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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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“Previous studies have estimated that approximately 40% of children and adolescents (hereinafter referred to as youth) with ASD have a coexisting anxiety disorder.(7) Having coexisting anxiety and ASD has been associated with worse health outcomes,(8) reduced quality of life,(9) and suicidal ideation(10) compared with…”
BackgroundIntraamygdaloid Oxytocin Reduces Anxiety in the Valproate-Induced Autism Rat Model
László, K., Kiss, O., Vörös, D., Mintál, K., Ollmann, T., Péczely, L., Kovács, A., Zagorácz, O., Kertes, E., Kállai, V., et al. (2022) · Biomedicines · doi:10.3390/biomedicines10020405 · Cited by 13
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BackgroundAnxiety in Autistic Youth: Understanding the Impact on Child, Caregiver, and Family Quality of Life
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InfluentialSingh, L. K., Kumar, A., Siddiqi, N. J., & Sharma, B. (2024) · Toxicology · doi:10.1016/j.tox.2024.153946 · Cited by 9
Richdale, A. L., Shui, A. M., Lampinen, L. A., & Katz, T. (2024) · Autism Research · doi:10.1002/aur.3233 · Cited by 9
“Of these conditions, anxiety and depression affect up to 40% of autistic children (van Steensel et al., 2011; Wigham et al., 2017), ADHD affects up to 70% of children (Ramtekkar, 2017), and sleep difficulties occur in up to 80% or more of children (Souders et al., 2017).”
Adams, D., Malone, S. A., Dargue, N., Keen, D., Rodgers, J., Simpson, K., Wicks, R., Bullot, A., & Rapee, R. M. (2024) · Journal of Autism and Developmental Disorders · doi:10.1007/s10803-024-06570-5 · Cited by 9
“The most frequently reported mental health diagnosis amongst autistic people is anxiety, with meta-analyses suggesting that approximately 40% of autistic youth will have a clinical diagnosis of an anxiety disorder (van Steensel et al., 2011 ).”
Farrag, E. A. E., Askar, M. H., Abdallah, Z., Mahmoud, S. M., Abdulhai, E. A., Abdel-Razik, E. A., Nashar, E. M. E., Alasiri, F. M., Alqahtani, A. N. S., Eldesoqui, M. B., et al. (2024) · Behavioral and Brain Functions · doi:10.1186/s12993-024-00250-1 · Cited by 10
“Decreased sociability, anxiety, and hyperactivity in rats matched with autism patients [34, 35].”
BackgroundAutism spectrum disorder, social anxiety and obsessive–compulsive disorders: beyond the comorbidity
Dell’Osso, L., Amatori, G., Bonelli, C., Nardi, B., Massimetti, E., Cremone, I. M., Pini, S., & Carpita, B. (2025) · BMC Psychiatry · doi:10.1186/s12888-024-06340-8 · Cited by 12
“Anxiety disorders are prevalent comorbidities in children and adolescents with Autism Spectrum Disorder (ASD) [7].”
InfluentialMcBride, N. M., Weinzimmer, S. A., Buissonnière-Ariza, V. L., Schneider, S. C., Ehrenreich, J. T., Lewin, A. B., Mcguire, J. F., Goodman, W. K., Wood, J. J., & Storch, E. A. (2020) · Child Psychiatry & Human Development · doi:10.1007/s10578-020-00961-2 · Cited by 10
Suicide and Autism: A Lifespan Perspective
Hedley, D., Hayward, S. M., Clarke, A., Uljarević, M., & Stokes, M. A. (2022) · Springer eBooks · doi:10.1007/978-3-030-98697-1_3 · Cited by 9
Wu, M., Joubran, E., Kumar, D., Assadi, N., & Nguyen, H. (2023) · Cureus · doi:10.7759/cureus.41759 · Cited by 9
Forbes, E. J., Morison, L. D., Lelik, F., Howell, T., Debono, S., Goel, H., Burger, P., Mandel, J., Geneviève, D., Amor, D. J., et al. (2024) · American Journal of Medical Genetics Part B Neuropsychiatric Genetics · doi:10.1002/ajmg.b.32971 · Cited by 10
Co-occurring Psychiatric Disorders in Individuals with Intellectual Disability
Ricciardi, J. N. (2013) · Issues in clinical child psychology · doi:10.1007/978-1-4614-6531-7_13 · Cited by 9
Flood, W. A., & Luiselli, J. K. (2016) · Clinical Case Studies · doi:10.1177/1534650116670512 · Cited by 9
Burke, M.-K., Prendeville, P., & Veale, A. (2017) · Educational Psychology in Practice · doi:10.1080/02667363.2017.1367648 · Cited by 9
Taylor, J. M., Volker, M. A., Rispoli, K. M., Rodgers, J. D., Thomeer, M. L., Lopata, C. J., Chow, S. Y., Toomey, J. A., & Smerbeck, A. (2018) · Journal of Autism and Developmental Disorders · doi:10.1007/s10803-018-3779-3 · Cited by 11
Overlaps in brain dynamic functional connectivity between schizophrenia and autism spectrum disorder
Andriamananjara, A., Muntari, R., & Crimi, A. (2018) · Scientific African · doi:10.1016/j.sciaf.2018.e00019 · Cited by 9
Howells, K., Sivaratnam, C. S., May, T., Lindor, E., & Rinehart, N. (2019) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph16245058 · Cited by 9
Gastrointestinal Problems in Chinese Children with Autism Spectrum Disorder
Lai, K. Y. C., Leung, P. W. L., Hung, S. F., Shea, C. K., Mo, F. Y. M., Che, K. K. I., Tse, C., Lau, F. L. F., Ma, S. L., Wu, J. C., et al. (2020) · Neuropsychiatric Disease and Treatment · doi:10.2147/ndt.s260654 · Cited by 9
Iakovidou, N. D., Lanzarini, E., Singh, J., Fiori, F., & Santosh, P. (2020) · Journal of Clinical Medicine · doi:10.3390/jcm9092842 · Cited by 9
“Given that there is a high incidence of comorbid anxiety in individuals with ASD [39], anxiety could be responsible for the higher variability of EDA displayed by some of the individuals within the ASD group.”
BackgroundMcFayden, T. C., Gatto, A. J., Dahiya, A. V., Antezana, L., Miyazaki, Y., & Cooper, L. D. (2021) · Journal of Autism and Developmental Disorders · doi:10.1007/s10803-020-04824-6 · Cited by 9
Chan, N., Sanner, C. M., McGregor, H. A., Preston, A. E., & Neece, C. L. (2021) · Journal of Mental Health Research in Intellectual Disabilities · doi:10.1080/19315864.2021.1883781 · Cited by 10
“Metaanalyses suggest that youth with ASD are almost four-times more likely to be diagnosed with an anxiety disorder than typically-developing (TD) youth (Costello et al., 2011; Van Steensel et al., 2011).”
BackgroundMayes, S. D., Baweja, R. K., Waschbusch, D. A., & Calhoun, S. L. (2022) · Journal of Mental Health Research in Intellectual Disabilities · doi:10.1080/19315864.2022.2029643 · Cited by 9
“Studies analyzing specific types of anxiety symptoms also yield mixed results (Sukhodolsky et al., 2008; Van Steensel et al., 2011).”
ResultThe same stress elicits different effects on anxiety-like behavior in rat models of Fmr1 and Pten
Dey, R., & Chattarji, S. (2022) · Behavioural Brain Research · doi:10.1016/j.bbr.2022.113892 · Cited by 9
Anxiety in Children with Autism Spectrum Disorder
Jennett, H. K., Vasa, R. A., & Hagopian, L. P. (2013) · Springer eBooks · doi:10.1007/978-1-4614-6599-7_16 · Cited by 9
Genetic Mechanisms Emerging from Mouse Models of CNV-Associated Neuropsychiatric Disorders
Nishi, A., & Hiroi, N. (2016) · Elsevier eBooks · doi:10.1016/b978-0-12-801829-3.00030-6 · Cited by 9
Social anxiety symptoms among youth with chronic health conditions: trajectories and related factors
McDougall, J., DeWit, D. J., & Wright, F. V. (2019) · Disability and Rehabilitation · doi:10.1080/09638288.2019.1590742 · Cited by 10
Groomes, D. A. G., Clemons, A., Hulme, S., Kort, K., & Mesibov, G. B. (2014) · Journal of Vocational Rehabilitation · doi:10.3233/jvr-140674 · Cited by 11
“Research has found the psychiatric disorders for which the QWLQ was designed share high co-morbidity rates and phenotypic correlates with ASD [35, 42, 61].”
Fernández, R. V., Plaza-Sanz, M., Hernández-Layna, C., Verde‐Cagiao, M., Benito-Ruiz, G., & Carvajal, F. (2023) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2023.1088727 · Cited by 8
Melkam, M., Demilew, D., Kassew, T., Fanta, B., Yitayih, S., Alemu, K., Yesuf, Y. M., Getnet, B., Abetu, E., Tarekegn, G. E., et al. (2024) · PLoS ONE · doi:10.1371/journal.pone.0300927 · Cited by 8
Castle, V. E., Sideropoulos, V., Jones, C. L., Zhang, D., Herwegen, J. V., & Palikara, O. (2024) · Review Journal of Autism and Developmental Disorders · doi:10.1007/s40489-024-00453-2 · Cited by 14
“…difficulties for those diagnosed with special educational needs and disabilities (SEND) prior to the COVID-19 pandemic (Rzepecka et al., 2011; Van Steensel et al., 2011), we might expect higher rates of mental health issues and lower mental well-being in SEND populations during the COVID-19…”
Pugliese, C. E., Handsman, R., You, X., Anthony, L. G., Vaidya, C. J., & Kenworthy, L. E. (2024) · Autism · doi:10.1177/13623613241246091 · Cited by 8
Yaffe, Y. (2024) · Child Psychiatry & Human Development · doi:10.1007/s10578-024-01757-4 · Cited by 8
Mental health and mental health problems among users of AAC: a scoping review
Østvik, J., Granlund, M., & Seim, A. R. (2024) · Augmentative and Alternative Communication · doi:10.1080/07434618.2024.2434680 · Cited by 8
“…in terms of anxiety and depressive symptoms than typically developing peers (augustine et al., 2022; oeseburg et al., 2010; 2011; smith et al., 2019; van steensel et al., 2011). among australian adolescents and adults with profound disabilities affecting their functional communication, 50.2%…”
InfluentialExperiences of interoception and anxiety in autistic adolescents: A reflexive thematic analysis
Kiera, A., Jonahs, S., Mary, B., Geoffrey, B., & Polly, W. (2025) · Autism · doi:10.1177/13623613251314595 · Cited by 6
“…of developing anxiety disorders, with research estimating that autistic children and adolescents are twice as likely as neurotypicals to have an anxiety disorder (Costello et al., 2005), and an estimated 40% of autistic youths experiencing one or more anxiety disorder (van Steensel et al., 2011).”
Zafeer, H. M. I., Maqbool, S., Rong, Y., & Maqbool, S. (2025) · Psychology in the Schools · doi:10.1002/pits.70077 · Cited by 8
“adolescents aged 12 – 18 meet the criteria for at least one anxiety disorder (Simonoff et al. 2008; Van Steensel et al. 2011), compared to just 3% of neurotypical peers.”
Autistic adolescents and their experiences of physical education at school
Waddington, E., Sadler, D., Jachyra, P., Armstrong, J., Riby, D. M., & Hanley, M. (2025) · Physical Education and Sport Pedagogy · doi:10.1080/17408989.2025.2553285 · Cited by 9
Smythe, L., Asan, L., Nicholson, T. R., Happe, F. G. E., & Edwards, M. J. (2025) · Journal of Neurology · doi:10.1007/s00415-025-13385-6 · Cited by 12
Anxiety and autistic traits in adults: a systematic review and meta-analysis
Callejo, L. T., Herrero, L., & Nieto, M. Á. P. (2025) · Frontiers in Psychology · doi:10.3389/fpsyg.2025.1680267 · Cited by 9
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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