The objective of this study was to examine the longitudinal relations between anxiety and IS in autistic children using a developmental cascade model. A longitudinal cohort of 421 autistic children was followed between 4 and 11 years of age. Anxiety was quantified using items from the Anxiety Problems subscale of the Child Behavior Checklist; sameness behaviours were measured using the Repetitive Behavior Scale-Revised, Ritualistic/sameness subscale (both parent-report measures). Structural equation modelling was used to examine the longitudinal and directional associations between anxiety and IS at four time-points, through cross-lagged panel models (CLPM) with and without a random-intercepts component (RI-CLPM). Both the CLPM and the RI-CLPM had good fit. Significant directional associations were detected whereby elevated or increasing IS preceded elevated or increasing anxiety symptoms 1–2 years later, respectively. Stable baseline tendencies towards anxiety and IS as between-person traits (intercepts) were strongly associated (standardized estimate = 0.69, p < 0.001). The magnitude of the cross-sectional associations between anxiety and IS appeared to lessen with age. IS and anxiety symptoms in autism are closely related. They appear to be shared traits that mirror each other particularly in younger children. Increasing IS may be a sign of emerging future anxiety. Interventions that target IS to reduce or prevent anxiety amongst school-aged autistic children merit further study.

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Acknowledgements

The authors thank all the children and families who have participated in the Pathways in ASD study. The authors also acknowledge the Pathways in ASD Study Team (research staff members and trainees) who have contributed to this study. Dr. Baribeau’s training was supported by the O’Brien Scholars Program, and the Canadian Institutes of Health Research.

Funding

This study was supported by the Canadian Institutes of Health Research (HDF-70333, FDN 93621), Kids Brain Health Network (formerly NeuroDevNet), Autism Speaks, the Government of British Columbia, Alberta Innovates Health Solutions, the Sinneave Family Foundation, and the Mayberry Family.

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Authors and Affiliations

  1. Department of Psychiatry, University of Toronto, Toronto, ON, Canada

    Danielle A. Baribeau, Simone N. Vigod & Peter Szatmari

  2. The Hospital for Sick Children, Toronto, ON, Canada

    Danielle A. Baribeau, Eleanor Pullenayegum & Peter Szatmari

  3. Department of Psychiatry, Women’s College Hospital and Women’s College Research Institute, Toronto, ON, Canada

    Simone N. Vigod

  4. Child Health Evaluative Sciences, The Hospital for Sick Children Research Institute, Toronto, ON, Canada

    Eleanor Pullenayegum

  5. Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada

    Eleanor Pullenayegum

  6. Department of Psychology, University of British Columbia, Vancouver, Canada

    Connor M. Kerns

  7. Counselling Psychology, Faculty of Education, University of Ottawa, Ottawa, ON, Canada

    Tracy Vaillancourt

  8. Offord Centre for Child Studies, Hamilton, ON, Canada

    Eric Duku & Teresa Bennett

  9. Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON, Canada

    Eric Duku & Teresa Bennett

  10. Department of Pediatrics, Dalhousie University, Halifax, NS, Canada

    Isabel M. Smith

  11. Autism Research Centre, IWK Health Centre, Halifax, NS, Canada

    Isabel M. Smith & Annie E. Richard

  12. Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, Canada

    Joanne Volden

  13. Department of Pediatrics, University of Alberta, Edmonton, Canada

    Lonnie Zwaigenbaum

  14. Montreal Neurological Institute, McGill University, Montreal, QC, Canada

    Mayada Elsabbagh

  15. Department of School Counseling and Special Education at the Constantiner School of Education, Tel Aviv University, Tel Aviv, Israel

    Anat Zaidman-Zait

  16. The School of Population and Public Health, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada

    Anat Zaidman-Zait

  17. Centre for Addiction and Mental Health, Toronto, ON, Canada

    Peter Szatmari

  18. The Hospital for Sick Children, University of Toronto, 123 Edward Street, 12th floor, Room 1210, Toronto, ON, M5G 1E2, Canada

    Danielle A. Baribeau

  19. Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, Toronto, Canada

    Danielle A. Baribeau

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  1. Danielle A. Baribeau
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Correspondence to Danielle A. Baribeau.

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Drs. Baribeau, Vigod, Pullenayegum, Mirenda, Smith, Vaillancourt, Volden, Waddell, Zwaigenbaum, Bennett, Duku, Elsabbagh, Georgiades, Kerns, Ungar, Zaidman-Zait, and Szatmari report no biomedical financial interests or potential conflicts of interest.

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Baribeau, D.A., Vigod, S.N., Pullenayegum, E. et al. Developmental cascades between insistence on sameness behaviour and anxiety symptoms in autism spectrum disorder. Eur Child Adolesc Psychiatry 32, 2109–2118 (2023). https://doi.org/10.1007/s00787-022-02049-9

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