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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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MethodGroup therapy for anxiety in children with autism spectrum disorder
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BackgroundAdams, D., Clark, M., & Keen, D. (2019) · Autism Research · doi:10.1002/aur.2155 · Cited by 77
“Despite the growing evidence that individuals on the autism spectrum are more vulnerable to anxiety conditions [van Steensel et al., 2011; White et al., 2009] and that they may experience anxiety differently from neurotypical populations [Lecavalier et al., 2014; White et al., 2015], there has been…”
BackgroundMartin, A. F., Jassi, A. D., Cullen, A. E., Broadbent, M. T. M., Downs, J. M., & Krebs, G. (2020) · European Child & Adolescent Psychiatry · doi:10.1007/s00787-020-01478-8 · Cited by 81
Liew, S. M., Thevaraja, N., Hong, R. Y. S., & Magiati, I. (2014) · Journal of Autism and Developmental Disorders · doi:10.1007/s10803-014-2238-z · Cited by 89
“We specifically examined social anxiety, worry and obsessive–compulsive symptoms, because these have been found to be increased in those with a diagnosis of ASD (van Steensel et al. 2011).”
BackgroundCorbett, B. A., Blain, S. D., Ioannou, S., & Balser, M. (2016) · Autism · doi:10.1177/1362361316643623 · Cited by 83
“anxiety, autism spectrum disorders, competence, cortisol, stress, theatre 1Vanderbilt University, USA 2Lipscomb University, USA Corresponding author: Blythe A Corbett, Department of Psychiatry, Vanderbilt University, PMB 40, 230 Appleton Place, Nashville, TN 37203, USA.”
InfluentialThe Differential Diagnosis of Anxiety Disorders in Cognitively-Able Youth With Autism
Kerns, C. M., Rump, K., Worley, J., Kratz, H., McVey, A., Herrington, J., & Miller, J. (2016) · Cognitive and Behavioral Practice · doi:10.1016/j.cbpra.2015.11.004 · Cited by 75
Fleming, M., Salim, E. E., Mackay, D., Henderson, A., Kinnear, D., Clark, D., King, A., McLay, J. S., Cooper, S., & Pell, J. P. (2020) · PLoS Medicine · doi:10.1371/journal.pmed.1003290 · Cited by 76
Uljarević, M., Richdale, A. L., Evans, D. W., Cai, R. Y., & Leekam, S. (2017) · Molecular Autism · doi:10.1186/s13229-017-0158-4 · Cited by 89
Smith, I. C., & White, S. W. (2020) · Autism · doi:10.1177/1362361320908101 · Cited by 81
“Prior work has explored its prevalence, considerations unique to ASD with regard to assessment and treatment, and mechanisms underlying its emergence in ASD (e.g. Kerns et al., 2015; Mazefsky & White, 2014; Van Steensel et al., 2011; Wood et al., 2009).”
BackgroundResultLambert, A., Tessier, S., Rochette, A., Scherzer, P. B., Mottron, L., & Godbout, R. (2015) · Research in Autism · doi:10.1016/j.rasd.2015.11.010 · Cited by 72
Beyond the Medial Regions of Prefrontal Cortex in the Regulation of Fear and Anxiety
Shiba, Y., Santangelo, A., & Roberts, A. (2016) · Frontiers in Systems Neuroscience · doi:10.3389/fnsys.2016.00012 · Cited by 76
“…other neuropsychiatric conditions, including schizophrenia (Braga et al., 2013), obsessive compulsive disorder (Murphy et al., 2013) and autism (van Steensel et al., 2011), being also common in neurodegenerative disorders such as Parkinson’s disease (Dissanayaka et al., 2014) and Huntington’s…”
BackgroundAraujo, D. J., Toriumi, K., Escamilla, C. O., Kulkarni, A., Anderson, A. G., Harper, M., Usui, N., Ellegood, J., Lerch, J. P., Birnbaum, S. G., et al. (2017) · The Journal of Neuroscience · doi:10.1523/jneurosci.1005-17.2017 · Cited by 73
“Symptoms common between ASD and ID include hyperactivity and anxiety (van Steensel et al., 2011; Ageranioti-Bélanger et al., 2012; Leitner, 2014; de la TorreUbieta et al., 2016).”
BackgroundMagiati, I., Ong, C. W., Lim, X. Y., Tan, J. W., Ong, A. Y. L., Patrycia, F., Fung, D. S. S., Sung, M., Poon, K. K., & Howlin, P. (2015) · Autism · doi:10.1177/1362361315577519 · Cited by 81
“Although many individuals with ASD often experience multiple anxiety problems (i.e. Simonoff et al., 2008; Van Steensel et al., 2011), which would suggest that it may be useful to try to explain and treat anxiety problems transdiagnostically in ASD (i.e. see Ewing et al., 2013 for unified anxiety…”
BackgroundResultInfluentialHedley, D., Uljarević, M., Bury, S. M., & Dissanayake, C. (2019) · Autism Research · doi:10.1002/aur.2064 · Cited by 84
Meilleur, A., Foster, N. E. V., Coll, S.-M., Brambati, S. M., & Hyde, K. L. (2020) · Neuroscience & Biobehavioral Reviews · doi:10.1016/j.neubiorev.2020.06.013 · Cited by 91
Anxiety moderates the influence of ASD severity on quality of life in adults with ASD
Smith, I. C., Ollendick, T. H., & White, S. W. (2019) · Research in Autism · doi:10.1016/j.rasd.2019.03.001 · Cited by 73
Pampaloni, I., Marriott, S., Pessina, E., Fisher, C., Govender, A., Mohamed, H., Chandler, A., Tyagi, H., Morris, L., & Pallanti, S. (2022) · Comprehensive Psychiatry · doi:10.1016/j.comppsych.2022.152342 · Cited by 95
Diallo, F. B., Fombonne, É., Kisely, S., Rochette, L., Vasiliadis, H.-M., Vanasse, A., Noiseux, M., Pelletier, É., Renaud, J., St-Laurent, D., et al. (2018) · The Canadian Journal of Psychiatry · doi:10.1177/0706743717737031 · Cited by 72
Wijnhoven, L. A. M. W., Creemers, D. H. M., Engels, R. C. M. E., & Granic, I. (2015) · BMC Psychiatry · doi:10.1186/s12888-015-0522-x · Cited by 69
“More specifically, 21 % of the children with an ASD suffer from subclinical anxiety [2] and approximately 40 % of the children with an ASD meet the criteria of at least one anxiety disorder [3].”
BackgroundBrief measures of anxiety in non-treatment-seeking youth with autism spectrum disorder
Kerns, C. M., Maddox, B. B., Kendall, P. C., Rump, K. M., Berry, L. N., Schultz, R. T., Souders, M. C., Bennett, A. E., Herrington, J. D., & Miller, J. S. (2015) · Autism · doi:10.1177/1362361314558465 · Cited by 75
“Though Van Steensel et al. (2013) found the sensitivity of the SCARED-71 to be comparable in children with and without ASD, this may, in part, be attributable to their use of an entirely anxiety-disordered rather than non-treatmentseeking sample.”
BackgroundMethodInfluentialDrmic, I., Aljunied, M., & Reaven, J. (2017) · Journal of Autism and Developmental Disorders · doi:10.1007/s10803-016-3007-y · Cited by 81
Fullana, M. A., Tortella‐Feliu, M., de la Cruz, L. F., Chamorro, J., Pérez-Vigil, A., Ioannidis, J. P. A., Solanes, A., Guardiola-Ripoll, M., Almodóvar-Payá, C., Miranda‐Olivos, R., et al. (2019) · Psychological Medicine · doi:10.1017/s0033291719001247 · Cited by 80
Bitsika, V., Sharpley, C. F., Sweeney, J. A., & McFarlane, J. R. (2014) · Physiology & Behavior · doi:10.1016/j.physbeh.2013.12.011 · Cited by 72
Emotion regulation in autism: reappraisal and suppression interactions
Cai, R. Y., Richdale, A. L., Dissanayake, C., Trollor, J., & Uljarević, M. (2019) · Autism · doi:10.1177/1362361318774558 · Cited by 71
The Relationship Between Sensory Reactivity Differences and Anxiety Subtypes in Autistic Children
MacLennan, K., Roach, L. E., & Tavassoli, T. (2020) · Autism Research · doi:10.1002/aur.2259 · Cited by 86
“In line with the previous literature, our study identified a substantial proportion of the sample presented with clinically elevated levels of anxiety as reported by parents [de Bruin et al., 2007; van Steensel et al., 2011].”
ResultA Case Study of Parent–Child Interaction Therapy for the Treatment of Autism Spectrum Disorder
Agazzi, H. C., Tan, R., & Tan, S. Y. (2013) · Clinical Case Studies · doi:10.1177/1534650113500067 · Cited by 69
Factor, R. S., Condy, E. E., Farley, J. P., & Scarpa, A. (2016) · Journal of Autism and Developmental Disorders · doi:10.1007/s10803-016-2781-x · Cited by 78
“Approximately 40 % of children with ASD have a comorbid anxiety diagnosis (Kerns et al. 2015; van Steensel et al. 2011; White et al. 2014).”
BackgroundRussell, A., Scriney, A., & Smyth, S. (2022) · Review Journal of Autism and Developmental Disorders · doi:10.1007/s40489-022-00303-z · Cited by 103
Adams, D. (2021) · Journal of Autism and Developmental Disorders · doi:10.1007/s10803-021-05211-5 · Cited by 68
Cervin, M. (2022) · Psychiatric Clinics of North America · doi:10.1016/j.psc.2022.10.006 · Cited by 80
Hallett, V., Ronald, A., Rijsdijk, F. V., & Happe, F. G. E. (2011) · Research on Child and Adolescent Psychopathology · doi:10.1007/s10802-011-9596-1 · Cited by 69
“However, in addition to these diagnostic symptoms, children with ASD often experience further behavioral and emotional difficulties including heightened levels of anxiety and depression (White et al. 2009).”
Validity Study of the CBCL 6–18 for the Assessment of Emotional Problems in Youth With ASD
Pandolfi, V., Magyar, C. I., & Norris, M. (2014) · Journal of Mental Health Research in Intellectual Disabilities · doi:10.1080/19315864.2014.930547 · Cited by 73
Westwood, H., Mandy, W., Simic, M., & Tchanturia, K. (2017) · Research on Child and Adolescent Psychopathology · doi:10.1007/s10802-017-0301-x · Cited by 73
“…as it is the case that individuals with ASD are also at increased risk of developing other psychiatric disorders e.g., anxiety disorders (van Steensel et al. 2011), depression (Sterling et al. 2008) and Schizophrenia (King and Lord 2011), ASD may not specifically be associated with the…”
BackgroundThe relationship between camouflaging and mental health in autistic children and adolescents
Ross, A., Grove, R., & McAloon, J. (2022) · Autism Research · doi:10.1002/aur.2859 · Cited by 66
“Indeed, cross-lagged modeling shows that anxiety symptoms result in later and higher levels of reported autistic traits (Duvekot et al., 2018), and meta-analytic evidence demonstrates that autism is highly comorbid with both anxiety (van Steensel et al., 2011) and depression (Hudson et al., 2019).”
Backgroundvan Steensel, F. J. A., Deutschman, A., & Bögels, S. M. (2012) · Autism · doi:10.1177/1362361312455875 · Cited by 70
“ADs are found to affect 11%–84% of the children with ASD (White et al., 2009b), with a meta-analytic estimate of nearly 40% of youth with ASD reaching clinical anxiety levels (Van Steensel et al., 2011).”
BackgroundSelf-citationAbbeduto, L., Thurman, A. J., McDuffie, A. S., Klusek, J., Feigles, R. T., Brown, W. T., Harvey, D. J., Adayev, T., LaFauci, G., Dobkins, C., et al. (2018) · Journal of Autism and Developmental Disorders · doi:10.1007/s10803-018-3796-2 · Cited by 75
Family therapy for autism spectrum disorders
Spain, D., Sin, J., Paliokosta, E., Furuta, M., Prunty, J. E., Chalder, T., Murphy, D., & Happe, F. G. E. (2017) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd011894.pub2 · Cited by 66
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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