How Anxious Do You Think I Am? Relationship Between State and Trait Anxiety in Children With and Without ASD During Social Tasks

Individuals with autism spectrum disorder (ASD) often exhibit increased anxiety, even in non-stressful situations. We investigate general anxiousness (anxiety trait) and responses to stressful situations (anxiety state) in 22 adolescents with ASD and 32 typically developing controls. We measured trait anxiety with standardized self- and parent-reported questionnaires. We used a Biopac system to capture state anxiety via skin conductance responses, mean heart rate and heart rate variability during high- and low-anxiety tasks. Results reveal higher trait anxiety in adolescents with ASD (p?<?0.05) and no group difference in state anxiety. Increased parent-reported trait anxiety may predict decreased state anxiety during high-stress conditions. Together, these findings suggest that higher trait anxiety may result in dampened physical responses to stress.     

The effects of a physical exercise program,LEGOR and Minecraft activities on anxiety in underserved children with autism spectrum disorder

BackgroundAnxiety is a frequent comorbidity in children with autism spectrum disorder (ASD). Physical exercise is a low cost and easy-to-access intervention with therapeutic benefits for reducing anxiety in adults and adolescents. There are currently no randomized controlled trials on the feasibility and efficacy of a physical exercise intervention to reduce anxiety in younger children with ASD.Method148 children (6–12 years old) with ASD were randomized into a clinical trial to evaluate the efficacy of an 8-week exercise protocol designed to reduce anxiety specifically in younger children with ASD. Participants were randomized to an exercise intervention group (N = 76) or sedentary activity LEGO/Minecraft group (N = 72). Both programs were administered 1–3 times weekly for 8 weeks. Anxiety was assessed via parent ratings with the Child Behavior Checklist DSM-5 anxiety subscale (CBCL DSM-5) at weeks 1, 3, 6, and 8 as well as follow up at weeks 12 and 16. Secondary outcome measures included child self-reported anxiety (Screen for Child Anxiety Related Disorders; SCARED), sleep (Child’s Sleep Habits Questionnaire, CSHQ-ATN), physical activity level (Physical Activity Questionnaire, PAQ-C), and salivary cortisol measured at weeks 1, 3, 6, and 8.ResultsParent-rated (CBCL DSM-5) and self-reported (SCARED) anxiety scores showed improvements at weeks 3, 6 and 8 in both groups with no significant differences between the physical exercise and sedentary activity (LEGO/Minecraft) groups. In addition, the CBCL DSM-5 anxiety scores decreased only in the physical exercise group at weeks 12 and 16 compared to baseline with no significant difference from LEGO/Minecraft group. Sleep also showed improvements during weeks 6 and 8 in the physical exercise group but not in the LEGO/Minecraft group with no significant differences between the groups. Physical activity level was significantly increased in the physical exercise group compared to the LEGO/Minecraft group at week 8. Salivary cortisol did not show any significant changes from weeks 1–8 or differences between groups.ConclusionEight-week physical exercise and sedentary LEGO/Minecraft interventions reduced parent-rated and self-reported anxiety in 6–12-year-old underserved children with ASD with no significant difference between the intervention groups.     

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.     

One-year course and predictors of abdominal pain in children with autism spectrum disorders: The role of anxiety and sensory over-responsivity

ObjectivesTo examine the one-year course of parent-reported abdominal pain in children with autism spectrum disorder (ASD), and to determine whether anxiety and sensory over-responsivity (SOR) contribute to the onset or remission of abdominal pain.MethodsParticipants included 225 children (ages 2–17) with ASD enrolled in the Autism Speaks Autism Treatment Network. Primary measures included the parent-reported GI Symptom Inventory Questionnaire, Child Behavior Checklist, and Short Sensory Profile.ResultsOne-fourth (25.8%) experienced chronic abdominal pain (duration ≥3 months) at baseline, persisting at one-year follow-up for 86.7%. New onset pain occurred for 23.8% of those without baseline pain. Anxiety, SOR, and chronic abdominal pain were associated at baseline. SOR significantly predicted new onset pain, but neither anxiety nor SOR were predictors of pain remission.ConclusionsAbdominal pain appears to be common and persistent among children with ASD. The relations among SOR, anxiety and abdominal pain offer information about potential underlying mechanisms.     

Restricted,Repetitive Behaviors in Autism Spectrum Disorder and Obsessive–Compulsive Disorder: A Comparative Review

This review paper critically examines literature regarding restricted and repetitive behaviors (RRBs) in Autism Spectrum Disorder (ASD) and Obsessive–Compulsive Disorder (OCD). The similar behavioral profiles of these disorders presents the potential for confusion regarding diagnoses and intervention efforts. As such, this review highlights the similarities and differences between RRBs in ASD and OCD. The developmental trajectories of RRBs are presented, followed by an exploration of three constructs implicated in RRB manifestation: anxiety, executive functioning, and sensory phenomena. While RRBs tend to develop with some similarity in both disorders, the differing role of anxiety highlights important distinctions between ASD and OCD. We urge researchers and clinicians to think critically about the dimensions that affect RRB presentation. Future research should use this review as a starting point to further elucidate the differences between RRBs in these two populations.     

Subcategories of Restricted and Repetitive Behaviors in Children with Autism Spectrum Disorders

Research suggests that restricted and repetitive behaviors (RRBs) can be subdivided into Repetitive Sensory Motor (RSM) and Insistence on Sameness (IS) behaviors. However, because the majority of previous studies have used the Autism Diagnostic Interview-Revised (ADI-R), it is not clear whether these subcategories reflect the actual organization of RRBs in ASD. Using data from the Simons Simplex Collection (n = 1,825), we examined the association between scores on the ADI-R and the Repetitive Behavior Scale-Revised. Analyses supported the construct validity of RSM and IS subcategories. As in previous studies, IS behaviors showed no relationship with IQ. These findings support the continued use of RRB subcategories, particularly IS behaviors, as a means of creating more behaviorally homogeneous subgroups of children with ASD.     

Age-Related Differences in Restricted Repetitive Behaviors in Autism Spectrum Disorders

Restricted repetitive behaviors (RRBs) were examined in a large group of children, adolescents and adults with ASD in order to describe age-related patterns of symptom change and association with specific contextual factors, and to examine if the patterns of change are different for the various types of RRBs. Over 700 individuals with ASD were rated on the Repetitive Behavior Scale-Revised. RRBs were less frequent and less severe among older than younger individuals, corroborating that autism symptoms abate with age. Our findings further suggest that repetitive behaviors are a heterogeneous group of behaviors, with the subtypes of RRBs having their own individual patterns across the lifespan, and in some cases, a differential association with age depending on intellectual functioning.     

Child-reported depression and anxiety in preadolescence: II. Preschool predictors

OBJECTIVE: To examine the predictive association of parent- and teacher-reported behaviors at age 2 to 3 years in relation to child-reported depression and anxiety at age 10 to 11 years. METHOD: Subjects were participants in a longitudinal study of 420 children aged 2 to 3 years from the general population first assessed in 1989 and again in 1991 (n = 397) and 1997 (n = 358). For the present study, 249 children were included for whom all relevant measures were obtained. These measures include the Child Behavior Checklist (CBCL) for 2- to 3-year-olds at time 1, the CBCL for 4- to 18-year-olds and the Teacher's Report Form at time 2, and the Dimensions of Depression Profile for Children and the State-Trait Anxiety Inventory for Children at time 3. RESULTS: Only 5 and 8 of 220 parent-reported preschool problem items were significantly related to later child-reported depression and anxiety, respectively, and only 3 of 120 teacher-reported problem items were related to later anxiety. Of 120 teacher-reported preschool problem items, 21 were significantly related to later depression, including items referring to early signs of depression and social and academic problems. CONCLUSIONS: Teachers, but not parents, can provide valuable information regarding preschool signals of preadolescent depression, but not anxiety. These signals include early social and academic problems.     

Receptive and Expressive Language as Predictors of Restricted and Repetitive Behaviors in Young Children with Autism Spectrum Disorders

This study examined whether language skills and nonverbal cognitive skills were associated with clinician-observed restricted and repetitive behaviors (RRBs) in a sample of 115 children with autism spectrum disorders (ASD) at ages 2 and 3. By age 3, RRBs were significantly negatively correlated with receptive and expressive language, as well as nonverbal cognitive skills. Increases in receptive and expressive language from age 2 to 3 significantly predicted decreases in RRBs, controlling for age in months, time between visits, and gains in nonverbal cognitive skills. This study contributes to the limited research that has examined early patterns and predictors of RRBs in young children with ASD.     

Psychometric properties of the Repetitive Behavior Scale-Revised for individuals with autism spectrum disorder in Japan

Restricted and repetitive behaviors (RRBs) constitute a core symptom of autism spectrum disorder (ASD). The Repetitive Behavior Scale-Revised (RBS-R) is a widely used questionnaire administered by parents or caregivers to assess RRBs in individuals with ASD. This study evaluated the psychometric properties of the RBS-R Japanese Version (RBS-R-J). The ASD and non-ASD groups comprised 274 and 36 participants, respectively. We examined corrected item-total correlation, Cronbach's alpha, and RBS-R-J scores of different diagnostic groups, as well as correlations between RBS-R-J scores and intelligence quotient (IQ), autistic symptoms, adaptive/maladaptive functioning, aberrant behaviors, and sensory processing. All items showed moderate corrected item-total correlations. Cronbach's alpha coefficient was .93. We found significant differences in the mean RBS-R-J scores of the low-functioning ASD group and the intellectual disabilities group, and of low-functioning and high-functioning ASD groups. RBS-R-J scores negatively correlated with IQ and scores on the Sensory Profile (Japanese version) and Adaptive Behavior Composite of the Maladaptive Behavior Index of the Vineland Adaptive Behavior Scales-Second Edition (VABS-II; Japanese version), but positively correlated with scores on the peak and current symptoms subscales of the Pervasive Developmental Disorders Autism Society Japan Rating Scale, the VABS-II, and the Aberrant Behavior Checklist-Community (Japanese version). From these results, we conclude that RBS-R-J showed good reliability, diagnostic validity, and convergent validity, indicating that it is a reliable, valid instrument for use among ASD individuals in clinical and research settings.     

Restricted and Repetitive Behaviors in Autism Spectrum Disorders and Typical Development: Cross-Sectional and Longitudinal Comparisons

Restricted and repetitive behaviors (RRBs) are characteristic of autism spectrum disorders (ASD). However, compared to social and communicative impairments, less is known about their development, trajectory and etiology. This study explored RRBs in young children with ASD matched to typically developing (TD) children on non-verbal development. RRBs were coded from direct observation at three time points within 13 months of development. Children with ASD displayed higher frequency and greater diversity of RRBs at all time points, however RRBs were not unique to ASD and evident in the TD control group albeit at a reduced frequency. RRBs did not correlate with social and communicative impairments in the ASD group, suggesting dissociation between these domains.     

Evidence-Based Behavioral Interventions for Repetitive Behaviors in Autism

Restricted and repetitive behaviors (RRBs) are a core symptom of autism spectrum disorders (ASD). There has been an increased research emphasis on repetitive behaviors; however, this research primarily has focused on phenomenology and mechanisms. Thus, the knowledge base on interventions is lagging behind other areas of research. The literature suggests there are evidence-based practices to treat “lower order” RRBs in ASD (e.g., stereotypies); yet, there is a lack of a focused program of intervention research for “higher order” behaviors (e.g., insistence on sameness). This paper will (a) discuss barriers to intervention development for RRBs; (b) review evidence-based interventions to treat RRBs in ASD, with a focus on higher order behaviors; and (c) conclude with recommendations for practice and research.     

State and trait anxiety in women affected by allergic and vasomotor rhinitis

It is still debatable whether anxiety and depression in patients affected by rhinitis could play a role in the genesis of the disease, whether they are a consequence of the symptoms. The aim of this study was to evaluate anxiety levels in both state and trait forms, and depression, in patients affected by allergic (AR) and vasomotor rhinitis (VMR). A total of 45 women, 24 AR and 21 VMR were compared with 64 healthy nonallergic women matched for age and sociodemographic characteristics. All subjects were administered the State and Trait Anxiety Inventory (STAI) and the Zung self-rating depression scale. The percentage of subjects with high levels of state anxiety was significantly higher in AR (p<0.005) and VMR (p<0.01) with respect to controls. The percentage of subjects with high levels of trait anxiety was significantly higher in AR (p<0.001) and VMR (p<0.05) than controls. There was no significant difference in depression between AR and VMR and controls. No significant difference was found in state anxiety, trait anxiety, or depression between AR and VMR. In conclusion, anxiety in patients with rhinitis is present both as a state and as a trait, at least when measured with the STAI.     

Comparing Autism,PDD-NOS,and Other Developmental Disabilities on Parent-Reported Behavior Problems: Little Evidence for ASD Subtype Validity

Studies on the distinction between Autistic Disorder (AD) and Pervasive Developmental Disorder Not Otherwise Specified (PDD-NOS) have been inconclusive. This study examined the validity of PDD-NOS by comparing it to AD and other developmental disorders (DD) on parent-reported behavior problems. Fifty-four children with PDD-NOS were individually matched on age and non-verbal IQ to 54 children with AD and 54 children with DD. Groups were compared on select subscales of the Child Behavior Checklist. High rates of psychopathology were observed in both ASD groups. The only difference between PDD-NOS and AD groups was higher scores in the PDD-NOS group on two items measuring Anxiety/Depression. Cognitive functioning may be a more salient variable than subtype when studying psychopathology in individuals with ASDs.     

Anxiety and Attentional Bias to Threat in Children at Increased Familial Risk for Autism Spectrum Disorder

Anxiety and threat bias were examined in 6-8-year-old children at familial-risk for Autism Spectrum Disorder (ASD) and low-risk (LR, n?=?37) controls. The high-risk (HR) group was divided into those who met diagnostic criteria for ASD (HR-ASD, n?=?15) and those who did not (HR-non ASD, n?=?24). The HR-ASD group had highest levels of parent-reported anxiety. The HR-non ASD group exhibited increased threat bias on a spatial-cueing task, while the HR-ASD group did not. Anxiety symptoms were associated with both threat bias and ASD severity. These findings suggest that the mechanisms underlying anxiety in HR siblings without ASD are similar to those in non-ASD populations. However, among children with ASD, hypersensitivity to threat may not underlie anxiety symptoms.     

Daily living skills in adolescents with autism spectrum disorder: Implications for intervention and independence

BackgroundChallenges in adaptive behaviors are present in individuals with autism spectrum disorder (ASD), while variation in IQ, social skills, and comorbidities are possible influences on adaptive behaviors. However, adaptive behaviors do not consistently map onto cognitive abilities in ASD, as high IQ is not protective against challenges in adaptive behaviors. Additionally, individuals with both ASD and elevated levels of externalizing problem behaviors experience even worse adaptive behaviors. Identifying factors that contribute to the variance in adaptive behaviors, particularly daily living skills (DLS), may inform strategies to improve adaptive behaviors necessary for independence in adulthood.MethodAdolescents with typical cognitive development (TD, n = 84), intellectual disability (ID, n = 30), or ASD (n = 45) were included in this study to examine group differences in adaptive behaviors, identify relations between IQ and DLS, and determine factors that contribute to variance in DLS at youth age 13. The Vineland Adaptive Behavior Scales, 2nd Edition (VABS-II) was used to measure adaptive behaviors.ResultsAll domains of adaptive behavior were significantly higher in TD groups compared to ASD and ID youth. Significant positive correlations were observed between IQ and DLS in the ASD and ID groups. In the ASD youth group, higher externalizing behavior problems explained the most variance in DLS.ConclusionsDLS are below age-expected levels in young adolescents with ASD, in part because of the higher externalizing behavior problems in this group. Incorporating adaptive skills training and behavior management strategies into current interventions may serve to prepare adolescents and families for the transition to adulthood.     

Respiratory Sinus Arrhythmia Predicts Restricted Repetitive Behavior Severity

In addition to social communication deficits, restricted repetitive behaviors (RRBs) are a key diagnostic feature of autism spectrum disorder (ASD). Dysfunction of the autonomic nervous system (ANS) in ASD has been posited as a mechanism of RRBs; however, most studies investigating ANS activity in ASD have focused on its relation to social functioning. This study used respiratory sinus arrhythmia (RSA) patterns to measure ANS functioning and analyze its relation to RRBs in children with and without an ASD diagnosis. Baseline RSA and RSA reactivity predicted RRB severity and exploratory analyses revealed these measures may be associated with RRB subgroups. These results are discussed in regards to the behavioral literature on RRBs and the benefits of finding biomarkers for these behaviors.     

Risk factors for postpartum depression in Japan

Abstract We conducted a longitudinal study to identify risk factors for postpartum depression. At the late phase of pregnancy, 627 pregnant women agreed to take the State-Trait Anxiety Inventory Trait (STAIT) test and to remain in the study until 4 months postpartum. At 1, 3 and 4 months postpartum, they took the Edinburgh Postnatal Depression Scale (EPDS) test and the State-Trait Anxiety Inventory State (STAIS) test. At 3 months postpartum, they were asked about socio-psychological and obstetric factors. High scores in the EPDS and STAIS tests were correlated with primiparity, premature delivery, difficult labor, experience of life events and worries about baby care. Furthermore, high scores in the STAIT test in late pregnancy were strongly correlated with high scores in the EPDS and STAIS tests in the postpartum period.     

Daily living skills in children with autism spectrum disorder and intellectual disability: A comparative study from Turkey

BackgroundBetter daily living skills (DLS) are associated with increased independence and positive functional outcomes in Autism Spectrum Disorder (ASD).MethodThe present study aimed to investigate daily living skills (DLS) and the associated factors in 51 children with ASD and intellectual disability (ASD group) and 51 age- and gender-matched controls with intellectual disability (ID group). The severity of the autistic symptoms was measured with the clinician-rated Childhood Autism Rating Scale and the parent-reported Autism Behavior Checklist (ABC) in all children. The mothers also completed the Pediatric Quality of Life Inventory and the Basic DLS Questionnaire.ResultsThe ASD group scored lower than the comparison group in the total DLS score, personal hygiene, dressing, safety and interpersonal skills, despite being comparable in the parent-reported quality of life. Regression analysis of the whole sample demonstrated that the child’s age, intellectual level, speech level, autism symptom severity and the monthly household income were independent correlates of the total DLS. Exploratory analyses for each group revealed differential effects of these variables: in the ASD group; a higher speech level and monthly income, while in the ID group; an older age, a higher intellectual level and monthly income and a lower ABC score emerged as significant predictors of higher DLS.ConclusionsDeficient DLS in Turkish children with ASD, given their IQ, suggest that lower level of adaptive skills is inherent in ASD, rather than culture-specific to US and Western Europe.     

Predictors of anxiety in early-stage Parkinson's disease – Results from the first two years of a prospective cohort study

AimAnxiety has a negative impact on daily functioning and quality of life in patients with Parkinson's disease (PD). This study aims at assessing which sociodemographic and clinical characteristics predict the course of anxiety in early PD.MethodsThe participants of this two-year prospective cohort study were recently diagnosed PD patients not receiving psychiatric medications or dopamine replacement therapy at baseline. Assessments were performed annually after baseline. The primary outcome measure was anxiety, as measured with the State-Trait Anxiety Inventory (STAI). Covariates were age, gender, family history, striatal dopamine transporter binding ratios, and severity of motor and non-motor features of PD at baseline. Data were analyzed using a mixed model analysis.ResultsInclusion criteria were met by 306 subjects. An increase in STAI total score was predicted by older age, lower score on the Montreal Cognitive Assessment, and the presence of a probable REM-sleep behavior disorder (RBD) at baseline. A decrease in STAI total score over time was predicted by a higher baseline score on the 15-item Geriatric Depression Scale, compulsive behavior at baseline and a family history of PD.ConclusionsMore severe baseline anxiety was associated with compulsive behavior and depressive symptoms. These symptoms had a parallel course, showing a decrease over time. An increase in anxiety was predicted by older age, worse cognitive functioning and the presence of RBD. Our findings, when replicated in a sample of PD patients in a more advanced disease stage, could provide starting points for prevention of anxiety in PD patients.