A review by Dr. Iliana Magiati draws on growing empirical literature to consider how anxiety presents in Autism Spectrum Disorder and to make recommendations for clinical practice.
Anxiety is a significant issue in individuals with Autism Spectrum Disorder (ASD) across the lifespan. Although not a core feature of ASD and not part of formal diagnostic criteria for ASD, many individuals with ASD will experience significant and impairing anxiety at some point in their lives, and little research has been done to systematically investigate the extent to which anxiety presents similarly or distinctly in ASD as compared to the general population.
To address these key issues, Dr. Iliana Magiati from the Department of Psychology in NUS, Dr. Ann Ozsivadjian from Guy’s and St. Thomas Foundation Trust in the UK, and Dr. Connor Kerns from Drexel University (USA) have recently reviewed empirical findings from a growing body of quantitative and qualitative research involving children and young adults with ASD, caregivers, and specialist school teachers.
They report that in ASD, anxiety may manifest in “traditional” (i.e., shared with individuals without ASD) physiological and behavioural ways, such as increased arousal, crying, and avoidance. Crucially, however, research has also identified specific ASD-related features of anxiety presentation, such as increased repetitive and ritualistic behaviours, and increased socially inappropriate behaviours (e.g., giggling when anxious).
This has important implications for how anxiety in ASD is conceptualized. In line with existing theoretical models proposing shared and unique processes of anxiety in ASD, this review highlights that anxiety problems in ASD should be considered from both the perspectives of co-occurring anxiety disorders with ASD (i.e., psychiatric comorbidity), as well as ASD variance where more distinct symptoms may reflect a distinct anxiety sub-type related to the individual’s core ASD challenges.
To disentangle the overlap between anxiety presentations and ASD features, the researchers propose that future studies assess and report anxiety presentations in ASD at a more specific level of detail. Evaluating the effectiveness of various approaches in treating “traditional” versus ASD-related anxiety will also likely be valuable. For example, the researchers suggest that traditional anxiety interventions focusing on cognitive behavioral approaches may be more effective for treating “traditional” anxiety, whereas more ASD-distinct anxiety presentations may be better treated by more ASD-specific adaptations in interventions and through targeting core ASD symptomatology.
Dr. Magiati (pictured above) adds:
Understanding the nature, triggers and factors implicated in the development and maintenance of anxiety in ASD is important in developing more specific ways to understand, make sense of and treat anxiety in individuals with ASD and support them in managing high stress and anxiety levels in different situations.
The researchers are currently analysing data from a large international pooled database from 14 studies and over 700 young people with ASD from the UK, USA and Singapore to explore in more detail the different presentations and symptoms of anxiety in ASD and develop a more comprehensive “map” of the ASD-specific presentations and triggers of anxiety.
Magiati, I., Ozsivadjian, A., & Kerns, C. M. (2017). Phenomenology and presentation of anxiety in autism spectrum disorder. In C. M. Kerns, P. Renno, E. A. Storch, P. C. Kendall, & J. J. Wood (Eds.), Anxiety in children and adolescents with autism spectrum disorder: Evidence-based assessment and treatment (pp. 33-54). London: Academic Press.