Phenomenology of Anxiety and Fears in Clinically Anxious Children with Autism Spectrum Disorders

Background: Children with autism spectrum disorders (ASD) are at increased risk for developing anxiety disorders in childhood compared to typically developing children and to children with other developmental disabilities.

Objectives: Currently, many of the treatments that have been effectively used with children with clinical diagnoses of anxiety disorders, without a developmental disability (AD), are being applied and modified for children with ASD. However, there is a lack of research on the ways in which anxiety disorders may be similar and different in clinically anxious children with ASD compared to children with AD. It is important to make this comparison so that we can develop appropriate models for understanding the influence of the core symptoms of ASD on the development of anxiety disorders, and then further develop intervention programs that target the types of anxiety symptoms that clinically anxious children with ASD display.

Methods: Anxiety symptoms in 19 children with ASD and anxiety disorders were compared to anxiety symptoms in 18 children with AD, matched on chronological age and verbal IQ. All participants were treatment-seeking or had parental concern for anxiety, and had clinical diagnoses of generalized anxiety disorder (GAD), separation anxiety disorder (SAD), and/or social phobia based on rating scales and interviews in the present study. Children participated in the study by completing questionnaires about their fear and anxiety symptoms, and their primary caregivers participated by completing questionnaires and a semi-structured interview about their children’s anxiety symptoms, in order to assess differences in specific anxiety symptoms endorsed, severity and types of specific fears, and comorbidity with other anxiety disorders and with other emotional and behavioral difficulties.

Results: Comparisons between children with AD and children with ASD on the Screen for Child Anxiety and Related Emotional Disorders (SCARED) showed similar types of anxiety symptoms, by both parent and child report. However, there were slight developmental delays in the types of most commonly reported anxiety symptoms by child self-report. On the Behavior Assessment Scale for Children (BASC) questionnaire, parents of children with comorbid ASD reported more severe problems of Attention and Adaptive Skills, whereas parents of children with AD reported more severe problems of Somatization. Comparisons between groups were also made on overall severity of fears on the Fear Survey Schedule-Revised (FSSC-R) and indicated similar overall fear severity scores, similar severity scores on fear subscales, and a similar proportion of children in each group who endorsed clinically significant levels of fears.

Conclusions: The findings of this study support an emerging body of research suggesting that clinically anxious children with ASD exhibit similar types of anxiety symptoms and fears as children with anxiety disorders, without developmental disabilities. It is likely that their difficulties related to having the core symptoms of ASD (i.e., social difficulties, language impairments, and perseverative behaviors) do not produce anxiety symptoms that are different from those of a subset of children who have GAD, SAD, and/or Social Phobia. Measurement, treatment, and phenomenological reasons for this are discussed.