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Anxiety Disorders in Children and Adolescents with Autistic Spectrum Disorders: A Meta-Analysis
Open accessAbstract
There is considerable evidence that children and adolescents with autistic spectrum disorders (ASD) are at increased risk of anxiety and anxiety disorders. However, it is less clear which of the specific DSM-IV anxiety disorders occur most in this population. The present study used meta-analytic techniques to help clarify this issue. A systematic review of the literature identified 31 studies involving 2,121 young people (aged <18 years) with ASD, and where the presence of anxiety disorder was assessed using standardized questionnaires or diagnostic interviews. Across studies, 39.6% of young people with ASD had at least one comorbid DSM-IV anxiety disorder, the most frequent being specific phobia (29.8%) followed by OCD (17.4%) and social anxiety disorder (16.6%). Associations were found between the specific anxiety disorders and ASD subtype, age, IQ, and assessment method (questionnaire versus interview). Implications for the identification and treatment of anxiety in young people with ASD are discussed.
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“Specific phobia (29%), obsessive–compulsive disorder (OCD) (17.4%), and social anxiety disorder (16.6%) were the three most commonly observed anxiety disorders in ASD youth [94].”
From Pharmacological treatment in autism: a proposal for guidelines on common co-occurring psychiatric symptoms (2025) · cites this paper as [94]
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“Approximately 20% of children under 6 years and 40% of children ages 6 to 18 years with ASD have one or more anxiety disorders [45, 47].”
From DINOSAUR: an integrated cognitive-behavioral treatment for anxiety in young children with ASD (2021) · cites this paper as [45]
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“Although prevalence estimates vary across studies, the current consensus is that 40%–50% of autistic individuals meet formal criteria for a co-occurring anxiety disorder (Buck et al., 2014; Van Steensel et al., 2011)”
From Self-guided mindfulness and cognitive behavioural practices reduce anxiety in autistic adults: A pilot 8-month waitlist-controlled trial of widely available online tools. (2020) · cites this paper as Van Steensel et al., 2011
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“Like ADHD, these other diagnoses are now recognized to occur commonly in individuals with ASD, including lifetime estimates for depression as high as 25% (Leyfer et al. 2006) and anxiety as high as 35% (van Steensel et al. 2011).”
From Recent Advances in Autism Research as Reflected in DSM-5 Criteria for Autism Spectrum Disorder (2015) · cites this paper as van Steensel et al. 2011
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“According to a meta-analysis, 39.6% of youth with ASD have at least one co-occurring anxiety disorder based on the DSM-IV criteria [71, 94].”
From Pharmacological treatment in autism: a proposal for guidelines on common co-occurring psychiatric symptoms (2025) · cites this paper as [94]
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Cognitive behavioural therapy for anxiety disorders in children and adolescents
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“A recent meta-analysis suggested 40 % of young people with ASD meet criteria for an anxiety disorder (Van Steensel and Bogels 2011).”
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InfluentialComorbid Social Anxiety Disorder in Adults with Autism Spectrum Disorder
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“By contrast, specific fears, alterations in arousal, social anxiety, and separation anxiety are more common and deserve comprehensive coverage (White et al. 2009; van Steensel et al. 2011; Kerns and Kendall 2012).”
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“Several reviews have noted that studies using questionnaires tend to yield lower estimates of anxiety in ASD than those using interviews, though this again may vary based on the form of anxiety being measured (Kerns & Kendall, 2012; van Steensel et al., 2011).”
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“Anxiety is estimated to exist in 30–81% of individuals diagnosed with ASD [69], with approximately 40% of children with ASD meeting the DSM-IV criteria for an anxiety disorder [70, 71].”
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“communication, and cognitive impairment,[2] anxiety disorders are commonly comorbid[3, 4] and confer significant disability above and beyond the ASD diagnosis.”
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“Children and adolescents with ASD experience high levels of anxiety disorders with an estimate prevalence rate of 40% [28].”
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An update on anxiety in youth with autism spectrum disorders
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“Anxiety disorders and symptoms are common cooccurring conditions in youth with autism spectrum disorders (ASD) [1].”
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“…Stanton et al., 2007; Markram et al., 2008; Bambini-Junior et al., 2011; Kim et al., 2011; Zhang et al., 2012) and commonly found in the autistic spectrum (McAlonan et al., 2002; Gaigg and Bowler, 2007; Perry et al., 2007; Hofvander et al., 2009; MacNeil et al., 2009; van Steensel et al., 2011).”
BackgroundPreschool Anxiety Disorders in Pediatric Primary Care: Prevalence and Comorbidity
Franz, L., Angold, A. C., Copeland, W., Costello, E. J., Towe‐Goodman, N. R., & EGGER, H. L. (2013) · Journal of the American Academy of Child & Adolescent Psychiatry · doi:10.1016/j.jaac.2013.09.008 · Cited by 152
“is considerable evidence that children and adolescents with autism spectrum disorders are at increased risk for anxiety disorders.(31) We also acknowledge that”
van Steensel, F. J. A., Bögels, S. M., & Dirksen, C. D. (2012) · Journal of Clinical Child & Adolescent Psychology · doi:10.1080/15374416.2012.698725 · Cited by 137
“A meta-analysis estimated that anxiety disorders occur in approximately 40% of youth with ASD (van Steensel, Bogels, & Perrin, 2011 ).”
BackgroundSelf-citationPersico, A. M., Ricciardello, A., Lamberti, M., Turriziani, L., Cucinotta, F., Brogna, C., Vitiello, B., & Arango, C. (2021) · Progress in Neuro-Psychopharmacology and Biological Psychiatry · doi:10.1016/j.pnpbp.2021.110326 · Cited by 142
Mutluer, T., Genç, H. A., Morey, A. Ö., Eser, H. Y., Ertinmaz, B., CAN, M., & Münir, K. (2022) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2022.856208 · Cited by 162
Hollocks, M. J., Howlin, P., Papadopoulos, A. S., Khondoker, M. R., & Simonoff, E. A. (2014) · Psychoneuroendocrinology · doi:10.1016/j.psyneuen.2014.04.004 · Cited by 148
Al-Amin, M. M., Rahman, M., Khan, F. R., Zaman, F., & Reza, H. M. (2015) · Behavioural Brain Research · doi:10.1016/j.bbr.2015.02.041 · Cited by 135
Zheng, Z., Zhang, L., Li, S., Zhao, F., Wang, Y., Huang, L., Huang, J., Zou, R., Qu, Y., & Mu, D. (2017) · Scientific Reports · doi:10.1038/s41598-017-12003-4 · Cited by 132
Motor Skill Differences in Autism Spectrum Disorder: a Clinically Focused Review
Zampella, C., Wang, L. A. L., Haley, M., Hutchinson, A. G., & de Marchena, A. B. (2021) · Current Psychiatry Reports · doi:10.1007/s11920-021-01280-6 · Cited by 151
Oakley, B. F., Tillmann, J., Ahmad, J., Crawley, D., San José Cáceres, A., Holt, R., Charman, T., Banaschewski, T., Buitelaar, J., Simonoff, E., et al. (2021) · Autism · doi:10.1177/1362361320959959 · Cited by 133
“Indeed, there are several diagnostic challenges to identifying cooccurring mental health/neurodevelopmental symptoms, meaning some individuals never receive a formal diagnosis and therefore remain underrepresented in such research (Hollocks et al., 2019; White et al., 2009).”
BackgroundAnxiety Disorders in Adults with Autism Spectrum Disorder: A Population-Based Study
Nimmo‐Smith, V., Heuvelman, H., Dalman, C., Lundberg, M., Nordström, S. I., Carpenter, P. K., Magnusson, C., & Rai, D. (2019) · Journal of Autism and Developmental Disorders · doi:10.1007/s10803-019-04234-3 · Cited by 151
“2009; Vasa and Mazurek 2015) less is known about the prevalence of anxiety disorders in adult populations.”
Background“Am I Doing Enough?” Special Educators’ Experiences with Emergency Remote Teaching in Spring 2020
Schuck, R. K., & Lambert, R. (2020) · Education Sciences · doi:10.3390/educsci10110320 · Cited by 144
Avni, E., Ben‐Itzchak, E., & Zachor, D. A. (2018) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2018.00717 · Cited by 126
Abramovitch, A., Dar, R., Mittelman, A., & Wilhelm, S. (2015) · Harvard Review of Psychiatry · doi:10.1097/hrp.0000000000000050 · Cited by 120
Assessment and Treatment of Anxiety in Youth With Autism Spectrum Disorders
Vasa, R. A., Mazurek, M. O., Mahajan, R., Bennett, A. E., Bernal, M. P., Nozzolillo, A. A., Arnold, L. E., & Coury, D. L. (2016) · PEDIATRICS · doi:10.1542/peds.2015-2851j · Cited by 139
Cannabidiol as a suggested candidate for treatment of autism spectrum disorder
Poleg, S., Golubchik, P., Offen, D., & Weizman, A. (2018) · Progress in Neuro-Psychopharmacology and Biological Psychiatry · doi:10.1016/j.pnpbp.2018.08.030 · Cited by 124
“Many ASD patients suffer from anxiety disorders that harm their quality of life (Gu, 2017; Haan et al., 2008; Perrin, 2011).”
BackgroundHogeveen, J., & Grafman, J. H. (2021) · Handbook of clinical neurology · doi:10.1016/b978-0-12-822290-4.00004-9 · Cited by 157
Corbett, B. A., Muscatello, R. A., Klemencic, M. E., & Schwartzman, J. M. (2021) · Autism Research · doi:10.1002/aur.2521 · Cited by 137
“Children and adolescents with ASD experience significant stress in response to various social and non-social situations (e.g., Corbett et al., 2012; Corbett et al., 2010; Muscatello & Corbett, 2018), and anxiety is common (Simonoff et al., 2008; van Steensel et al., 2011; White et al., 2009).”
BackgroundRomero, M., Aguilar, J. M., Del-Rey-Mejías, Á., Mayoral, F., Rapado, M., Peciña, M., Barbancho, M. Á., Ruiz-Veguilla, M., & Lara, J. P. (2016) · International Journal of Clinical and Health Psychology · doi:10.1016/j.ijchp.2016.03.001 · Cited by 115
“Even without a clinical diagnosis, the results found that 31.7% of patients had severe problems with anxiety, congruent with the review of van Steensel, Bogels, and Perrin (2011), in which a percentage of 40% was found.”
InfluentialSaqr, Y., Braun, E., Porter, K., Barnette, D., & Hanks, C. (2018) · Autism · doi:10.1177/1362361317709970 · Cited by 114
“For example, past studies show that the prevalence of at least one anxiety disorder among patients with ASD was 39.6% (Van Steensel et al., 2011).”
BackgroundInfluentialMast cells, brain inflammation and autism
Theoharides, T. C., Stewart, J. M., Panagiotidou, S., & Melamed, I. (2016) · European Journal of Pharmacology · doi:10.1016/j.ejphar.2015.03.086 · Cited by 138
Interactive Technologies for Autism
Kientz, J. A., Goodwin, M. S., Hayes, G. R., & Abowd, G. D. (2013) · Synthesis lectures on assistive, rehabilitative, and health-preserving technologies · doi:10.2200/s00533ed1v01y201309arh004 · Cited by 122
Baribeau, D. A., Vigod, S. N., Pullenayegum, E., Kerns, C. M., Mirenda, P., Smith, I. M., Vaillancourt, T., Volden, J., Waddell, C., Zwaigenbaum, L., et al. (2019) · Journal of the American Academy of Child & Adolescent Psychiatry · doi:10.1016/j.jaac.2019.08.478 · Cited by 118
Anxiety in Youth With and Without Autism Spectrum Disorder: Examination of Factorial Equivalence
White, S. W., Lerner, M. D., McLeod, B. D., Wood, J. J., Ginsburg, G. S., Kerns, C. M., Ollendick, T. H., Kendall, P. C., Piacentini, J. C., Walkup, J. T., et al. (2014) · Behavior Therapy · doi:10.1016/j.beth.2014.05.005 · Cited by 115
Obsessive-Compulsive Disorder and Autism Spectrum Disorders: Longitudinal and Offspring Risk
Meier, S. M., Petersen, L. V., Schendel, D., Mattheisen, M., Mortensen, P. B., & Mors, O. N. (2015) · PLoS ONE · doi:10.1371/journal.pone.0141703 · Cited by 127
“A recent systematic review revealed that approximately 40% of patients with autism spectrum disorders are assigned at least one comorbid diagnosis of anxiety, the most frequent being specific phobia (30%) followed by obsessive-compulsive disorder (OCD; 17%) [7].”
BackgroundMaskey, M., Rodgers, J., Grahame, V., Glod, M., Honey, E., Kinnear, J., Labus, M., Milne, J., Minos, D., McConachie, H., et al. (2019) · Journal of Autism and Developmental Disorders · doi:10.1007/s10803-018-3861-x · Cited by 112
Roberts, J., & Webster, A. A. (2020) · International Journal of Inclusive Education · doi:10.1080/13603116.2020.1712622 · Cited by 170
“…indicates that students with autism are not obtaining the support they need and often fail to successfully participate and achieve, both in school (MacNeil, Lopes, and Minnes 2009; van Steensel, Bögels, and Perrin 2011; White et al. 2009) and postschool environments (Burgess and Cimera 2014).”
BackgroundOzsivadjian, A., Hibberd, C., & Hollocks, M. J. (2013) · Journal of Autism and Developmental Disorders · doi:10.1007/s10803-013-1937-1 · Cited by 110
“It is now well known that people with autism spectrum disorder (ASD) experience high levels of co-occurring psychiatric problems, particularly emotional disorders (Simonoff et al. 2008; Van Steensel et al. 2011).”
Trauma and Autism Spectrum Disorder: Review, Proposed Treatment Adaptations and Future Directions
Peterson, J. L., Earl, R. K., Fox, E. A., Ma, R., Haidar, G., Pepper, M., Berliner, L., Wallace, A. S., & Bernier, R. (2019) · Journal of Child & Adolescent Trauma · doi:10.1007/s40653-019-00253-5 · Cited by 133
Sharma, S., Hucker, A., Matthews, T., Grohmann, D., & Laws, K. R. (2021) · BMC Psychology · doi:10.1186/s40359-021-00658-8 · Cited by 109
“[3] reported a pooled prevalence of 39.”
Bossenbroek, R., Wols, A., Weerdmeester, J., Lichtwarck‐Aschoff, A., Granic, I., & van Rooij, M. M. J. W. (2020) · JMIR Mental Health · doi:10.2196/16066 · Cited by 121
“In addition, 27% to 32% of the Dutch heterogeneous special school population exhibits clinical levels of anxiety [2], indicated by high comorbidity rates between anxiety and ASD (40%) [3] and ADHD (25%) [4].”
BackgroundBernardin, C. J., Lewis, T., Bell, D., & Kanne, S. (2021) · Autism · doi:10.1177/1362361321997284 · Cited by 185
“For example, studies have found that autistic adolescents report higher levels of anxiety and depression than non-autistic adolescents (Keith et al., 2019; Mertens et al., 2017; Rynkiewicz & Łucka, 2015; van Steensel et al., 2011).”
BackgroundResultMcVey, A. J., Dolan, B. K., Willar, K. S., Pleiss, S. S., Karst, J. S., Casnar, C. L., Caiozzo, C. N., Vogt, E. M., Gordon, N. S., & Hecke, A. V. V. (2016) · Journal of Autism and Developmental Disorders · doi:10.1007/s10803-016-2911-5 · Cited by 119
“White and Roberson-Nay (2009) found that children and adolescents with ASD who demonstrated higher levels of loneliness also showed higher levels of anxiety, via self- and parent-report 1 3 in community and clinic-referred samples (van Steensel et al. 2011; White et al. 2009).”
Are ASD and ADHD a Continuum? A Comparison of Pathophysiological Similarities Between the Disorders
Kern, J. K., Geier, D. A., Sykes, L. K., Geier, M. R., & Deth, R. C. (2012) · Journal of Attention Disorders · doi:10.1177/1087054712459886 · Cited by 114
“Sleep disturbance is considered common in ASD (Guénolé et al., 2011), and van Steensel, Bögels, and Perrin (2011) found that, across studies, 39.6% of young people with ASD had at least one comorbid DSM-IV-TR anxiety disorder.”
BackgroundInfluentialRDoC-based categorization of amygdala functions and its implications in autism
Hennessey, T., Andari, E., & Rainnie, D. G. (2018) · Neuroscience & Biobehavioral Reviews · doi:10.1016/j.neubiorev.2018.04.007 · Cited by 107
“2), there are substantial serotonin (5-HT) inputs to the BLA from the dorsal raphe which are sensitive to the presence of stressors (Vertes, 1991).”
Cai, R. Y., Richdale, A. L., Dissanayake, C., & Uljarević, M. (2018) · Journal of Autism and Developmental Disorders · doi:10.1007/s10803-017-3318-7 · Cited by 107
Kret, M. E., & Ploeger, A. (2015) · Neuroscience & Biobehavioral Reviews · doi:10.1016/j.neubiorev.2015.02.011 · Cited by 115
May, T., Cornish, K. M., Conduit, R., Rajaratnam, S. M. W., & Rinehart, N. (2013) · Behavioral Sleep Medicine · doi:10.1080/15402002.2013.829064 · Cited by 114
“Given particularly high levels of anxiety are already present in ASD (Van Steensel et al., 2011), knowledge that a child is experiencing sleep disturbance may be an important alert for clinicians to consider anxiety interventions.”
Background
Metadata
- Authors
- van Steensel, F. J. A., Bögels, S. M., & Perrin, S.
- Affiliations
- University of Amsterdam (NL)
- King's College London (GB)
- Venue
- Clinical Child and Family Psychology Review
- Published
- 2011-07-07
- Volume
- 14
- Issue
- 3
- Pages
- 302-317
- ISSN
- 1096-4037 (ISSN-L)
- 1573-2827
- PMC
- PMC3162631
- OpenAlex
- W2138006810
- Cited by
- 1,463
- References
- 104
- Citations by year
- 2026: 147 · 2025: 105 · 2024: 94 · 2023: 109 · 2022: 134 · 2021: 137 · 2020: 138 · 2019: 112 · 2018: 107 · 2017: 94 · 2016: 83 · 2015: 70 · 2014: 59 · 2013: 52 · 2012: 21
- FWCI
- 3.53
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Licence
- cc-by-nc
- Locations
- Clinical Child and Family Psychology Review (publishedVersion, cc-by-nc)
- Europe PMC (PubMed Central) (publishedVersion, cc-by-nc)
- PubMed Central (publishedVersion, cc-by-nc)
- PubMed (publishedVersion)
- UvA-DARE (University of Amsterdam) (submittedVersion, other-oa)
- Research Portal (King's College London) (submittedVersion)
- Lund University Publications (Lund University) (submittedVersion)
- Data Archiving and Networked Services (DANS) (submittedVersion, other-oa)
- Topics
- Life Sciences › Neuroscience › Cognitive Neuroscience › Autism Spectrum Disorder Research
- Social Sciences › Psychology › Clinical Psychology › Child and Adolescent Psychosocial and Emotional Development
- Health Sciences › Medicine › Psychiatry and Mental health › Child Nutrition and Feeding Issues
- Keywords
- autism spectrum disorder, anxiety disorders, comorbidities, children and adolescents, specific phobia, obsessive-compulsive disorder, social anxiety disorder, ASD subtypes, IQ
- MeSH terms
- Adolescent, Anxiety Disorders, Child, Child Development Disorders, Pervasive, Child, Preschool, Humans, Intelligence, Obsessive-Compulsive Disorder, Phobic Disorders, Comorbidity, Prevalence, Databases, Bibliographic
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