Depression and Anxiety Symptoms in Children and Adolescents with Autism Spectrum Disorders without Intellectual Disability

Recent studies have shown that rates of depression and anxiety symptoms are elevated among individuals with autism spectrum disorders (ASDs) of various ages and IQs and that depression/anxiety symptoms are associated with higher IQ and fewer ASD symptoms. In this study which examined correlates of depression and anxiety symptoms in the full school-age range of children and adolescents (age 6-18) with ASDs and IQs ≥ 70 (n = 95), we also observed elevated rates of depression/anxiety symptoms, but we did not find higher IQ or fewer ASD symptoms among individuals with ASDs and depression or anxiety symptoms. These findings indicate an increased risk for depression/anxiety symptoms in children and adolescents with ASDs without intellectual disability, regardless of age, IQ, or ASD symptoms.     

Parents’ State and Trait Anxiety: Relationships with Anxiety Severity and Treatment Response in Adolescents with Autism Spectrum Disorders

Comorbid anxiety is common among children with Autism Spectrum Disorder (ASD), and parents of children with ASD are more likely to have anxiety disorders. This study investigated the relationship between parents’ state and trait anxiety and parent-reported internalizing and externalizing symptoms among adolescents (n = 30) with ASD, as well as the relationship of parents’ anxiety symptoms and adolescent treatment response in the context of a randomized controlled trial. Parental state anxiety correlated with severity of adolescent anxiety, and trait anxiety in parents correlated with parent-reported adolescent internalizing and externalizing symptoms. Also, parents of adolescent treatment responders experienced a decrease in their own trait anxiety. Findings highlight the importance of considering parental anxiety when targeting anxiety among youth with ASD.     

Discriminant and Convergent Validity of the Anxiety Construct in Children with Autism Spectrum Disorders

Despite reports of high anxiety in children with autism spectrum disorders (ASD), there is controversy regarding differential diagnosis of ASD symptoms and anxiety symptoms. This study examined 88 children, aged 7–11 years, with ASD referred for concerns about anxiety. A multitrait-(social anxiety, separation anxiety, overall anxiety severity, and overall ASD severity), multimethod-(diagnostic interviews, parent-, and child-based measures) analysis was conducted. Results from structural equation modeling suggest statistical discrimination between anxiety and ASD severity and convergence among differing reports of two of the anxiety subdomains (separation anxiety and overall anxiety). These findings suggest that anxiety symptoms experienced by children with ASD are separate from ASD symptom severity and may instead reflect anxiety syndromes (e.g., separation anxiety) similar to those that occur in typically developing children.     

Are Generalized Anxiety and Depression Symptoms Associated with Social Competence in Children with and without Autism Spectrum Disorder?

Generalized anxiety and depression symptoms may be associated with poorer social outcomes among children with Autism Spectrum Disorder (ASD) without intellectual disability. The goal of this study was to examine whether generalized anxiety and depression symptoms were associated with social competence after accounting for IQ, age, and gender in typically developing children and in children with ASD. Results indicated that for the TD group, generalized anxiety and depression accounted for 38% of the variance in social competence and for children with ASD, they accounted for 29% of the variance in social competence. However, only depression accounted for a significant amount of the variance. The findings underscore the importance of assessing the social impact of internalizing symptoms in children with ASD.     

Randomized Controlled Trial: Multimodal Anxiety and Social Skill Intervention for Adolescents with Autism Spectrum Disorder

Anxiety is common among adolescents with autism spectrum disorders (ASD) and may amplify the core social disability, thus necessitating combined treatment approaches. This pilot, randomized controlled trial evaluated the feasibility and preliminary outcomes of the Multimodal Anxiety and Social Skills Intervention (MASSI) program in a sample of 30 adolescents with ASD and anxiety symptoms of moderate or greater severity. The treatment was acceptable to families, subject adherence was high, and therapist fidelity was high. A 16 % improvement in ASD social impairment (within-group effect size = 1.18) was observed on a parent-reported scale. Although anxiety symptoms declined by 26 %, the change was not statistically significant. These findings suggest MASSI is a feasible treatment program and further evaluation is warranted.     

Age-related differences in the prevalence and correlates of anxiety in youth with autism spectrum disorders

Age-related differences in the prevalence and correlates of anxiety were cross-sectionally examined in 1316 children and adolescents with autism spectrum disorder (ASD) who presented for initial evaluation at 14 outpatient autism centers around the country and in Canada. The prevalence of clinical and subclinical anxiety as well as the correlates of anxiety were examined in three age groups of children: preschool, school age and adolescents. Findings showed that the prevalence of anxiety in each age group exceeded the prevalence of anxiety in the general population. Adolescents and school age children had the highest prevalence of clinical (40%) and subclinical anxiety (26%), respectively. Higher IQ and less ASD severity were each weakly correlated with more anxiety in preschool and school age children. Affective symptoms were strongly associated with anxiety in each age group. Age specific psychiatric comorbidities were also present. Anxiety was associated with attention deficit hyperactivity disorder (ADHD) and oppositional defiant disorder (ODD) symptoms in the preschool group, ODD and somatic symptoms in the school age children, and ADHD symptoms in adolescents. These data underscore the need for prevention and treatment of anxiety as well as research examining the characteristics of anxiety in children with ASD using a developmental framework.     

Family Report of ASD Concomitant with Depression or Anxiety Among US Children

The objective is to estimate prevalence of parent-reported depression or anxiety among children with ASD, and describe parental concerns for their children. The design is Analysis of National Survey of Children’s Health, 2003–2004. The participants are a national sample of 102,353 parents. 311,870 (544/100,000) parents of children ages 4–17 in the US reported that their child was diagnosed with autism. 125,809 also reported that their child had depression or anxiety (219/100,000). These parents report substantially higher concerns about their child’s self-esteem, academic success, and potential to be bullied. Clinicians should take into account that children with ASD may face increased risk of depression or anxiety in adolescence. Coordinated care addressing social and emotional health in addition to clinical attention is important in this population.     

Association of Reactive–Proactive Aggression and Anxiety Sensitivity with Internalizing and Externalizing Symptoms in Children with Attention-Deficit/Hyperactivity Disorder

This study evaluates the associations among the symptoms of anxiety, depression, and disruptive behavioral disorders (DBD) in the context of their relationships with reactive–proactive aggression and anxiety sensitivity in children with attention-deficit/hyperactivity disorder (ADHD). The sample consisted of 342 treatment-naive children with ADHD. The severity of ADHD and DBD symptoms were assessed via parent- and teacher-rated inventories. Anxiety sensitivity, reactive–proactive aggression and severity of anxiety and depression symptoms of children were evaluated by self-report inventories. According to structural equation modeling, depression and anxiety scores had a relation with the DBD scores through reactive–proactive aggression. Results also showed a negative relation of the total scores of anxiety sensitivity on DBD scores, while conduct disorder scores had a positive relation with anxiety scores. This study suggests that examining the relations of reactive–proactive aggression and anxiety sensitivity with internalizing and externalizing disorders could be useful for understanding the link among these disorders in ADHD.     

Anxiety in children and adolescents with Autism Spectrum Disorders

Anxiety symptoms and disorders are highly prevalent in children and adolescents with Autism Spectrum Disorder (ASD), although they are often unrecognized or misdiagnosed. The purpose of the present review is to (1) provide clinicians with practical information on assessment and diagnosis of co-morbid anxiety in children and adolescents with ASD, (2) summarize and critically examine the literature on anxiety in children and adolescents with ASD, and (3) recommend avenues for future research in this area. A review of the literature yielded several recommendations for the assessment of anxiety in youth with ASD. It was concluded that comprehensive assessments of anxiety in ASD populations should use multiple informants, multimodal assessment techniques, and standardized assessment methods that are appropriate for clinical use in ASD samples. Overall, studies suggest that youth with ASD experience greater levels of anxiety than community populations, similar levels of anxiety to clinically anxious groups, and different patterns of anxiety when compared to other clinical groups. Although existing studies are methodologically fair, their correspondence with clinical recommendations for assessment is poor. Recommendations to improve of the quality of empirical studies and directions for future research are discussed.     

Anxiety and depression in adolescents with ADHD and autism spectrum disorders; correlation between parent- and self-reports and with attention and adaptive functioning

Background: Adolescents with attention-deficit/hyperactive disorder (ADHD) or autism spectrum disorder (ASD) are at high risk of anxiety and depression. This is important to identify in the clinical assessment to understand its impact.

Aims: The aim of this study is to investigate the correlation between parent- and self-reports of anxiety and depression in adolescents with ADHD or ASD, as well as the correlation with adaptive functioning and performance on an attention test.

Method: A total of 65 adolescents with an ADHD diagnosis (n?=?24) or an ASD diagnosis (n?=?41) filled out Beck Youth Inventories of Emotional and Social Impairment (BYI) to assess depression and anxiety and completed a Continuous Performance Test (QbTest) measuring ADHD symptoms. Parents of the participants completed the internalizing domain in the Five to Fifteen questionnaire (FTF), measuring symptoms of anxiety and depression, and the Vineland Adaptive Behavior Scales (VABS) about the adolescent’s adaptive functioning.

Results: Approximately a third of the study group self-reported substantial internalizing mental symptoms not always recognized by parents, and not always obvious in adaptive function or performance at ADHD test. Correlations between BYI and FTF were low. The BYI depression inventory correlated negatively with VABS and positively with activity level in a subgroup medicated for ADHD. There was a stronger correlation between girls BYI and FTF results as compared with boys.

Conclusions: The results highlight the need for identification of anxiety and depression, using both self- and parent report. Present anxiety and depression symptoms do not seem to affect the clinical assessment of ASD and ADHD.     

Depression and anxiety in childhood epilepsy: A review

Population based studies suggest that symptoms of depression and anxiety are more frequent in children and adolescents with epilepsy compared with the general population. In terms of the manifestations of symptoms of depression and anxiety, there would appear to some symptoms unique to epilepsy in that they are associated with seizures and/or antiepileptic medications but these idiosyncratic symptoms remain under reported and have not been extensively studied. In terms of correlates of significant symptoms of depression and anxiety in children with epilepsy, some reports indicate that seizure variables (e.g., seizure frequency) and use of polytherapy are associated with increases in symptoms whereas other studies have not found this relationship. Child and family attitude/adaptation to epilepsy may also be risk factors for depression and anxiety but more research is needed in this area. The assessment of symptoms of depression and anxiety in children with epilepsy can be challenging given the possible role of seizures and AEDs, and comprehensive assessment will involve the use of screening measures, diagnostic interviews and a consideration of epilepsy specific factors. There have been few studies carried out with respect to the treatment of symptoms and depression and anxiety in children and adolescents with epilepsy. There is a significant need for a greater understanding of the nature of symptoms of depression and anxiety in children with epilepsy to inform treatment decisions. While treatment of epilepsy specific symptoms of depression and anxiety may involve an evaluation of the current epilepsy treatment protocols, there may also be a need for pharmacological and/or psychotherapeutic interventions in the treatment of symptoms of depression and anxiety which are not epilepsy specific.     

Application of the Tripartite Model to a Complicated Sample of Residential Youth with Externalizing Problems

The tripartite model of anxiety and depression has received strong support among child and adolescent populations. Clinical samples of children and adolescents in these studies, however, have usually been referred for treatment of anxiety and depression. This study investigated the fit of the tripartite model with a complicated sample of residential youths with externalizing problems. Structural Equation Modeling was used to test the tripartite model relationships between negative affect, positive affect, and mood symptoms. Multiple fit indices were used to provide a reliable and conservative evaluation of the model. As predicted, the tripartite model provided a good fit for symptoms of emotional disorders in this complicated sample of children and adolescents. Implications of these findings are discussed in terms of the utility of the tripartite model in understanding anxiety and depression in more diverse populations and recommendations for residential assessment.     

Social Media Use,Friendship Quality,and the Moderating Role of Anxiety in Adolescents with Autism Spectrum Disorder

Social media holds promise as a technology to facilitate social engagement, but may displace offline social activities. Adolescents with ASD are well suited to capitalize on the unique features of social media, which requires less decoding of complex social information. In this cross-sectional study, we assessed social media use, anxiety and friendship quality in 44 adolescents with ASD, and 56 clinical comparison controls. Social media use was significantly associated with high friendship quality in adolescents with ASD, which was moderated by the adolescents’ anxiety levels. No associations were founds between social media use, anxiety and friendship quality in the controls. Social media may be a way for adolescents with ASD without significant anxiety to improve the quality of their friendships.     

Subclinical autism spectrum symptoms in pediatric obsessive–compulsive disorder

The literature on subclinical autism spectrum (ASD) symptoms in pediatric obsessive–compulsive disorder (OCD) is scarce, and it remains unclear whether ASD symptoms are related to OCD severity. The aims of the present study were to assess the prevalence of ASD symptoms and age and sex differences in children and adolescents with OCD, and to explore the relation between ASD symptoms and OCD severity. This is the largest study of ASD symptoms in an OCD population to date, and the first directly aimed at elucidating sex and age differences in this matter. The study used baseline data from the Nordic Long-term OCD Treatment Study in which parents of 257 children and adolescents with OCD aged 7–17 completed the Autism Spectrum Screening Questionnaire. OCD severity was assessed with the Children’s Yale–Brown Obsessive Compulsive Scale. Pediatric OCD patients were found to exhibit elevated rates of ASD symptoms compared to a norm group of school-age children. ASD symptoms were concentrated in a subgroup with a prevalence of 10–17 %. This subgroup was characterized by a male preponderance with a sex ratio of approximately 2.6:1, while children versus adolescents with OCD exhibited similar rates. Autism-specific social and communication difficulties were not related to OCD severity, while restricted repetitive behavior was positively related to OCD severity. The results indicate that clinicians need to be aware of ASD symptoms in children and adolescents with OCD since one out of ten exhibits such symptoms at a clinical sub-threshold.     

Predictors of Psychiatric Symptoms in Children with an Autism Spectrum Disorder

This study examined mental health risk/protective factors for DSM-IV psychiatric symptoms in children with an autism spectrum disorder (ASD) and their contribution to functioning separate from ASD symptom severity. Mothers/teachers completed measures of risk/protection and social, adaptive, and school functioning in 6- to 12-year-olds with a diagnosed ASD (N = 238). Bivariate correlations and simultaneous regression analyses indicated a unique pattern of predictors for attention-deficit/hyperactivity disorder, aggression, anxiety, and depression symptoms. Moreover, psychiatric symptoms differentially predicted social and school performance. Findings indicate that co-occurring psychiatric symptoms and their associated mental health risk/protective factors may have important clinical implications and generally support a biopsychosocial model of psychopathology in children with an ASD that appears to share many similarities with models for nonASD children.     

Friendship interventions and measurements in children with ASD: A systematic review

BackgroundFriendships are vital to children's social well-being and overall development, and they can also serve as a protector factor from peer victimization and bullying. For children with ASD, friendship development can be an area of challenge. Friendship interventions may help children and adolescents with ASD in developing the skills for making and keeping friends.MethodThis systematic review examined friendship interventions for children and adolescents with autism spectrum disorder (ASD). It also explored measures of friendship skills in children with ASD. Twenty-seven studies met the inclusion criteria: (a) experimental intervention studies focused on improving friendships of individuals with ASD, (b) the measurement of friendship outcomes, and (c) strong or acceptable methodological ratings.ResultsFifteen unique interventions were tested across the 27 studies. Thirteen interventions included strategies specifically focused on improving (making and maintaining) friendships in the participants with ASD. Friendship interventions were primarily focused on behaviorally based social skills building and varied in implementation settings. Friendship measures included the use of parent reports, child and adolescent surveys and questionnaires, peer nominations, and sociometric ratings.ConclusionThe results highlighted the benefit of including targeted friendship-building strategies in social and friendship interventions and the value of multiple perspectives when measuring friendship. The findings of the study can influence how families and practitioners collaborate to support children and adolescents with ASD in the development and maintenance of their friendships.     

Psychiatric problems of Chinese college students with high autism traits

Recent research has documented increased psychiatric problems in individuals who report elevated traits of autism spectrum disorder (ASD). However, most of the studies are conducted in Western countries, and suicidal behaviors in particular are scarcely examined in this population. The objective of the current study was to examine the prevalence of Chinese college students who surpassed a clinical cutoff for ASD, the correlations between ASD traits and psychiatric problems (i.e., depression, anxiety, obsessive-compulsive disorder [OCD], suicidal behaviors), and factors that possibly mediated the relations between ASD traits and suicidal behaviors. Results indicated that 1.50% of individuals in the sample surpassed the clinical cutoff score for ASD. Among this group who surpassed the clinical cutoff for ASD, severity of OCD symptoms was the highest among the measured psychiatric problems. ASD traits were significantly positively correlated with depression, anxiety, suicide ideation and plans, as well as OCD and its six dimensions (i.e., ordering, washing, hoarding, checking, obsession, and neutralizing). After controlling other psychiatric indicators, however, partial correlation analysis indicated that associations between ASD traits and suicide behaviors were no longer significant. Though, depression symptoms were found to mediate the link between the ASD traits and suicide ideation (for females and males) and suicide plans (for males only). Overall, these results provide a deeper insight into the characteristics of ASD traits, as well as the relationship between ASD traits and co-occurring psychiatric symptoms in a non-Western sample of Chinese college students.     

Preliminary study of family accommodation in youth with autism spectrum disorders and anxiety: Incidence,clinical correlates,and behavioral treatment response

Anxiety symptoms are common in youth with autism spectrum disorders (ASD) and directly associated with symptom severity and functional impairment. Family accommodation occurs frequently among individuals with obsessive-compulsive and anxiety disorders; to date, no data exist on the nature and correlates of family accommodation in youth with ASD and anxiety, as well as its relationship to cognitive-behavioral therapy outcome. Forty children with ASD and a comorbid anxiety disorder participated. Clinicians administered measures of ASD and anxiety disorder caseness, anxiety symptom severity, and family accommodation; parents completed questionnaires assessing social responsiveness, internalizing and externalizing behaviors, and functional impairment. A subsample of youth (n = 24) completed a course of cognitive-behavioral therapy. Family accommodation was common and positively correlated with anxiety symptom severity, but not functional impairment, general internalizing symptoms, externalizing behavior, or social responsiveness. Family accommodation decreased following cognitive-behavioral therapy with decreases in family accommodation being associated with decreases in anxiety levels. Treatment responders reported lower family accommodation frequency and lower parent impact relative to non-responders. Clinical implications of this study in assessing and psychotherapeutically treating youth with ASD and comorbid anxiety are discussed.     

Sleep problems and their relation to cognitive factors,anxiety, and depressive symptoms in children and adolescents

Background: Existing research indicates sleep problems to be prevalent in youth with internalizing disorders. However, childhood sleep problems are common in the general population and few data are available examining unique relationships between sleep, specific types of anxiety and depressive symptoms among non‐clinical samples of children and adolescents. Methods: The presence of sleep problems was examined among a community sample of children and adolescents (N=175) in association with anxiety and depressive symptoms, age, and gender. Based on emerging findings from the adult literature we also examined associations between cognitive biases and sleep problems. Results: Overall findings revealed significant associations between sleep problems and both anxiety and depressive symptoms, though results varied by age. Depressive symptoms showed a greater association with sleep problems among adolescents, while anxiety symptoms were generally associated with sleep problems in all youth. Cognitive factors (cognitive errors and control beliefs) linked with anxiety and depression also were associated with sleep problems among adolescents, though these correlations were no longer significant after controlling for internalizing symptoms. Conclusions: Results are discussed in terms of their implications for research and treatment of sleep and internalizing disorders in youth. Depression and Anxiety, 2009. Published 2008 Wiley‐Liss, Inc.