Cited by 1,463Autism Spectrum Disorder ResearchChild and Adolescent Psychosocial and Emotional DevelopmentChild Nutrition and Feeding Issues

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Anxiety Disorders in Children and Adolescents with Autistic Spectrum Disorders: A Meta-Analysis

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van Steensel, Francisca J. A., Bögels, Susan M., Perrin, Sean·2011·Clinical Child and Family Psychology Review

DOI 10.1007/s10567-011-0097-0PMC PMC3162631

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Abstract

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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Result

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“A meta ‐ analysis of autistic children found that 40% had at least one co ‐ occurring anxiety disorder that met diagnostic criteria (Van Steensel et al., 2011); similarly, Simonoff and colleagues (2008) found 42% of school ‐ age autistic children to have at least one anxiety disorder in a…”
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Gao, X., Yin, L., Tian, S., Huang, Y., & Ji, Q. (2024) · IEEE Sensors Journal · doi:10.1109/jsen.2024.3374762 · Cited by 32
“Such dysregulation manifests as heightened levels of stress [88] and anxiety [11], prevalent among individuals with ASD.”
Background
Repetitive Behaviors in Autism and Obsessive-Compulsive Disorder: A Systematic Review
O’Loghlen, J., McKenzie, M. L., Lang, C. P., & Paynter, J. M. (2024) · Journal of Autism and Developmental Disorders · doi:10.1007/s10803-024-06357-8 · Cited by 38
Negative Valence in Autism Spectrum Disorder: The Relationship Between Amygdala Activity, Selective Attention, and Co-occurring Anxiety
Herrington, J. D., Maddox, B. B., McVey, A. J., Franklin, M. E., Yerys, B. E., Miller, J. S., & Schultz, R. T. (2017) · Biological Psychiatry Cognitive Neuroscience and Neuroimaging · doi:10.1016/j.bpsc.2017.03.009 · Cited by 26
School-Based Mental Health Services for Students with Disabilities: Urgent Need, Systemic Barriers, and a Proposal
Skaar, N. R., Etscheidt, S. L., & Kraayenbrink, A. (2020) · Exceptionality · doi:10.1080/09362835.2020.1801437 · Cited by 26
“For example, anxiety symptoms and disorders are highly prevalent in children with ASD (Kerns & Hardan, 2017; MacNeil et al., 2009; Van Steensel et al., 2011) and require intensive therapy.”
Background
The Monash Autism-ADHD genetics and neurodevelopment (MAGNET) project design and methodologies: a dimensional approach to understanding neurobiological and genetic aetiology
Knott, R., Johnson, B. P., Tiego, J., Mellahn, O. J., Finlay, A., Kallady, K., Kouspos, M., Sindhu, V. P. M., Hawi, Z., Arnatkevičiūtė, A., et al. (2021) · Molecular Autism · doi:10.1186/s13229-021-00457-3 · Cited by 28
Criss‐crossing autism spectrum disorder and adult neurogenesis
Bicker, F., Nardi, L., Maier, J., Vasić, V., & Schmeißer, M. J. (2021) · Journal of Neurochemistry · doi:10.1111/jnc.15501 · Cited by 26
The effect of early handling on anxiety-like behaviors of rats exposed to valproic acid pre-and post-natally
Shafaghi, A., Shahrbabaki, S. S. V., Aminzadeh, A., Heidari, M. R., Meymandi, M. S., & Bashiri, H. (2021) · Neurotoxicology and Teratology · doi:10.1016/j.ntt.2021.107050 · Cited by 26
The role of anger rumination and autism spectrum disorder–linked perseveration in the experience of aggression in the general population
Pugliese, C. E., Fritz, M. S., & White, S. W. (2014) · Autism · doi:10.1177/1362361314548731 · Cited by 30
“…is hypothesized to contribute to the development of secondary social anxiety and heightened fear of negative peer evaluation (White and Roberson-Nay, 2009), and social anxiety is one of the most frequently reported problems in individuals with ASD (Kuusikko et al., 2008; Van Steensel et al., 2011).”
Background
Anxiety in Asperger’s syndrome: Assessment in real time
Hare, D. J., Wood, C. S., Wastell, S., & Skirrow, P. M. (2014) · Autism · doi:10.1177/1362361314531340 · Cited by 28
How do teachers support their students on the autism spectrum in Australian primary schools?
Clark, M., Adams, D., Roberts, J., & Westerveld, M. F. (2019) · Journal of Research in Special Educational Needs · doi:10.1111/1471-3802.12464 · Cited by 26
Impact of multiple co-occurring emotional and behavioural conditions on children with autism and their families
Dovgan, K., & Mazurek, M. O. (2019) · Journal of Applied Research in Intellectual Disabilities · doi:10.1111/jar.12590 · Cited by 24
A Retrospective Chart Review of Buspirone for the Treatment of Anxiety in Psychiatrically Referred Youth with High-Functioning Autism Spectrum Disorder
Ceranoglu, T. A., Wozniak, J., Fried, R., Galdo, M., Hoskova, B., DeLeon Fong, M., Biederman, J., & Joshi, G. (2019) · Journal of Child and Adolescent Psychopharmacology · doi:10.1089/cap.2018.0021 · Cited by 35
“…performance in HF-ASD individuals with already compromised social competence, highlighting the importance of assessment and treatment of anxiety problems in addition to interventions targeting social communication impairment in children with ASD (van Steensel et al. 2011; Duvekot et al. 2017).”
Background
Examining clinical correlates, treatment outcomes and mediators in young people with comorbid obsessive–compulsive disorder and autism spectrum disorder
Jassi, A. D., Vidal‐Ribas, P., Krebs, G., Mataix‐Cols, D., & Monzani, B. A. (2021) · European Child & Adolescent Psychiatry · doi:10.1007/s00787-021-01921-4 · Cited by 31
“A meta-analysis of data from 31 studies estimated the prevalence of OCD among youth with ASD to be over 17% [5].”
Method
Anxiety Prevalence in Youth with Autism: A Systematic Review and Meta-analysis of Methodological and Sample Moderators
Thiele-Swift, H. N., & Dorstyn, D. (2024) · Review Journal of Autism and Developmental Disorders · doi:10.1007/s40489-023-00427-w · Cited by 31
Temporal fractal analysis of the rs-BOLD signal identifies brain abnormalities in autism spectrum disorder
Dona, O., Hall, G. B., & Noseworthy, M. D. (2017) · PLoS ONE · doi:10.1371/journal.pone.0190081 · Cited by 30
Views of Teachers on Anxiety Symptoms in Students with Autism Spectrum Disorder
Syriopoulou–Delli, C. K., Polychronopoulou, S. A., Kolaitis, G. A., & Antoniou, A.-S. G. (2018) · Journal of Autism and Developmental Disorders · doi:10.1007/s10803-018-3752-1 · Cited by 31
Parent-Reported Rates and Clinical Correlates of Suicidality in Children with Autism Spectrum Disorder: A Longitudinal Study
Hunsche, M. C., Saqui, S., Mirenda, P., Zaidman‐Zait, A., Bennett, T. A., Duku, E., Elsabbagh, M., Georgiades, S., Smith, I. M., Szatmári, P., et al. (2020) · Journal of Autism and Developmental Disorders · doi:10.1007/s10803-020-04373-y · Cited by 25
Effectiveness of a modified group cognitive behavioral therapy program for anxiety in children with ASD delivered in a community context
Solish, A., Klemencic, N., Ritzema, A. M., Nolan, V., Pilkington, M., Anagnostou, E. A., & Brian, J. A. (2020) · Molecular Autism · doi:10.1186/s13229-020-00341-6 · Cited by 25
“The role of age is also unclear, with older children experiencing higher anxiety in some studies [29, 30], but not others [27, 31].”
Background
Peer Actors and Theater Techniques Play Pivotal Roles in Improving Social Play and Anxiety for Children With Autism
Ioannou, S., Key, A. P. F., Muscatello, R. A., Klemencic, M. E., & Corbett, B. A. (2020) · Frontiers in Psychology · doi:10.3389/fpsyg.2020.00908 · Cited by 29
IQ and Internalising Symptoms in Adolescents with ASD
Edirisooriya, M., Dykiert, D., & Bonnie Auyeung, B. (2020) · Journal of Autism and Developmental Disorders · doi:10.1007/s10803-020-04810-y · Cited by 26
The Impact of Anxiety on the Participation of Children on the Autism Spectrum
Ambrose, K., Simpson, K., & Adams, D. (2021) · Journal of Autism and Developmental Disorders · doi:10.1007/s10803-021-05162-x · Cited by 25
Trait Anxiety in Individuals on the Autism Spectrum: a Systematic Review
Jolliffe, R., Adams, D., & Simpson, K. (2022) · Review Journal of Autism and Developmental Disorders · doi:10.1007/s40489-022-00308-8 · Cited by 25
Autism‐friendly eyecare: Developing recommendations for service providers based on the experiences of autistic adults
Parmar, K. R., Porter, C. S., Dickinson, C., Baimbridge, P., Pelham, J. H., & Gowen, E. (2022) · Ophthalmic and Physiological Optics · doi:10.1111/opo.12975 · Cited by 25
Stress and Anxiety Among Parents of Transition-Aged Children with Autism Spectrum Disorder: a Systematic Review of Interventions and Scales
Agarwal, R., Wuyke, G. M., Sharma, U., Burke, S. L., Howard, M. M., Li, T., Sánchez, M., & Bastida, E. (2022) · Review Journal of Autism and Developmental Disorders · doi:10.1007/s40489-022-00340-8 · Cited by 32
“…children in its mindfulness intervention, despite the high rates of anxiety among transition-aged children with ASD (Kaat & Lecavalier, 2015; van Steensel et al., 2011) and the potential of mindfulness training to improve behaviors, ASD symptoms, and emotional regulation (Salem-Guirgis et…”
A Systematic Review of Longitudinal Trajectories of Mental Health Problems in Children with Neurodevelopmental Disabilities
Danielsson, H., Imms, C., Ivarsson, M., Almqvist, L., Lundqvist, L., King, G. A., Lyngbäck, L. A., Andersson, A. K., Arnell, S., Arvidsson, P., et al. (2023) · Journal of Developmental and Physical Disabilities · doi:10.1007/s10882-023-09914-8 · Cited by 25
“The most commonly studied populations were children with ADHD and ASD, represented in 12 publications each.”
Influential
Age-Related Differences in Response to Music-Evoked Emotion Among Children and Adolescents with Autism Spectrum Disorders
Stephenson, K. G., Quintin, E., & South, M. (2015) · Journal of Autism and Developmental Disorders · doi:10.1007/s10803-015-2624-1 · Cited by 26
“In addition to core clinical symptoms of ASD there are a number of associated physical and emotional symptoms, for instance frequent, severe symptoms of anxiety (van Steensel et al. 2011; Vasa et al. 2013).”
Background
Disentangling the autism−anxiety overlap: fMRI of reward processing in a community-based longitudinal study
Mikita, N., Simonoff, E. A., Pine, D. S., Goodman, R., Artiges, É., Banaschewski, T., Bokde, A. L. W., Bromberg, U., Büchel, C., Cattrell, A., et al. (2016) · Translational Psychiatry · doi:10.1038/tp.2016.107 · Cited by 30
Adults With Autism
Mazefsky, C. A., & White, S. W. (2014) · Wiley eBooks · doi:10.1002/9781118911389.hautc08 · Cited by 26
COGNITIVE BEHAVIOR THERAPY IN THE TREATMENT OF ANXIETY FOR ADOLESCENTS AND ADULTS WITH AUTISM SPECTRUM DISORDERS
Scattone, D., & Mong, M. D. (2013) · Psychology in the Schools · doi:10.1002/pits.21717 · Cited by 29
Exploring profiles of anxiety symptoms in male and female children on the autism spectrum
Ambrose, K., Adams, D., Simpson, K., & Keen, D. (2020) · Research in Autism · doi:10.1016/j.rasd.2020.101601 · Cited by 24
Coping style predicts sense of security and mediates the relationship between autistic traits and social anxiety: Moderation by a polymorphism of the FKBP5 gene
Yang, T., Liu, J., Zhang, Y., Zhang, Q., Shangguan, L., Li, Z., Luo, X., & Gong, J. (2021) · Behavioural Brain Research · doi:10.1016/j.bbr.2021.113142 · Cited by 25
Resilience in Autism and Intellectual Disability: a Systematic Review
Clark, M., & Adams, D. (2021) · Review Journal of Autism and Developmental Disorders · doi:10.1007/s40489-021-00239-w · Cited by 29
Utilizing the Child Behavior Checklist (CBCL) as an Autism Spectrum Disorder Preliminary Screener and Outcome Measure for the PEERS® Intervention for Autistic Adolescents
Arias, A. A., Rea, M., Adler, E. J., Haendel, A. D., & Hecke, A. V. V. (2021) · Journal of Autism and Developmental Disorders · doi:10.1007/s10803-021-05103-8 · Cited by 28
Repetitive transcranial magnetic stimulation (rTMS) in autism spectrum disorder: protocol for a multicentre randomised controlled clinical trial
Enticott, P. G., Barlow, K. M., Guastella, A. J., Licari, M. K., Rogasch, N. C., Middeldorp, C. M., Clark, S. R., Vallence, A., Boulton, K., Hickie, I. B., et al. (2021) · BMJ Open · doi:10.1136/bmjopen-2020-046830 · Cited by 24
Symptoms of autism spectrum disorder and anxiety: shared familial transmission and cross‐assortative mating
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Do social skills interventions positively influence mood in children and young people with autism? A systematic review
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Assessment of Anxiety in Youth With Autism Spectrum Disorder
Moskowitz, L. J., Rosen, T. E., Lerner, M. D., & Levine, K. (2017) · Elsevier eBooks · doi:10.1016/b978-0-12-805122-1.00005-3 · Cited by 24
Behavioural characterization of AnkyrinG deficient mice, a model for ANK3 related disorders
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“Increased anxiety is a comorbidity commonly seen in patients with autism spectrum disorders, with almost 40% of children and adolescents diagnosed with ASD having clinically elevated levels of anxiety or even a diagnosed anxiety disorder [32].”
Can a combination of mental health services and ADL therapies improve quality of life in families of children with autism spectrum disorder?
Fong, V. C., Gardiner, E., & Iarocci, G. (2020) · Quality of Life Research · doi:10.1007/s11136-020-02440-6 · Cited by 24
“This is extremely problematic given the high comorbidity of depression and anxiety in ASD [24, 28].”
Background
Acceptability and caregiver‐reported outcomes for young children with autism spectrum disorder whose parents attended a preventative population‐based intervention for anxiety: A pilot study
Bischof, N. L., Rapee, R. M., Hudry, K., & Bayer, J. K. (2018) · Autism Research · doi:10.1002/aur.1963 · Cited by 23
“However, the observed 1:20 case rate seems reasonable given the known comorbidity of anxiety with ASD even among pre-schoolers [van Steensel et al., 2011].”
Background
Anxiety Disorders
(2022) · American Psychiatric Association Publishing eBooks · doi:10.1176/appi.books.9780890425787.x05_anxiety_disorders · Cited by 35

Authors: van Steensel, F. J. A., Bögels, S. M., & Perrin, S.
Affiliations: University of Amsterdam (NL)
King's College London (GB)
ORCID: Bögels, Susan M.
Perrin, Sean
Venue: Clinical Child and Family Psychology Review
Publisher: Springer Science and Business Media LLC
Published: 2011-07-07
Volume: 14
Issue: 3
Pages: 302-317
ISSN: 1096-4037 (ISSN-L)
1573-2827
DOI: 10.1007/s10567-011-0097-0
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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Anxiety Disorders in Children and Adolescents with Autistic Spectrum Disorders: A Meta-Analysis

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