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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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“Van Steensel, Bögels, and Perrin (2011) reviewed 31 studies of ASD and revealed that 39.6% of children with ASD have at least one DSM-IV anxiety disorder.”
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“…examining the manifestation of anxiety in individuals with ASD, including meta-analyses that show anxiety to be more prevalent (31 studies: van Steensel et al., 2011) and more elevated (83 studies: van Steensel & Heeman, 2017) in children with ASD, especially in children with higher cognitive…”
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Autism - A Comprehensive Array of Prominent Signs and Symptoms
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“All subjects were required to (1) be between 8 and 17 years of age; (2) be in mainstream education, performing at or near grade level and have a WASI50 full scale IQ (FSIQ-IV) score greater than 80; (3) be right-handed; (4) be fluent in and have a parent fluent in English; (5) not have a history of loss of consciousne…”
BackgroundThe impact of sleep quality on quality of life for autistic adults
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“Anxiety disorders commonly co-occur with autism; data suggest between 20 and 60% of autistic children will meet diagnostic criteria for an anxiety disorder by middle childhood [2, 3].”
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“Anxiety disorders are the most prevalent mental health problem in both children (Van Steensel et al., 2011) and adults (Skokauskas and Gallagher, 2010).”
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Autism-friendly public bus transport: A personal experience–based perspective
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Elevated Level of PKMζ Underlies the Excessive Anxiety in an Autism Model
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“People with ASD are more likely to suffer from psychiatric comorbidities and mental health problems [5,6].”
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“Autistic youth are at higher risk for internalizing psychopathology (267, 268), sleep problems (269), and attention problems (270) than their neurotypical peers; co-occurring psychopathology in autistic participants could contribute to the heterogeneity of fi ndings.”
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No Teacher Left Behind: Educating Students with ASD and ADHD in the Inclusion Classroom
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“OCD is particularly common among young people with autism spectrum disorder (ASD); it is estimated that up to 37% of those with ASD also experience OCD [5, 6].”
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“Meta-analytic evidence also supports the finding that studies of younger children on the autism spectrum report higher rates of separation anxiety [van Steensel et al., 2011].”
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“Anxiety concerns in ASD persist over the life span [1] and occur across all levels of functioning [2].”
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Brief Report: Investigating the Impact of Anxious Symptomatology in Autistic Children
den Houting, J., Adams, D., Roberts, J., & Keen, D. (2020) · International Journal of Disability Development and Education · doi:10.1080/1034912x.2020.1727420 · Cited by 22
“…have suggested that anxiety is associated with poorer individual and family outcomes for autistic children (MacNeil, Lopes, & Minnes, 2009; van Steensel et al., 2011), but empirical research investigating the specific effects of anxiety on functioning and outcomes for autistic children and…”
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“These reviews covered phenomenology and prevalence of anxiety (MacNeil, Lopes, & Minnes, 2009; van Steensel et al., 2011;White, Oswald, Ollendick, & Scahill, 2009; Wigham & McConachie, 2014), assessment (Lecavalier et al., 2014; Wigham & McConachie, 2014), and treatment (Johnco & Storch, 2015;…”
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Obsessions, Compulsions, and Repetitive Behavior: Autism and/or OCD
Wu, M. S., Rudy, B. M., & Storch, E. A. (2014) · Autism and Child Psychopathology Series · doi:10.1007/978-3-319-06796-4_8 · Cited by 43
Time is of the essence: Age at autism diagnosis, sex assigned at birth, and psychopathology
Smith, J. V., McQuaid, G. A., Wallace, G. L., Neuhaus, E., Lopez, A., Ratto, A. B., Jack, A., Khuu, A., Webb, S. J., Verbalis, A. D., et al. (2024) · Autism · doi:10.1177/13623613241249878 · Cited by 19
“The present findings converge with others of preadolescent youth (Ambrose et al., 2020; Sukhodolsky et al., 2020) and may be attributable to sex-based trajectories of psychopathology that become apparent only with maturation (Gotham et al., 2015; van Steensel et al., 2011).”
Tyner, S., Brewer, A. T., Helman, M., León, Y., Pritchard, J. K., & Schlund, M. W. (2016) · Behavior Analysis in Practice · doi:10.1007/s40617-016-0113-4 · Cited by 21
Krebs, G., Murray, K., & Jassi, A. D. (2016) · Journal of Clinical Psychology · doi:10.1002/jclp.22396 · Cited by 19
Reliability and validity of the Pediatric Anxiety Rating Scale modified for autism spectrum disorder
Maddox, B. B., Lecavalier, L., Miller, J. S., Pritchett, J., Hollway, J. A., White, S. W., Gillespie, S. E., Evans, A. N., Schultz, R. T., Herrington, J. D., et al. (2020) · Autism · doi:10.1177/1362361320922682 · Cited by 21
“Based on a meta-analysis of 31 studies, approximately 40% of youth with ASD have at least one anxiety disorder (van Steensel et al., 2011).”
MethodA Cognitive Behavioral Intervention for Driving for Autistic Teens and Adults: A Pilot Study
Baker-Ericzén, M. J., Smith, L., Tran, A., & Scarvie, K. M. (2020) · Autism in Adulthood · doi:10.1089/aut.2020.0009 · Cited by 19
“14,15 Such anxiety often manifests behind the wheel.”
Dissecting Molecular Genetic Mechanisms of 1q21.1 CNV in Neuropsychiatric Disorders
Yoon, J., & Mao, Y. (2021) · International Journal of Molecular Sciences · doi:10.3390/ijms22115811 · Cited by 19
The Benefits of Pets for Human Health
Biswas, S. (2019) · Psychology and Behavioral Science International Journal · doi:10.19080/pbsij.2019.13.555862 · Cited by 19
Mammarella, I. C., Cardillo, R., & Semrud‐Clikeman, M. (2022) · Research in Developmental Disabilities · doi:10.1016/j.ridd.2022.104242 · Cited by 23
Möhrle, D., Yuen, M., Zheng, A., Haddad, F. L., Allman, B. L., & Schmid, S. (2023) · Genes Brain & Behavior · doi:10.1111/gbb.12841 · Cited by 21
Molloy, C., & Farrell, R. (2024) · Computers in the Schools · doi:10.1080/07380569.2024.2325441 · Cited by 27
“…Affective learning attention issues, deficits in executive functioning, difficulties in social communication, self-injurious behaviors, stereotypical behaviors, and heightened emotional sensitivity (Cappadocia et al., 2012), along with co-morbid anxiety disorders (Van Steensel et al., 2011).”
BackgroundLung, S. L. M., Picard, È., Soulières, I., & Bertone, A. (2024) · Research in Autism · doi:10.1016/j.rasd.2024.102458 · Cited by 27
Tsai, L. Y. (2014) · Journal of Experimental & Clinical Medicine · doi:10.1016/j.jecm.2014.10.005 · Cited by 21
Assessment of psychosis in ASD/ID: a case study
Kildahl, A. N., Bakken, T. L., Holm, O. K., & Helverschou, S. B. (2017) · Advances in Mental Health and Intellectual Disabilities · doi:10.1108/amhid-11-2016-0036 · Cited by 19
Varela, R. E., Dupont, R. T., Kamps, J. L., Weems, C. F., Niditch, L. A., Beaton, E. A., & Pucci, G. (2019) · Journal of Autism and Developmental Disorders · doi:10.1007/s10803-019-04289-2 · Cited by 19
Balint, Z. K., Raper, J., Michopoulos, V., Howell, L. H., Gunter, C., Bachevalier, J., & Sánchez, M. M. (2021) · PLoS ONE · doi:10.1371/journal.pone.0235946 · Cited by 18
Scherff, A. D., Taylor, M. J., Eley, T. C., Happe, F. G. E., Charman, T., & Ronald, A. (2013) · Research on Child and Adolescent Psychopathology · doi:10.1007/s10802-013-9796-y · Cited by 19
Gardner, L. M., Campbell, J. M., Bush, A. J., & Murphy, L. E. (2017) · Journal of Psychoeducational Assessment · doi:10.1177/0734282916689438 · Cited by 18
Coucouvanis, J., Hallas, D. M., & Farley, J. N. (2012) · Wiley eBooks · doi:10.1002/9781118704660.ch13 · Cited by 19
Ollendick, T., Muskett, A., Radtke, S. R., & Smith, I. (2021) · Journal of Autism and Developmental Disorders · doi:10.1007/s10803-020-04582-5 · Cited by 16
Wise, J. M., Cepeda, S. L., Ordaz, D. L., McBride, N. M., Cavitt, M. A., Howie, F. R., Scalli, L., Ehrenreich-May, J., Wood, J. J., Lewin, A. B., et al. (2019) · Child Psychiatry & Human Development · doi:10.1007/s10578-018-0817-5 · Cited by 18
Reduced anxiety following pivotal response treatment in young children with autism spectrum disorder
Lei, J., Sukhodolsky, D. G., Abdullahi, S. M., Braconnier, M. L., & Ventola, P. (2017) · Research in Autism Spectrum Disorders · doi:10.1016/j.rasd.2017.09.002 · Cited by 18
Ozsivadjian, A., Hollocks, M. J., Southcott, J., Absoud, M., & Holmes, E. (2017) · Journal of Autism and Developmental Disorders · doi:10.1007/s10803-016-2840-3 · Cited by 18
“In young people with ASD, prevalence studies have established that anxiety disorders occur in approximately 40 % of cases (van Steensel et al. 2011), which is significantly elevated compared to the general paediatric population rate of 2–3 % (Costello et al. 2003).”
Person‐Oriented Research Ethics to Address the Needs of Participants on the Autism Spectrum
Cascio, M. A., Weiss, J. A., & Racine, É. (2020) · Ethics & Human Research · doi:10.1002/eahr.500064 · Cited by 21
Lloyd‐Esenkaya, V., Forrest, C. L., Jordan, A. L., Russell, A., & Clair, M. S. (2021) · Autism & Developmental Language Impairments · doi:10.1177/23969415211005307 · Cited by 20
Douglas, S. N., Shi, Y. R., Das, S., & Biswas, S. K. (2021) · Focus on Autism and Other Developmental Disabilities · doi:10.1177/10883576211028223 · Cited by 18
“Children who engage more frequently with peers display higher levels of social competence (Veiga et al., 2016) and show gains in language and cognitive development (StantonChapman et al., 2010).”
BackgroundParent-Led Cognitive Behavioural Therapy for Children with Autism Spectrum Conditions. A Pilot Study
Byrne, G., Ghráda, Á. N., & O’Mahony, T. (2022) · Journal of Autism and Developmental Disorders · doi:10.1007/s10803-022-05424-2 · Cited by 22
Stroth, S., Tauscher, J., Wolff, N., Küpper, C. S., Poustka, L., Roepke, S., Roessner, V., Heider, D., & Kamp‐Becker, I. (2022) · Molecular Autism · doi:10.1186/s13229-022-00491-9 · Cited by 18
Doering, S., Halldner, L., Larsson, H., Gillberg, C., Kuja‐Halkola, R., Lichtenstein, P., & Lundström, S. (2022) · Psychiatry Research · doi:10.1016/j.psychres.2022.114556 · Cited by 25
“It is also possible that experienced distress may mediate associations between NDDs and anxiety/depression, which has been suggested for the relationship be-tween ASD and anxiety and depression, respectively (e.g., Baron et al., 2006; van Steensel et al., 2011).”
Autism Spectrum Disorder: a Review of Behavioral and Psychiatric Challenges Across the Lifespan
Genovese, A., & Ellerbeck, K. A. (2022) · SN Comprehensive Clinical Medicine · doi:10.1007/s42399-022-01302-1 · Cited by 23
Guzick, A. G., Schneider, S. C., Kendall, P. C., Wood, J. J., Kerns, C. M., Small, B. J., Park, Y. E., Cepeda, S. L., & Storch, E. A. (2022) · Journal of Consulting and Clinical Psychology · doi:10.1037/ccp0000755 · Cited by 19
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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