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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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“In addition, forty percent of individuals with ASD are co-diagnosed with anxiety disorders [6], which include phobias, social anxiety disorder, and obsessive-compulsive disorder [7].”
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Self-citationRelationships Between Anxiety and Sleep and Feeding in Young Children with ASD
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“A more recent meta-analysis suggested 40 % of children with ASD met criteria for at least one anxiety disorder based on DSM-IV (van Steensel et al. 2011).”
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Dimensional Deconstruction and Reconstruction of CNV-Associated Neuropsychiatric Disorders
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“A uthor M anuscript A uthor M anuscript A uthor M anuscript A uthor M anuscript being one of the most common with Significant anxiety has been reported in around 50% of children and adolescents (Simonoff et al., 2008; Van Steensel et al., 2011).”
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“…covariate on that basis, in order to be conservative in the light of the previous findings regarding different levels of anxiety across the two age groups (van Steensel et al. 2011), MANOVA on ABC and CASI-GAD scores across the two age groups was conducted with WASI-II Full Scale IQ as a covariate.”
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Feelings of incompleteness explain symptoms of OCD and OCPD beyond harm avoidance
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“Without early screening, children ’ s de fi cits may go undetected, leading to signi fi cant challenges at school and placing the child at risk for behavioral and emotional dif fi culties (van Steensel et al., 2011).”
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Gu, B. (2017) · Global Drugs and Therapeutics · doi:10.15761/gdt.1000134 · Cited by 14
Uljarević, M., McCabe, K., Angkustsiri, K., Simon, T. J., & Hardan, A. Y. (2019) · Autism Research · doi:10.1002/aur.2194 · Cited by 14
Hossain, M. M., Khan, N., Sultana, A., Ma, P., McKyer, E. L. J., Ahmed, H. U., & Purohit, N. (2020) · doi:10.31124/advance.11497014 · Cited by 14
Wong, O. W. H., Lam, A. M. W., Lai, K. Y. C., Ma, S. L., Hung, S. F., Chan, S. S. M., Wong, S. H., & Leung, P. W. L. (2021) · Autism Research · doi:10.1002/aur.2555 · Cited by 13
“At disorder level, different entities of anxiety disorders are also common comorbidities in ASD (van Steensel et al., 2011).”
BackgroundVanegas, S. B., Xu, Y., Magaña, S., & Heller, T. (2022) · Journal of Developmental and Physical Disabilities · doi:10.1007/s10882-022-09864-7 · Cited by 13
“Between 40 and 70% of individuals with ASD are reported to have a co-occurring mental illness (Eaves & Ho, 2008; Nah et al., 2018; van Steensel et al., 2011).”
BackgroundConti, M. V., Breda, C., Basilico, S., Luzzi, A., Voto, L., Santero, S., de Filippo, G., & Cena, H. (2023) · Eating and Weight Disorders - Studies on Anorexia Bulimia and Obesity · doi:10.1007/s40519-023-01590-z · Cited by 26
Anxiety and Mentalizing: Uncertainty as a Driver of Egocentrism
Surtees, A. D. R., Briscoe, H., & Todd, A. R. (2024) · Current Directions in Psychological Science · doi:10.1177/09637214231217314 · Cited by 14
“Autistic children (Van Steensel et al., 2011) and adults (Lai et al., 2017) report high rates of anxiety disorders and score above their neurotypical counterparts on anxiety measures (Van Steensel & Heeman, 2017).”
BackgroundAtkinson, E., Wright, S., & Wood‐Downie, H. (2025) · Journal of Autism and Developmental Disorders · doi:10.1007/s10803-024-06668-w · Cited by 14
Autism spectrum disorders : an epidemiological and clinical study
Mattila, M. (2013) · Cited by 12
Psychological Comorbidities in Autism Spectrum Disorder
Shaltout, E., Al-Dewik, N. I. E., Samara, M. M., Morsi, H. M., & Khattab, A. (2020) · Advances in neurobiology · doi:10.1007/978-3-030-30402-7_6 · Cited by 14
Obsessive–Compulsive Disorder in Autism Spectrum Disorder Across the Lifespan
Pazuniak, M., & Pekrul, S. R. (2020) · Psychiatric Clinics of North America · doi:10.1016/j.psc.2020.08.010 · Cited by 14
Urao, Y., Ohira, I., Koshiba, T., Ishikawa, S., Sato, Y., & Shimizu, E. (2021) · Child and Adolescent Psychiatry and Mental Health · doi:10.1186/s13034-021-00374-6 · Cited by 13
“It has been reported that 40% of children with ASD experience complications of comorbid anxiety disorders [43].”
BackgroundCan stratification biomarkers address the heterogeneity of autism spectrum disorder?
Molloy, C. J., & Gallagher, L. (2021) · Irish Journal of Psychological Medicine · doi:10.1017/ipm.2021.73 · Cited by 15
“This is further complicated by changes in behaviours and symptoms throughout development and maturation, as well as the frequent presence of co-occurring conditions (van Steensel et al. 2011; van Steensel & Heeman, 2017; Zheng et al. 2018; Hollocks et al. 2019; Lai et al. 2019).”
BackgroundAdams, L., Simonoff, E. A., Tierney, K. J., Hollocks, M. J., Brewster, A., Watson, J., & Valmaggia, L. (2022) · Design for Health · doi:10.1080/24735132.2022.2062151 · Cited by 14
“SA often becomes more prominent during adolescence, affecting up to 40% of autistic young people (van Steensel, B€ogels, and Perrin 2011), which may be because this is when social communication and relationships become more complex (Bellini 2004; Kuusikko et al. 2008).”
BackgroundSensory and Social Subtypes of Japanese Individuals with Autism Spectrum Disorders
Kaneko, A., Ohshima, R., Noda, H., Matsumaru, T., Iwanaga, R., & Ide, M. (2022) · Journal of Autism and Developmental Disorders · doi:10.1007/s10803-022-05577-0 · Cited by 13
Toxic Metal -Mediated Neurodegradation: A Focus on Glutathione and GST Gene Variants.
Gasmi, A., Noor, S., Piscopo, S., & Menzel, A. (2022) · PubMed · doi:10.22092/ari.2021.356279.1816 · Cited by 15
Impact of sleep disorders on behavioral issues in preschoolers with autism spectrum disorder
Distefano, G., Calderoni, S., Apicella, F., Cosenza, A., Igliozzi, R., Palermo, G., Tancredi, R., Tritto, G., Craig, F., Muratori, F., et al. (2023) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2023.1181466 · Cited by 13
Video Game Playing Effects on Obesity in an Adolescent with Autism Spectrum Disorder: A Case Study
Strahan, B. E., & Elder, J. H. (2015) · Autism Research and Treatment · doi:10.1155/2015/128365 · Cited by 13
Park, S. M., Plachez, C., & Huang, S. (2018) · Frontiers in Behavioral Neuroscience · doi:10.3389/fnbeh.2018.00261 · Cited by 13
Thorkelson, G., Laughlin, S. F., Turner, K. S., Ober, N., & Handen, B. L. (2019) · Journal of Child and Adolescent Psychopharmacology · doi:10.1089/cap.2019.0001 · Cited by 13
“…with ASD have been found to have a comorbid anxiety disorder (de Bruin et al. 2007; Simonoff et al. 2008; White et al. 2009; Vasa et al. 2014), and a recent meta-analysis suggests that nearly 40% of children with ASD have a diagnosis of at least one anxiety disorder (van Steensel et al. 2011).”
InfluentialExplaining Variance in Social Symptoms of Children with Autism Spectrum Disorder
Alkire, D. R., Warnell, K. R., Kirby, L., Moraczewski, D., & Redcay, E. (2020) · Journal of Autism and Developmental Disorders · doi:10.1007/s10803-020-04598-x · Cited by 16
Kiselev, Y., Handal, M., Hjellvik, V., Reichborn‐Kjennerud, T., Stoltenberg, C., Surén, P., Havdahl, A., & Skurtveit, S. O. (2020) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2020.596032 · Cited by 14
Persico, A. M., Cucinotta, F., Ricciardello, A., & Turriziani, L. (2020) · Elsevier eBooks · doi:10.1016/b978-0-12-814409-1.00003-3 · Cited by 15
Kang, E., Clarkson, T., Keifer, C. M., Rosen, T. E., & Lerner, M. D. (2019) · Biological Psychology · doi:10.1016/j.biopsycho.2019.05.010 · Cited by 12
Exploring the clinical features of minimally verbal autistic children
Guerrera, S., Fucà, E., Petrolo, E., Stefano, A. D., Casula, L., Logrieco, M. G., Valeri, G., & Vicari, S. (2025) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2025.1549092 · Cited by 13
Subcortical brain volume variations in autistic individuals across the lifespan
Christensen, D., Shin, Y. S., Wang, J., Cuomo, C. R., Dentry, T., Gemmell, H. M., Pulver, S. L., Orlando, A., McKinney, W. S., Stevens, C. J., et al. (2025) · Molecular Autism · doi:10.1186/s13229-025-00673-1 · Cited by 12
Barros, F., Figueiredo, C., & Soares, S. C. (2022) · Research in Developmental Disabilities · doi:10.1016/j.ridd.2022.104361 · Cited by 13
Ferguson, E. F., Spackman, E. K., Cai, R. Y., Hardan, A. Y., & Uljarević, M. (2024) · Autism Research · doi:10.1002/aur.3207 · Cited by 12
“…ID experience less anxiety (Mayes et al., 2011; Mazurek & Kanne, 2010; Mingins et al., 2021; Sukhodolsky et al., 2008), others propose that the severity of anxiety is equal (Kerns et al., 2021; Scahill et al., 2019), or potentially higher in those with co-occurring ID (van Steensel et al., 2011).”
Chin, W., Li, H., Chao, K., & Chang, H. (2018) · Nursing and Health Sciences · doi:10.1111/nhs.12583 · Cited by 12
Ersoy, M., Charman, T., Pasco, G., Carr, E., Johnson, M. H., Jones, E. J. H., The BASIS Team, Blasi, A., Cheung, C. H. M., Davies, K., et al. (2020) · Journal of Autism and Developmental Disorders · doi:10.1007/s10803-020-04734-7 · Cited by 12
Godoy, P. B. G., Shephard, E., Milosavljevic, B., Johnson, M. H., Charman, T., The BASIS Team, Baron‐Cohen, S., Bedford, R., Bolton, P., Chandler, S., et al. (2020) · Journal of Autism and Developmental Disorders · doi:10.1007/s10803-020-04732-9 · Cited by 12
Lenart, A., & Pasternak, J. (2021) · Journal of Autism and Developmental Disorders · doi:10.1007/s10803-021-05142-1 · Cited by 15
Distinct social attention profiles in preschoolers with autism contrasted to fragile X syndrome
Wall, C. A., Shic, F., Varanasi, S., & Roberts, J. E. (2022) · Autism Research · doi:10.1002/aur.2857 · Cited by 13
“Prevalence studies vary in their findings, with 17%–37.5% of individuals with ASD meeting diagnostic criteria for social anxiety (Driscoll et al., 2020; van Steensel et al., 2011; Vasa et al., 2020).”
BackgroundInfluentialTownsend, A. N., Guzick, A. G., Hertz, A. G., Kerns, C. M., Goodman, W. K., Berry, L. N., Kendall, P. C., Wood, J. J., & Storch, E. A. (2022) · Child Psychiatry & Human Development · doi:10.1007/s10578-022-01489-3 · Cited by 12
“Total scores can range from 0 to 9, with scores categorized as mild [ 1– 3], moderate [4 –6 ], or clinically severe [ 7– 9].”
Guzick, A. G., Schneider, S. C., Garcia, A. B. P., Kook, M., Greenberg, R. L., Riddle, D., McNeel, M. M., Barajas, S. R., Yang, M. X., Upshaw, B. M., et al. (2023) · Journal of Obsessive-Compulsive and Related Disorders · doi:10.1016/j.jocrd.2023.100789 · Cited by 14
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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