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Characterization and Prediction of Anxiety in Adolescents with Autism Spectrum Disorder: A Longitudinal Study

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Abstract

Anxiety is one of the most common comorbidities in youth with autism spectrum disorder (ASD). The current study’s aims were: To examine the frequency of elevated anxiety symptoms in adolescents diagnosed with ASD in toddlerhood; To explore the impact of comorbid anxiety in adolescents on clinical presentation; To evaluate variables in toddlerhood that associate with anxiety symptom severity in adolescence. The study included 61 adolescents (mean age = 13:8y) diagnosed with ASD in toddlerhood (T1). Participants underwent a comprehensive assessment of cognitive ability, adaptive skills and autism severity at T1 and again as adolescents (T2), and an evaluation of anxiety symptoms at T2. For the first aim, the most prevalent anxiety subtypes noted in adolescence were separation (39.3%), social (27.9%) and generalized anxiety (18.0%). For the second aim, cognitive ability, autism severity and adaptive skills in adolescents with and without elevated anxiety symptoms scores of any type did not differ significantly. For the third aim, younger age at adolescence was associated with more severe separation and generalized anxiety symptoms. Higher cognitive ability and adaptive skills in toddlerhood were associated with elevated generalized anxiety symptoms in adolescence. Lower adaptive behaviors and repetitive behaviors (RRBs) correlated with elevated social anxiety symptoms. Lower cognitive abilities and more severe RRBs in toddlerhood predicted separation anxiety in adolescence. The study sheds light on early characteristics in ASD that associate with anxiety symptom severity in adolescence. The type of elevated anxiety symptoms presented in adolescence associated with the level of cognitive ability, adaptive skills and RRBs in toddlerhood.

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Acknowledgements

We would like to thank the Israeli National Association for Children with Autism (ALUT) for logistical support. To our research assistants, Tamar Matz Vaisman, Tom Shai, Naama Sabag and Analia Shefer for their extensive help throughout the project. A special thanks to the participating families, who put in a great effort to complete the evaluations.

Funding

The research was made possible by private funding given by the Jewish National Fund of Ottawa, Canada.

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Authors and Affiliations

  1. Bruckner Center for Research in Autism Spectrum Disorders, Department of Communication Disorders, Ariel University, 40700, Ariel, Israel

    Esther Ben-Itzchak

  2. Seymour Fox School of Education, The Hebrew University of Jerusalem, Mt. Scopus, 9190501, Jerusalem, Israel

    Judah Koller

  3. The Autism Center, Department of Pediatrics, Assaf Harofeh Medical Center, Sackler Faculty of Medicine, Tel Aviv University, 70300, Zerifin, Israel

    Ditza A. Zachor

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  1. Esther Ben-Itzchak
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Correspondence to Esther Ben-Itzchak.

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The research procedure was approved by the Shamir Medical Center (Assaf Harofeh)’s Helsinki committee. Parents whoagreed to participate signed a consent form as required. One of the participants who was older than 18 signed the consent form himself.

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Ben-Itzchak, E., Koller, J. & Zachor, D.A. Characterization and Prediction of Anxiety in Adolescents with Autism Spectrum Disorder: A Longitudinal Study. J Abnorm Child Psychol 48, 1239–1249 (2020). https://doi.org/10.1007/s10802-020-00673-0

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