Skip to main content
SpringerLink
Log in

Network Analysis of Anxiety in the Autism Realm

  • Original Paper
  • Published:
Journal of Autism and Developmental Disorders Aims and scope Submit manuscript

Abstract

The anxiety and autism realms are each complicated and heterogeneous, and relationships between the two areas are especially complex. Network analysis offers a promising approach to the phenotypic complexities of typical and atypical human behavior. The Revised Children’s Anxiety and Depression Scale (RCADS) was used to assess anxiety in 126 high-functioning 9–13 year-olds with ASDs. Network graphs of Autism Diagnostic Observation Schedule items and RCADS anxiety total score, social, generalized, panic and separation anxiety subscores consistently found the anxiety node (score) to be highly peripheral. Also, the networks of RCADS anxiety items themselves were similar for the ASDs group and a general population comparison group (n = 2017). The results suggest anxiety is not a central part of autism and that anxiety is dynamically similar (aspects of anxiety relate to one another in a similar manner) in high-functioning autism and the general population.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

References

  • Anderson, G. M. (2008). The potential role for emergence in autism. Autism Research, 1, 18–30.

    Article  Google Scholar 

  • Anderson, G. M., Montazeri, F., & De Bildt, A. (2015). Network approach to autistic traits: Group and subgroup analyses of ADOS item scores. Journal of Autism and Developmental Disorders, 45, 3115–3132.

    Article  Google Scholar 

  • Barrett, L. F. (2017). Functionalism cannot save the classical view of emotion. Social Cognitive and Affective Neuroscience, 12, 34–36.

    Article  Google Scholar 

  • Bellini, S. (2006). The development of social anxiety in adolescents with autism spectrum disorders. Focus on Autism and Other Developmental Disabilities, 21(3), 138–145.

    Article  Google Scholar 

  • Borsboom, D., & Cramer, A. O. (2013). Network analysis: An integrative approach to the structure of psychopathology. Annual Review of Clinical Psychology, 9, 91–121.

    Article  Google Scholar 

  • Bringmann, L. F., Vissers, N., Wichers, M., Geschwind, N., Kuppens, P., Peeters, F., Borsboom, D., & Tuerlinckx, F. (2013). A network approach to psychopathology: New insights into clinical longitudinal data. PLoS ONE, 8(4), e60188.

    Article  Google Scholar 

  • Chang, Y. C., Quan, J., & Wood, J. J. (2012). Effects of anxiety disorder severity on social functioning in children with autism spectrum disorders. Journal of Developmental and Physical Disability, 24(3), 235–245.

    Article  Google Scholar 

  • Cholemkery, H., Mojica, L., Rohrmann, S., Gensthaler, A., & Freitag, C. M. (2014). Can autism spectrum disorders and social anxiety disorders be differentiated by the social responsiveness scale in children and adolescents? Journal of Autism and Developmental Disorders, 44(5), 1168–1182.

    Article  Google Scholar 

  • Chorpita, B. F., Yim, L., Moffitt, C., Umemoto, L. A., & Francis, S. E. (2000). Assessment of symptoms of DSM-IV anxiety and depression in children: A Revised Child Anxiety and Depression Scale. Behaviour Research and Therapy, 38, 835–855.

    Article  Google Scholar 

  • Cramer, A. O., Waldorp, L. J., van der Maas, H. L., & Borsboom, D. (2010a). Comorbidity: A network perspective. Behavioral and Brain Sciences, 33, 137–193.

    Article  Google Scholar 

  • Cramer, A. O., Waldorp, L. J., van der Maas, H. L., & Borsboom, D. (2010b). Complex realities require complex theories: Refining and extending the network approach to mental disorders. Behavioral and Brain Sciences, 33, 178–193.

    Article  Google Scholar 

  • Dekker, V., Nauta, M. H., Mulder, E. J., Timmerman, M. E., & de Bildt, A. (2014). A randomized controlled study of a social skills training for preadolescent children with autism spectrum disorders: Generalization of skills by training parents and teachers? BMC Psychiatry, 14, 189.

    Article  Google Scholar 

  • Duifhuis, E. A., den Boer, J. C., Doornbos, A., Buitelaar, J. K., Oosterling, I. J., & Klip, H. (2017). The effect of pivotal response treatment in children with autism spectrum disorders: A non-randomized study with a blinded outcome measure. Journal of Autism and Developmental Disorders, 47, 231–242.

    Article  Google Scholar 

  • Eussen, M. L., Van Gool, A. R., Verheij, F., De Nijs, P. F., Verhulst, F. C., & Greaves-Lord, K. (2013). The association of quality of social relations, symptom severity and intelligence with anxiety in children with autism spectrum disorders. Autism, 17(6), 723–735.

    Article  Google Scholar 

  • 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, 9, 392–415.

    Article  Google Scholar 

  • Hallett, V., Ronald, A., Colvert, E., Ames, C., Woodhouse, E., Lietz, S., Garnett, R., Gillan, N., Rijsdijk, F., Scahill, L., Bolton, P., & Happé, F. (2013). Exploring anxiety symptoms in a large-scale twin study of children with autism spectrum disorders, their co-twins and controls. Journal of Child Psychology and Psychiatry, 54, 1176–1185.

    Article  Google Scholar 

  • Happe, F., Ronald, A., & Plomin, R. (2006). Time to give up on a single explanation for autism. Nature Neuroscience, 9, 1218–1220.

    Article  Google Scholar 

  • Heeren, A., & McNally, R. J. (2016). An integrative network approach to social anxiety disorder: The complex dynamic interplay among attentional bias for threat, attentional control, and symptoms. Journal of Anxiety Disorders, 42, 95–104.

    Article  Google Scholar 

  • Huisman, M., Oldehinkel, A. J., De Winter, A., Minderaa, R. B., De Bildt, A., Huizink, A. F., Verhulst, F. C., & Ormel, J. (2008). Cohort profile: The Dutch ‘tracking adolescents’ individual lives survey’. International Journal of Epidemiology, 37(6), 1227–1235.

    Article  Google Scholar 

  • Jeste, S. S., & Geschwind, D. H. (2014). Disentangling the heterogeneity of autism spectrum disorder through genetic findings. Nature Reviews Neurology, 10, 74–81.

    Article  Google Scholar 

  • Kaat, A. J., & Lecavalier, L. (2015). Reliability and validity of parent- and child-rated anxiety measures in autism spectrum disorder. Journal of Autism and Developmental Disorders, 45, 3219–3231.

    Article  Google Scholar 

  • Kamada, T., & Kawai, S. (1989). An algorithm for drawing general undirected graphs. Information Processing Letters, 31(1), 7–15.

    Article  Google Scholar 

  • Kerns, C. M., Kendall, P. C., Berry, L., Souders, M. C., Franklin, M. E., Schultz, R. T., Miller, J., & Herrington, J. (2014). Traditional and atypical presentations of anxiety in youth with autism spectrum disorder. Journal of Autism and Developmental Disorders, 44, 2851–2861.

    Article  Google Scholar 

  • Kobourov, S. G. (2012). Spring embedders and force-directed graph drawing algorithms. http://arxiv.org/abs/1201.3011.

  • LeDoux, J. E., & Pine, D. S. (2016). Using Neuroscience to help understand fear and anxiety: A two-system framework. American Journal of Psychiatry, 173(11), 1083–1093.

    Article  Google Scholar 

  • Lee, M., Aggen, S. H., Otowa, T., Castelao, E., Preisig, M., Grabe, H. J., Hartman, C. A., Oldehinkel, A. J., Middeldorp, C. M., Tiemeier, H., & Hettema, J. M. (2016). Assessment and characterization of phenotypic heterogeneity of anxiety disorders across five large cohorts. International Journal of Methods in Psychiatric Research, 25(4), 255–266.

    Article  Google Scholar 

  • Lenroot, R. K., & Yeung, P. K. (2013). Heterogeneity within autism spectrum disorders: What have we learned from neuroimaging studies? Frontiers in Human Neuroscience, 7, 733.

    Article  Google Scholar 

  • Lindquist, K. A., Siegel, E. H., Quigley, K. S., & Barrett, L. F. (2013). The hundred-year emotion war: Are emotions natural kinds or psychological constructions? Comment on Lench, Flores, & Bench (2011). Psychological Bulletin, 139, 255–263.

    Article  Google Scholar 

  • Liu, Y., Slotine, J., & Barabási, A. (2011). Controllability of complex networks. Nature, 473, 167.

    Article  Google Scholar 

  • Lord, C., Rutter, M., DiLavore, P. C., & Risi, S. (1999). ADOS Autism Diagnostic Observation Schedule Manual. Los Angeles: WPS.

    Google Scholar 

  • Lord, C., Rutter, M., DiLavore, P. C., Risi, S., Gotham, K., & Bishop, S. (2012). Autism diagnostic observation schedule, second edition (ADOS-2) manual (Part I): Modules 1–4. Torrance, CA: Western Psychological Services.

    Google Scholar 

  • Maddox, B. B., & White, S. W. (2015). Comorbid social anxiety disorder in adults with autism spectrum disorder. Journal of Autism and Developmental Disorders, 45, 3949–3960.

    Article  Google Scholar 

  • 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(4), 387–393.

    Article  Google Scholar 

  • Pelphrey, K. A., Shultz, S., Hudac, C. M., & Vander Wyk, B. C. (2011) Research review: Constraining heterogeneity: The social brain and its development in autism spectrum disorder. Journal of Child Psychology and Psychiatry, 52, 631–644.

    Article  Google Scholar 

  • Piqueras, J. A., Martín-Vivar, M., Sandin, B., Luis, S., C., & Pineda, D. (2017). The Revised Child Anxiety and Depression Scale: A systematic review and reliability generalization meta-analysis. Journal of Affective Disorders, 218, 153–169.

    Article  Google Scholar 

  • Raymond, J. G., Steele, J. D., & Seriès, P. (2017). Modeling trait anxiety: From computational processes to personality. Frontiers in Psychiatry, 8, 1.

    Article  Google Scholar 

  • Rodgers, J., Wigham, S., McConachie, H., Freeston, M., Honey, E., & Parr, J. R. (2016). Development of the Anxiety Scale for Children with autism spectrum disorder (ASC-ASD). Autism Research, 9, 1205–1215.

    Article  Google Scholar 

  • Rutter, M., Le Couteur, A., & Lord, C. (2003). ADI-R Autism Diagnostic Interview Revised Manual. Los Angeles: Western Psychological Services.

    Google Scholar 

  • Shackman, A. J., Fox, A. S., Oler, J. A., Shelton, S. E., Davidson, R. J., & Kalin, N. H. (2013). Neural mechanisms underlying heterogeneity in the presentation of anxious temperament. Proceedings of the National Academy of Sciences USA, 110, 6145–6150.

    Article  Google Scholar 

  • 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.

    Article  Google Scholar 

  • Simpson, H. B. (2012). The RDOC Project: A new paradigm for investigating the pathophysiology of anxiety. Depression and Anxiety, 29, 251–252.

    Article  Google Scholar 

  • South, M., & Rodgers, J. (2017). Sensory, emotional and cognitive contributions to anxiety in autism spectrum disorders. Frontiers in Human Neuroscience, 24, 11–20.

    Google Scholar 

  • Sparrow, S. S., Balla, D., & Cicchetti, D. V. (1984). Vineland Adaptive Behavior Scales (Survey ed.). Circle Pines, MN: American Guidance Service.

    Google Scholar 

  • Sterling, L., Renno, P., Storch, E. A., Ehrenreich-May, J., Lewin, A. B., Arnold, E., Lin, E., & Wood, J. (2015). Validity of the Revised Children’s Anxiety and Depression Scale for youth with autism spectrum disorders. Autism, 19, 113–117.

    Article  Google Scholar 

  • Sukhodolsky, D. G., Scahill, L., Gadow, K. D., Arnold, L. E., Aman, M. G., McDougle, C. J., McCracken, J. T., Tierney, E., White, W., Lecavalier, S. L., & Vitiello, B. (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(1), 117–128.

    Article  Google Scholar 

  • Suzuki, R., & Shimodaira, H. (2006). Pvclust: An R package for assessing the uncertainty in hierarchical clustering. Bioinformatics, 22, 1540–1542.

    Article  Google Scholar 

  • Ung, D., Wood, J. J., Ehrenreich-May, J., Arnold, E. B., Fuji, C., Renno, P., Murphy, T. K., Lewin, A. B., Mutch, P. J., & Storch, E. A. (2013). Clinical characteristics of high-functioning youth with autism spectrum disorder and anxiety. Neuropsychiatry (London), 3(2). https://doi.org/10.2217/npy.13.9

  • Van Steensel, F. J., Bögels, 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.

    Article  Google Scholar 

  • Volkmar, F. R., & McPartland, J. C. (2016). Moving beyond a categorical diagnosis of autism. Lancet Neurology, 15, 237–238.

    Article  Google Scholar 

  • Wechsler, D. (1999). Wechsler Intelligence Scale for Children, 3rd edn. San Antonio, TX: Psychological Corporation.

    Google Scholar 

  • 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.

    Article  Google Scholar 

  • White, S. W., Kreiser, N. L., Pugliese, C., & Scarpa, A. (2012). Social anxiety mediates the effect of autism spectrum disorder characteristics on hostility in young adults. Autism, 16(5), 453–464.

    Article  Google Scholar 

  • White, S. W., Mazefsky, C. A., Dichter, G. S., Chiu, P. H., Richey, J. A., & Ollendick, T. H. (2014). Social-cognitive, physiological, and neural mechanisms underlying emotion regulation impairments: Understanding anxiety in autism spectrum disorder. International Journal of Developmental Neuroscience, 39, 22–36.

    Article  Google Scholar 

  • White, S. W., Oswald, D., Ollendick, T., & Scahill, L. (2009). Anxiety in children and adolescents with autism spectrum disorders. Clinical Psychology Review, 29(3), 216–229.

    Article  Google Scholar 

  • 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(4), 281–292.

    Google Scholar 

Download references

Acknowledgments

The current study is based on data from the Efficacy of Social Skills Training in Autism (ESTIA) study, conducted by Accare Center for Child and Adolescent Psychiatry and financed by the Netherlands Organization for Health Research and Development (ZonMw, nr 157003005). The study also used data from the TRacking Adolescents’ Individual Lives Survey (TRAILS). Participating centers of TRAILS include various departments of the University Medical Center and University of Groningen, the Erasmus University Medical Center Rotterdam, the University of Utrecht, the Radboud Medical Center Nijmegen, and the Parnassia Bavo group, all in the Netherlands. TRAILS has been financially supported by various grants from the Netherlands Organization for Scientific Research (NWO), ZonMW, GB-MaGW, the Dutch Ministry of Justice, the European Science Foundation, BBMRI-NL, the participating universities, and Accare Center for Child and Adolescent Psychiatry. We are grateful to all children, their parents, and teachers who participated in this research, and to everyone who worked on this project and made it possible.

Funding

The current study is based on data from the Efficacy of Social Skills Training in Autism (ESTIA) study, conducted by Accare Center for Child and Adolescent Psychiatry and funded by the Netherlands Organization for Health Research and Development (ZonMw, nr 157003005).

Author information

Authors and Affiliations

  1. Child Study Center, Yale University School of Medicine, 230 S. Frontage Rd, New Haven, CT, 06519, USA

    Farhad Montazeri & George M. Anderson

  2. Department of Child and Adolescent Psychiatry, University of Groningen Medical Center, University of Groningen, Groningen, The Netherlands

    Annelies de Bildt & Vera Dekker

  3. Accare, Child and Adolescent Psychiatry, Groningen, The Netherlands

    Annelies de Bildt & Vera Dekker

Authors
  1. Farhad Montazeri
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Annelies de Bildt
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Vera Dekker
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. George M. Anderson
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

GMA conceived the project, oversaw the data analysis, and wrote the paper. FM performed data analysis and wrote the paper. AdB oversaw all clinical aspects of the project, and wrote the paper. VD contributed to the patient assessment and methodological aspects of the paper.

Corresponding author

Correspondence to George M. Anderson.

Ethics declarations

Conflict of interest

Author FM declares he has no conflict of interest. Author AdB is first author on the Dutch ADOS manual for which her institution (Accare) receives remuneration. Author VD declares she has no conflict of interest. Author GMA has received remuneration from the law firm Pepper Hamilton LLP, Philadelphia, PA, for consultation regarding their representation of the pharmaceutical firm Eli Lilly & Co.

Disclosure

Author AdB received a grand by the Netherlands Organization for Health Research and Development (ZonMw, nr 157003005) which funded this study. The agency had no role in the data analyses, the decision to publish, or the preparation of the manuscript.

Ethical Approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed Consent

Informed consent was obtained from all individual participants included in the study.

Electronic Supplementary material

Below is the link to the electronic supplementary material.

Supplementary material 1 (DOCX 1944 KB)

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Montazeri, F., de Bildt, A., Dekker, V. et al. Network Analysis of Anxiety in the Autism Realm. J Autism Dev Disord 49, 2219–2230 (2019). https://doi.org/10.1007/s10803-018-3474-4

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10803-018-3474-4

Keywords

Search

Navigation