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Exploring the Manifestations of Anxiety in Children with Autism Spectrum Disorders

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Abstract

This study explores the manifestation and measurement of anxiety symptoms in 415 children with ASDs on a 20-item, parent-rated, DSM-IV referenced anxiety scale. In both high and low-functioning children (IQ above vs. below 70), commonly endorsed items assessed restlessness, tension and sleep difficulties. Items requiring verbal expression of worry by the child were rarely endorsed. Higher anxiety was associated with functional language, IQ above 70 and higher scores on several other behavioral measures. Four underlying factors emerged: Generalized Anxiety, Separation Anxiety, Social Anxiety and Over-arousal. Our findings extend our understanding of anxiety across IQ in ASD and provide guidance for improving anxiety outcome measurement.

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Abbreviations

ASDs:

Autism spectrum disorders

PDD:

Pervasive developmental disorder

RUPP:

Research Units in Pediatric Psychopharmcology

STAART:

Studies to Advance Autism Research and Treatment

CYBOCS-PDD:

Children’s Yale-Brown Obsessive Compulsive Scales modified for Pervasive Developmental Disorders

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Acknowledgments

The authors acknowledge Ann Wagner, PhD and Louise Ritz, MBA at NIMH; James Robinson, MED, at NKI; Mark Davies, MPH at NY State Psychiatric Institute, Stacey Grinnon, MA at KAI Research, Inc; Deborah Hirtz MD at the National Institute of Neurological Disorders and Stroke, Bethesda, Lisa Sullivan, PhD at Boston University; Fay Robinson, MPH at DMSTAT and James Dziura, PhD, Sunkyung Yu, MS, Yanhong Deng, MPH and Allison Gavaletz, BS at Yale University. The RUPP studies were funded by the following NIMH grants and contracts: N01MH70009 and U10MH66764 (Yale); N01MH70001 and U10MH66766 (Indiana University); N01MH80011 and U10MH66768 (Ohio State University); N01MH70010 (UCLA). This publication was also supported by the Yale Clinical and Translational Science Award (CTSA) UL1RR024139, Indiana University CTSA UL1 RR025761, and Ohio State University CTSA UL1 RR025755 from the National Center for Research Resources (NCRR). The STAART citalopram study was funded by NIH via the following center contracts: Mount Sinai School of Medicine: U54-MH066673; University of North Carolina at ChapelHill: U54-MH066418; University of California at Los Angeles: U54-MH068172; Yale University: U54-MH066494. Dartmouth Medical School and Boston University: U54-MH066398; and DM-STAT, Inc, Boston: U01-HD045023.

Conflict of interest

Dr. Scahill: Roche, consultant; Pfizer, consultant; Bracket, consultatnt, BioMarin, consultant. Shire, research support; Roche, research support; Pfizer, research support. Dr. Aman: Roche, consultant; Bristol-Meyers Squibb, consultant, research grant; Forest, consultant; Pfizer, consultant; Supernus, consultant; Johnson & Johnson, research grant. Dr. Gadow: Checkmate Plus, publisher of the Child and Adolescent Symptom Invetory-4; Dr. McDougle: Bristol-Myers Squibb, research grant, speaker’s bureau. Dr. McCracken: salary from UCLA, research support from NIH, Seaside Therapeutics, Roche, and Otsuka; consultant income from Novartis, BioMarin, PharmaNet, and Noven; speaker’s honoraria from the Tourette Syndrome Association; and research study drug supply from Shire; Dr. Arnold: AstraZeneca, advisory board; Biomarin, advisory board; CureMark, research funding; Lilly, research funding; Noven, advisory board; Seaside therapeutics, advisory board; Shire, research funding. Dr. Tierney: BioMarin, consultant. Dr. Donnelly: consultant for Eli Lilly Pharmaceutical Company, Abbott Pharmaceutical Company and Shire Pharmaceuticals. He has served on the Speaker’s Bureau for Eli Lilly, and Shire. He has received research funding from Eli Lilly. Dr. Hollander reports serving as a consultant to Neuropharm. Dr. King reports serving as a consultant to Biomarin and Neuropharm and as an unpaid consultant to Forest, Nastech, and Seaside Therapeutics. He has received or has pending research grant support from Neuropharm and Seaside Therapeutics. Dr. Sikich has received support from Bristol Myers Squibb and Pfizer, participated in clinical trials sponsored by Neuropharm, Curemark, Seaside Pharmaceuticals, and recieved medications or software Janssen Pharmaceutica, Eli Lilly, Pfizer, Bristol Myers Squibb and Positscience. Dr. Hallett, Dr. Lecavalier, Dr. Sukhodolsky, Dr. Vitiello, Ms Katsovich Dr. Anagnostou, Dr. Bregman, and Dr. Dukes report no financial relationships with commercial interests.

Author information

Author notes

  1. Victoria Hallett

    Present address: Department of Psychology, Institute of Psychiatry, Kings College London, London, UK

  2. Lawrence Scahill

    Present address: Marcus Autism Center, Emory University, 1920 Briarcliff Road, Atlanta, GA, 30329-4010, USA

Authors and Affiliations

  1. Child Study Center and School of Nursing, Yale University, New Haven, CT, USA

    Victoria Hallett, Denis G. Sukhodolsky, Noreen Cipriano, Lily Katsovich & Lawrence Scahill

  2. Department of Psychology, Ohio State University, Columbus, OH, USA

    Luc Lecavalier & Michael G. Aman

  3. Division of Child and Adolescent Psychiatry, Semel Institute for Neurosciences, UCLA School of Medicine, Los Angeles, CA, USA

    James T. McCracken

  4. Lurie Center for Autism, Massachusetts General Hospital for Children and Harvard Medical School, Boston, MA, USA

    Christopher J. McDougle

  5. Department of Psychiatry, Kennedy Krieger Institute, Baltimore, MD, USA

    Elaine Tierney

  6. Department of Psychiatry, Seattle Children’s Hospital, University of Washington, Seattle, WA, USA

    Bryan H. King

  7. Montefiore Medical Center, Albert Einstein College of Medicine, New York, NY, USA

    Eric Hollander

  8. Department of Pediatrics, Bloorview Research Institute, University of Toronto, Toronto, ON, Canada

    Evdokia Anagnostou

  9. Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA

    Linmarie Sikich

  10. The Center for Autism, Philadelphia, PA, USA

    Joel Bregman

  11. Department of Psychiatry, Dartmouth Medical School, Hanover, NH, USA

    Craig Donnelly

  12. DM-STAT, Inc, Malden, MA, USA

    Kimberly Dukes

  13. Department of Biostatistics, Boston University, Boston, MA, USA

    Kimberly Dukes

  14. National Institute of Mental Health, Bethesda, MD, USA

    Benedetto Vitiello

  15. Department of Psychiatry and Behavioral Science, State University of New York at Stony Brook, Stony Brook, NY, USA

    Kenneth Gadow

Authors
  1. Victoria Hallett
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  2. Luc Lecavalier
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  3. Denis G. Sukhodolsky
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  4. Noreen Cipriano
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  5. Michael G. Aman
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  6. James T. McCracken
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  7. Christopher J. McDougle
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  8. Elaine Tierney
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  9. Bryan H. King
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  10. Eric Hollander
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  11. Linmarie Sikich
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  12. Joel Bregman
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  13. Evdokia Anagnostou
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  14. Craig Donnelly
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  15. Lily Katsovich
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  16. Kimberly Dukes
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  17. Benedetto Vitiello
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  18. Kenneth Gadow
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  19. Lawrence Scahill
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Corresponding author

Correspondence to Lawrence Scahill.

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Hallett, V., Lecavalier, L., Sukhodolsky, D.G. et al. Exploring the Manifestations of Anxiety in Children with Autism Spectrum Disorders. J Autism Dev Disord 43, 2341–2352 (2013). https://doi.org/10.1007/s10803-013-1775-1

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