The Relationship Between Restricted Interests and Anxiety Disorder Symptoms in Children with Autism Spectrum Disorders (ASD)

Background:  A preoccupation with restricted interests (RI) is a core symptom of autism spectrum disorders (ASD) associated with further impacting the overall functioning of children with ASD. The presence of anxiety disorders and overlap in the symptomatology of RI (e.g. obsessive compulsive disorder (OCD)), suggests a possible linkage. Children engage in their RI through various forms of activities, such as fact collection or symbolic enactment through play (Klin et al., 2007). Similarly, the role that RI play in the functioning of ASD has also been speculated to be multidimensional. At this time, there is little research examining the linkage between RI and anxiety.

Objectives:  The current study examined the association between RI expression and anxiety disorder symptoms in children with ASD. The goals were to examine (a) the association between RI and anxiety symptomatology; (b) differences in anxiety symptoms based on the expression of RI; (c) the relationship between time engaged in RI and anxiety.

Methods:  Data were analyzed from children diagnosed with ASD (N = 68; 7-13 years of age; IQ > 70) and co-occuring anxiety disorders who had participated in a federally funded investigation of a treatment program for anxiety in ASD (c.f. Wood et al., 2009). Measures from the Yale Special Interest Survey (YSIS; Klin et al., 2007), the Children’s Yale-Brown Obsessive Compulsive Scale (CY-BOCS; Goodman et al., 1989), the Anxiety Disorders Interview Schedule (ADIS; Silverman and Albano, 1996), and the Multidimensional Anxiety Scale for Children–Parent Version (MASC-P; March, 1997) were analyzed. Time spent engaging in RI and categories of RI expression comprised of (a) facts/verbal memory and learning, (b) attachment to objects, and (c) symbolic enactment were coded using the YSIS.

Results:  Findings indicated that symbolic enactment of RI in the form of play, rather than information collection or time engaged in RI, was significantly linked with the increased presence and severity of anxiety symptoms. The manner in which RI were manifested was highly associated with anxiety symptoms and severity. Children who exhibited symbolic enactment of RI were more likely to demonstrate a greater number of anxiety symptoms (t (68)=2.48, p < .01), including OCD (t (68)=2.27, p<.05) and general anxiety symptoms, in addition to increased severe of primary anxiety diagnoses (t (57)=2.55, p = .05). RI expressed through facts/verbal memory and learning were unrelated to symptoms of anxiety. Time engaged in RI seemed to play only a small role in relation to anxiety symptoms, associated only with increased frequency of OCD-compulsive symptoms (r (68)=.23, p=.05).

Conclusions:  The association between symbolically enacted RI and heightened anxiety suggest that RI can be conceptualized as a way to cope with anxiety. Expression of RI that are more intense or take on specific (symbolically enacted) forms could be used as a way to manage anxiety. In the absence of more effective coping strategies, engaging in intensive RI may serve as a limited relief. Further exploration is warranted and research to develop effective alternatives for RI (e.g., coping behaviors) appears to be essential.