Ideas Improving Diagnosis of Anxiety in Autism Spectrum Disorders

Background:  Children with high-functioning autism spectrum disorders (ASDs) are at high risk for developing psychiatric symptoms, with anxiety disorders among the most commonly co occurring. Cognitive behaviour therapies (CBTs) are considered the best practice for treating anxiety in the general population. Modified CBT approaches for children with high-functioning ASD and anxiety have resulted in significant reduction of anxiety following intervention. Facing your Fears (FYF) is a standardized cognitive behavioural group treatment with parental involvement with the purpose of decreasing anxiety symptoms in children with high functioning ASD.  The intervention is designed to target more specific social, separation and generalized anxiety symptoms in ASD population. The program comprises core components of CBT psychoeducation, awareness of negative thoughts, somatic management of physical symptoms of anxiety, graded exposure. Physiological data collected during exposure can inform whether the treatment enact changes in the patients'  responses to anxious situations. 

Objectives:  To detect if there is physiological change in response/or during exposure to anxiety provoking stimuli that correlate with behavioural measures in children with ASD and Anxiety. (b) To detect if the change in the physiological response that correlate with behavioural measures of anxiety are still maintained after completion of FYF intervention.

Methods: Four children with a confirmed diagnosis of ASD and Anxiety and an IQ above 80 and their parents were enrolled in the 14 weeks FYF program. Independent clinical evaluators completed behavioural (Screen for Child Anxiety Related Disorders, Anxiety Disorders Interview Schedule for DSM IV) and neurocognitive (Emotion Recognition Task, Visual Dot Probe) pre- and post intervention condition. Biological parameters, such as salivary cortisol is collected pre- and post graded exposure, whereas physiological ones such as: Heart Rate, Galvanic Skin Response, Respiration and Voice is collected during the graded exposure using BioSignalPluX equipment. Baseline values for salivary cortisol are established by collection of saliva samples 3 times per day in two consecutive days. Collection of the physiological parameters 10 minutes prior graded exposure provides the baseline values for Heart Rate, Galvanic Skin Response, Respiration Rate and Voice.  Behavioral measures of anxiety prior, during and post exposure are stated using Subjective Units of Distress (SUD).

Results:  The estimated findings of this pilot study regard the variation of the physiological parameters in response to anxiety provoking stimuli that correlate with behavioural mesures in the presence of anxiety disorders in individuals with ASD. Results will also inform whether the changes in physiological and neurocognitive measures are still maintained after 3 months of completion FYF intervention.

Conclusions:  The output of the study will consist on a comprehensive evaluation of manifestations of anxiety in children with autism and anxiety identifying specific targets and strategies for interventions. As a second output of this pilot study is to attain a greater specification in assessment of anxiety in ASD population augmenting behavioural measures with physiological measures.