Does Generalized Anxiety Predict Peer Relations in Youth with High Functioning Autism Spectrum Disorder?

Background: A recent systematic literature review on anxiety in ASD revealed that prevalence rates for anxiety range between 11% and 84%, with overall rates of anxiety disorder diagnosis at approximately 42% (White et al., 2009).  Simonoff et al. (2008) found generalized anxiety to be one of the most commonly diagnosed comorbid disorders (13.4%) in ASD.  Despite the high prevalence rate of generalized anxiety, there is a paucity of research examining the impact of these symptoms on social outcomes in high functioning (HF) youth with ASD.  Furthermore, depression often co-occurs with anxiety, especially in HF youth with ASD, and may also have a negative impact on peer relations.    

Objectives: The primary goal of this study was to examine the relations between parent ratings of generalized anxiety symptoms and peer relations in HF youth with ASD, including the degree to which generalized anxiety is predictive of peer relations.  Because depression is often comorbid with anxiety and may also be associated with significant social difficulties, it was included in our analyses. 

Methods: Fifty five youth with high functioning autism (i.e., IQ >85) between the ages of 7 and 18 were included.  All relevant data were collected between 2007 and 2012 from youth and parents participating in research in the Autism and Developmental Disorders Lab at Simon Fraser University in British Columbia, Canada.  Correlation analyses were used to test the relations between each of the predictor variables (generalized anxiety, depression, and social impairment) and covariates (age, IQ, and gender) with the outcome variable (peer relations).  Multiple hierarchical regression analyses were conducted to examine whether a.) level of social impairment predicted peer relations after controlling for covariates, b.) generalized anxiety symptoms predicted peer relations after controlling for covariates and social impairment, c.) depression symptoms predicted peer relations after controlling for covariates and social impairment, d.) generalized anxiety symptoms predicted peer relations after controlling for covariates, social impairment, and depression.  In this study social impairment was measured using the Social Responsiveness Scale (Constantino, 2005) and both generalized anxiety and depression symptoms were measured using the Behaviour Assessment System for Children, Second Edition (Reynolds & Kamphaus, 2004).

Results: Although generalized anxiety was related to poorer peer relations, it was not predictive of peer relations over and above age, gender, IQ, autistic social impairment, or depression symptoms.  However, IQ and depressive symptoms were strong predictors of peer relations in these youth.  Overall, 38% of the sample scored in the clinically elevated range for generalized anxiety symptoms and many of these participants (42%) had a comorbid anxiety disorder diagnosis.  In contrast, 55% of the sample fell in the clinically elevated range for depression, yet only two participants had a comorbid mood disorder diagnosis.

Conclusions: This finding highlights that depression symptoms, not generalized anxiety symptoms, are a predictor of poorer peer relations in youth with HFASD.  This finding underscores the importance of screening for depression and other mental health issues in this population.