The Kids Know Best: Adolescent Vs. Caregiver Ratings of Anxiety and Relations to EEG Asymmetry and Respiratory Sinus Arrhythmia

Background: Measurement of anxiety in young people with ASD has often relied on caregiver or self-report checklists, but very few studies have examined the ecological validity of such approaches when compared to neurobiological or physiological measures of stress/ anxiety. Along with high social anxiety (White et al., 2009), many individuals with ASD present with right hemisphere asymmetry/dominance, and dysregulated physiological arousal (quantified as lower respiratory sinus arrhythmia, RSA), both of which may contribute to anxiety profiles in ASD (Van Hecke et al., 2009, 2013). 

Objectives: 1) how strongly are self- vs. caregiver-rated measures of anxiety related, and 2) which, if any, of the anxiety ratings are related to RSA and EEG asymmetry in adolescents with ASD?

Methods: 106 adolescents (mean/sd age= 13.5/1.5 years; 91 male; 88% Caucasian) with ASD and their caregivers were recruited. Participants had a verbal IQ > 70 (mean/sd=100/18.5) and diagnoses were confirmed with the ADOS-G. Data included (1) resting-state frontal EEG gamma asymmetry; (2) resting-state RSA; and (3) the Social Anxiety Scale- Adolescent and Caregiver forms (SAS: La Greca & Lopez, 1998).

Results: Adolescent and caregiver ratings of adolescent anxiety on all subscales and total score on the SAS were significantly related, rs (83) = .21 - .47, ps = .05 - .0001. Higher left hemisphere frontal EEG asymmetry/dominance was related to higher anxiety as rated by adolescents on the SAS-SADNEW subscale (measures fear and anxiety about unfamiliar peers), r (102) = -.20, p = .04.  Higher RSA was related to higher anxiety as rated by adolescents on the SAS-SADNEW, r (104) = .20, p = .04.

Conclusions: Although all self- and caregiver-rated measurements of social anxiety were related, only anxiety measures rated by adolescents were related to physiological and neurological measures.  Further, these relations were not in the predicted direction. Adolescents with ASD, with higher physiological regulation (RSA) and higher relative left hemisphere asymmetry, also endorsed high levels of social anxiety.  Results suggest a unique additive value of self-ratings when considering links amongst anxiety and neurophysiological measures, and a potential paradoxical effect, in that neurophysiological systems that support social approach may be linked with higher anxiety in adolescents with ASD.