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Anxiety Disorders in Children and Adolescents with Autistic Spectrum Disorders: A Meta-Analysis
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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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A dimensional perspective on the genetics of obsessive-compulsive disorder
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“This characterization includes co-occurring psychiatric conditions common in ASD, such as anxiety disorders (van Steensel et al. 2011), which may further complicate and confound investigations of ANS function.”
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“Given the common comorbidity of ASD symptoms and anxiety in youth (van Steensel et al. 2011), it is possible that hoarding symptoms may be exacerbated by the co-occurrence of symptoms.”
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Cervin, M., Perrin, S. G., Olsson, E., Claesdotter‐Knutsson, E., & Lindvall, M. L. (2020) · European Child & Adolescent Psychiatry · doi:10.1007/s00787-020-01514-7 · Cited by 35
Self-citationEffect of Stress on Neuroimmune Processes
Theoharides, T. C. (2020) · Clinical Therapeutics · doi:10.1016/j.clinthera.2020.05.002 · Cited by 36
Lake, J. K., Modica, P. T., Chan, V., & Weiss, J. A. (2020) · Autism · doi:10.1177/1362361320918754 · Cited by 38
“Email: jonweiss@yorku.ca It is well known that many individuals with autism experience comorbid mental health and behavior issues, including anxiety and depression (Kim et al., 2000; Maskey et al., 2013; Strang et al., 2012; van Steensel et al., 2011; White et al., 2009).”
BackgroundUng, D., Arnold, E. B., Nadai, A. S. D., Lewin, A. B., Phares, V., Murphy, T. K., & Storch, E. A. (2013) · Journal of Developmental and Physical Disabilities · doi:10.1007/s10882-013-9343-3 · Cited by 36
Rodgers, J., Goodwin, J., Garland, D., Grahame, V., Isard, L., Kernohan, A., Labus, M., Osborne, M. M., Parr, J. R., Rob, P., et al. (2023) · Journal of Autism and Developmental Disorders · doi:10.1007/s10803-022-05645-5 · Cited by 34
Fucà, E., Guerrera, S., Valeri, G., Casula, L., Novello, R. L., Menghini, D., & Vicari, S. (2023) · Journal of Clinical Medicine · doi:10.3390/jcm12020677 · Cited by 38
Strom, N. I., Burton, C. L., Iyegbe, C. O., Silzer, T. K., Antonyan, L., Pool, R., Lemire, M., Crowley, J. J., Hottenga, J., Ivanov, V. Z., et al. (2024) · Molecular Psychiatry · doi:10.1038/s41380-024-02489-6 · Cited by 42
Murphy, S., Chowdhury, U., White, S. W., Reynolds, L., Donald, L., Gahan, H., Iqbal, Z., Kulkarni, M., Scrivener, L., Shaker-Naeeni, H., et al. (2017) · Journal of Autism and Developmental Disorders · doi:10.1007/s10803-017-3252-8 · Cited by 34
Psychosocial interventions for internalizing disorders in youth and adults with ASD
Keefer, A. J., White, S. W., Vasa, R. A., & Reaven, J. (2018) · International Review of Psychiatry · doi:10.1080/09540261.2018.1432575 · Cited by 38
Adams, D., Simpson, K., & Keen, D. (2019) · Autism Research · doi:10.1002/aur.2246 · Cited by 34
“Rates of additional diagnoses were in line with estimates stated by reviews [e.g., Leitner, 2014; van Steensel et al., 2011].”
BackgroundResultLiu, D., Cao, H., Kural, K. C., Fang, Q., & Zhang, F. (2019) · Bioscience Reports · doi:10.1042/bsr20191942 · Cited by 34
“reported that about 40% of patients with ASD are assigned at least one comorbid diagnosis of anxiety and approximately 17% of children with ASD meet criteria for OCD [8].”
BackgroundPsychiatric Comorbidities in Children With ASD: Autism Centre Experience
Ivanović, I. (2021) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2021.673169 · Cited by 34
“8% in fixed and random effects models, respectively (18).”
BackgroundHill, C., Keville, S., & Ludlow, A. (2021) · International Journal of Developmental Disabilities · doi:10.1080/20473869.2021.1975253 · Cited by 34
“…et al., 2014); attention deficit hyperactivity disorder (ADHD)(59%; Stevens, Peng and Barnard-Brak, 2016); at least one anxiety disorder (29.6%; van Steensel et al., 2011); and gastrointestinal problems (9-91%; Mannion and Leader, 2013); including abdominal pain (2-41%), constipation (6-45%),…”
BackgroundInfluentialvan Steensel, F. J. A., Dirksen, C. D., & Bögels, S. M. (2013) · Journal of Autism and Developmental Disorders · doi:10.1007/s10803-013-1835-6 · Cited by 41
Self-citationAccommodation of Anxiety in Youth with Autism Spectrum Disorder: Results from the TAASD Study
Frank, H. E., Kagan, E. R., Storch, E. A., Wood, J. J., Kerns, C. M., Lewin, A. B., Small, B. J., & Kendall, P. C. (2022) · Journal of Clinical Child & Adolescent Psychology · doi:10.1080/15374416.2020.1759075 · Cited by 33
“Approximately 20–40% of youth with ASD also meet criteria for one or more anxiety diagnoses (Lai et al., 2019; Van Steensel et al., 2011), and the percentagemay be higher when considering distinct presentations of anxiety specific to ASD (Kerns et al., 2020).”
BackgroundFrancis, G. A., Deniz, E., Torgerson, C. J., & Toseeb, U. (2022) · Autism & Developmental Language Impairments · doi:10.1177/23969415211073118 · Cited by 47
“Approximately 40% of children and adolescents with ASD have a diagnosable anxiety disorder (van Steensel et al., 2011).”
BackgroundMazurek, M. O., Keefer, A. J., Shui, A. M., & Vasa, R. A. (2014) · Research in Autism · doi:10.1016/j.rasd.2014.07.018 · Cited by 32
Burrows, C. A., Usher, L. V., Schwartz, C. B., Mundy, P. C., & Henderson, H. A. (2015) · Journal of Autism and Developmental Disorders · doi:10.1007/s10803-015-2653-9 · Cited by 35
“Individuals with high-functioning autism (HFA) display a great deal of heterogeneity in presentation of maladaptive behavior problems, prognosis, and patterns of comorbidity, particularly as they enter adolescence (Kerns et al. 2014; van Steensel et al. 2011).”
Mental illness with intellectual disabilities and autism spectrum disorders
Bakken, T. L., Helverschou, S. B., Høidal, S. H., & Martinsen, H. (2015) · Cambridge University Press eBooks · doi:10.1017/cbo9781107588714.012 · Cited by 33
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Echevarria-Cooper, D. M., Hawkins, N. A., Misra, S. N., Huffman, A. M., Thaxton, T. T., Thompson, C. H., Ben‐Shalom, R., Nelson, A. D., Lipkin, A. M., George, A. L., et al. (2022) · Human Molecular Genetics · doi:10.1093/hmg/ddac087 · Cited by 34
“…anxiety-related behavior in Scn2aK1422E mice There is evidence to suggest that individuals with ASD are at increased risk for co-morbid anxiety (van Steensel et al., 2011; Perihan et al., 2021) and anxiety-related behavior is frequently assessed in mouse models of ASD-related genes, including…”
BackgroundKuschner, E. S., Morton, H. E., Maddox, B. B., de Marchena, A. B., Anthony, L. G., & Reaven, J. (2017) · Clinical Child and Family Psychology Review · doi:10.1007/s10567-017-0236-3 · Cited by 41
“High rates of co-occurring anxiety seen in ASD (Ung et al. 2015; van Steensel et al. 2011) increase the likelihood that children with ASD will develop food neophobia, a fear of eating new foods.”
BackgroundAkkermans, S. E. A., Rheinheimer, N., Bruchhage, M. M. K., Durston, S., Brandeis, D., Banaschewski, T., Boecker-Schlier, R., Wolf, I., Williams, S. C. R., Buitelaar, J. K., et al. (2019) · Psychological Medicine · doi:10.1017/s0033291718003136 · Cited by 33
“Between 17% and 37% of youth with ASD have been found to meet diagnostic criteria for OCD (Leyfer et al., 2006; van Steensel et al., 2011).”
Maskey, M., McConachie, H., Rodgers, J., Grahame, V., Maxwell, J., Tavernor, L., & Parr, J. R. (2019) · Research in Autism Spectrum Disorders · doi:10.1016/j.rasd.2018.11.005 · Cited by 37
Matsushima, K., Matsubayashi, J., Toichi, M., Funabiki, Y., Kato, T., Awaya, T., & Kato, T. (2016) · Research in Autism · doi:10.1016/j.rasd.2015.12.006 · Cited by 37
Pickard, K. E., Reyes, N., & Reaven, J. (2018) · Autism · doi:10.1177/1362361318795678 · Cited by 33
“Children and adolescents with autism spectrum disorder (ASD) are at high risk for developing co-occurring mental health conditions, and anxiety represents one of the most commonly co-occurring psychiatric conditions (Van Steensel et al., 2011).”
BackgroundSchiltz, H. K., McVey, A. J., Barrington, A., Haendel, A. D., Dolan, B. K., Willar, K. S., Pleiss, S. S., Karst, J. S., Vogt, E. M., Murphy, C. C., et al. (2018) · Autism Research · doi:10.1002/aur.2016 · Cited by 34
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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