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Relations Between Anxiety and Executive Function in Youth with ASD
Youth with ASD report more anxiety symptoms and have higher rates of anxiety than their typically developing (TD) peers. Anxiety in TD children has been associated with difficulties in executive function (EF) related to a failure to flexibly disengage from negative stimuli (Hollocks et al., 2014). Flexibility impairment, as measured in the laboratory tasks and parent report, is greater among youth with ASD when compared to TD youth. As such, youth with ASD may be particularly vulnerable to the development of negative processing styles associated with anxiety due to deficits in EF and shifting abilities.
Objectives:
To examine whether greater EF problems, particularly cognitive shifting, on parent-report and lab based tasks were related to greater parent-reported anxiety symptoms. An additional aim was to determine whether the EF profile was unique to children with ASD and high levels of anxiety
Methods:
192 youth (34 females) with a DSM diagnosis of ASD between the ages of 6 and 18 (M=10.39, SD=2.50) were evaluated on the Behavior Rating Scale of Executive Function (BRIEF) and Child Behavior Checklist (CBCL). A subsample were administered the Tower of London (ToL). Participants possessed average IQ (M=109.67, SD=16.94) and met CPEA criteria for ‘broad ASD’ on the ADI-R and/or ADOS. To examine the relationship between anxiety and EF, participants were divided into High Anxiety (n=107) and Low Anxiety (n=85) groups using a mean split on the CBCL DSM Anxiety Problems scale. T-tests examined differences in EF between groups on the BRIEF and ToL. The group was then divided using a mean split on the CBCL DSM ADHD Problems into high (n=92) and low (n=100) problem groups to confirm differentiated EF profiles between the two scales.
Results:
CBCL Anxiety Problems scores correlated significantly with BRIEF Shift (r=0.39, p< .001) and Global Executive Composite scores (GEC; r=0.35, p< .001). There were significant differences between the high and low anxiety group on age and all BRIEF scales except on inhibition scales (see Table 1). While the low anxious group was not significantly elevated on any BRIEF scales, the high anxious group demonstrated clinical elevations (e.g., T>65) on the Shift, Working Memory, Plan/Organize, and Monitor (see Figure 1). There were no significant differences between the high (n=20) and low anxiety (n=38) groups on the ToL. The most significant gap between the low/high anxiety groups was on the Shift subscale (d=0.68), while the low/high ADHD groups were the most different on the Inhibit (d=0.93) and Working Memory (d=1.48) subscale.
Conclusions:
Parent-reported anxiety was associated with behavioral manifestation of EF problems but not deficits on lab-based EF tasks. Notably, the high anxiety group had the greatest difficulty with cognitive shifting. Providing evidence that the difference between high and low anxiety groups on the BRIEF was not simply the result of parent reporting biases across measures, the profile of EF skills was different when the group was divided into high and low ADHD symptom groups. Thus, targeting EF and cognitive flexibility via intervention may reduce anxiety in youth with ASD, or vice versa.