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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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“…also chose to exclude behaviors that may be difficult to accurately assess in rodents, such as social anxiety, which although common in ASD (Bejerot et al., 2014; Spain et al., 2018; van Steensel et al., 2011), may appear as, or be masked by, diminished social interest or social reward in rodents.”
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“A meta-analysis conducted several years ago found that specific phobia was the most commonly diagnosed anxiety disorder in a sample of children with ASD (Van Steensel et al., 2011).”
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“Many studies simply report “at least one” anxiety disorder for autistic children and not specific results for multiple anxiety disorders (see van Steensel et al., 2011; see White et al., 2009), even though evidence suggests that anxiety disorders are highly co-occurring (Sherbourne et al., 2010).”
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“The prevalence of OCD in individuals with ASD has been reported to range between 9% and 22% in the literature (Hollocks et al., 2019; Hossain et al., 2020; Lai et al., 2019; Van Steensel et al., 2011) There is a paucity of knowledge regarding the prevalence of OCD in forensic populations.”
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“These core symptoms are often accompanied by additional mental health conditions (Salazar et al., 2015; Simonoff et al., 2008); in particular, internalising-related disorders such as anxiety (van Steensel et al., 2011).”
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“…high comorbidities of ASD and ANX render the situation more difficult, with 40% of children and adolescents with ASD having a concurrent ANX diagnosis (van Steensel et al., 2011), suggesting the existence of common neurodevelopmental perturbations (White et al., 2009; van Steensel et al., 2011).”
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Xiang, F., Li, K., Jiang, Q., Zhang, Y., Gong, Z., Zhi, H., Yu, J., Li, W., & Li, J. (2022) · Medicine · doi:10.1097/md.0000000000028957 · Cited by 6
RetractedWaldman, J., McPaul, A., & Jahoda, A. J. (2022) · Autism · doi:10.1177/13623613221111313 · Cited by 10
“It is estimated that 40% of autistic children meet the diagnostic criteria for an anxiety disorder (van Steensel et al., 2011) and up to 84% suffer from sub-clinical anxiety symptoms (White et al., 2009).”
BackgroundRaman, N., Ringold, S. M., Jayashankar, A., Butera, C. D., Kilroy, E., Harrison, L., Cermak, S. A., & Aziz‐Zadeh, L. (2023) · Brain Sciences · doi:10.3390/brainsci13081161 · Cited by 11
“In ASD, there is a high co-occurrence of anxiety disorder (29.7–49.6% of autistic children) [37] and sleep disturbances (44–83% of autistic children) [38,39].”
BackgroundInfluentialGardner, L. M., Erkfritz-Gay, K. N., Campbell, J. M., Bradley, T. L., & Murphy, L. E. (2016) · Autism and child psychopathology series · doi:10.1007/978-3-319-27171-2_3 · Cited by 6
Autism Spectrum Disorder and Psychosis: A Case Study
Cashin, A. J. (2016) · Journal of Child and Adolescent Psychiatric Nursing · doi:10.1111/jcap.12145 · Cited by 7
Reaven, J., & Willar, K. S. (2017) · Elsevier eBooks · doi:10.1016/b978-0-12-805122-1.00008-9 · Cited by 7
Campbell, B., Curran, M., Inkpen, R., Katsikitis, M., & Kannis‐Dymand, L. (2018) · Advances in Autism · doi:10.1108/aia-08-2017-0017 · Cited by 6
Ishimoto, Y., Yamane, T., & Matsumoto, Y. (2019) · Journal of Autism and Developmental Disorders · doi:10.1007/s10803-019-04092-z · Cited by 6
Interactive Technologies and Autism, Second Edition
Kientz, J. A., Hayes, G. R., Goodwin, M. S., Gelsomini, M., & Abowd, G. D. (2020) · Synthesis lectures on assistive, rehabilitative, and health-preserving technologies · doi:10.2200/s00988ed2v01y202002arh013 · Cited by 48
Health-related risky behaviors and their risk factors in adolescents with high-functioning autism
Sun, Y., Xu, L., Ma, Z., Yang, Y., Yin, T., Gong, X., Gao, Z.-L., Liu, Y., & Liu, J. (2021) · World Journal of Clinical Cases · doi:10.12998/wjcc.v9.i22.6329 · Cited by 6
The Roles of Animals for Individuals With Autism Spectrum Disorder
Grandin, T., Fine, A. H., O’Haire, M. E., Carlisle, G. K., & Gabriels, R. L. (2019) · Elsevier eBooks · doi:10.1016/b978-0-12-815395-6.00018-3 · Cited by 7
Improving access and reducing barriers to dental care for children with autism spectrum disorder
Barry, S. M. (2012) · White Rose eTheses Online (University of Leeds, The University of Sheffield, University of York) · Cited by 6
Uljarević, M. (2013) · ORCA Online Research @Cardiff (Cardiff University) · Cited by 6
Coocurrencia entre ansiedad y autismo. Las hipótesis del error social y de la carga alostática
Pérez, I. P. (2013) · Revista de Neurología · doi:10.33588/rn.56s01.2012652 · Cited by 9
“121 personas con autismo menores de 18 años y con las que se evaluó la sintomatología ansiosa que presentaban a través de cuestionarios estandarizados [13].”
BackgroundModeling flexible behaviour in autism spectrum disorder and typical developmentPreprint
Crawley, D., Zhang, L., Jones, E. J. H., Ahmad, J., Cáceres, A. S. J., Oakley, B. F. M., Charman, T., Buitelaar, J. K., Murphy, D., Chatham, C. H., et al. (2019) · PsyArXiv (OSF Preprints) · doi:10.31234/osf.io/h7jcm · Cited by 7
Family therapy for autism spectrum disorders
Spain, D., Sin, J., Paliokosta, E., Furuta, M., Chalder, T., Murphy, D., & Happe, F. G. E. (2015) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd011894 · Cited by 6
(2021) · Journal of Psychiatry and Brain Science · doi:10.20900/jpbs20210013 · Cited by 6
“According to metanalyses, 40% of young individuals with ASD have clinical anxiety [6] and adults are estimated to experience depression at quadruple the rate of the general population [7].”
BackgroundAnxiety Disorders in Autistic People
Schiltz, H. K., McVey, A. J., & Lord, C. (2024) · Psychiatric Clinics of North America · doi:10.1016/j.psc.2024.04.016 · Cited by 5
Wijnhoven, L. A. M. W., Engels, R. C. M. E., Onghena, P., Otten, R., & Creemers, D. H. M. (2022) · Journal of Autism and Developmental Disorders · doi:10.1007/s10803-021-04927-8 · Cited by 6
McGuinness, L., Abbot‐Smith, K., & Gambi, C. (2024) · Autism · doi:10.1177/13623613241292172 · Cited by 5
“Overall, this may also contribute to other adverse experiences of some autistic youths, including elevated rates of bullying (Maïano et al., 2015) and loneliness (Hymas et al., 2022), as well as frequent co-occurring anxiety (van Steensel et al., 2011).”
Effects of Cannabidiol Isolated or in Association With Risperidone in an Animal Model of Autism
da Costa, M. D. A., Fernandes, G. Z., Maiochi, E., Ebs, M. F. P., Darós, F. D. S., Bolan, S. J., Costa, R. R. N., de Rezende, V. L., da Silva, G. C., de Bitencourt, R. M., et al. (2024) · Developmental Neurobiology · doi:10.1002/dneu.22955 · Cited by 10
“…comorbidities, such as anxiety, obsessive–compulsive disorder, sleep disorders, particularly insomnia (Malow and McGrew 2008; Postorino et al. 2017; van Steensel, Bögels, and Perrin 2011), self-injury, aggression (Mostafavi and Gaitanis 2020), gastrointestinal symptoms (Lin et al. 2024),…”
Reis, S. M., & Renzulli, S. (2025) · Behavioral Sciences · doi:10.3390/bs15060834 · Cited by 9
Lertpeerapan, P., Kanlayaprasit, S., Thongkorn, S., Kasitipradit, K., Panjabud, P., Songsritaya, K., Jantheang, T., Morita, M., Akaike, T., Hu, V. W., et al. (2025) · Biology of Sex Differences · doi:10.1186/s13293-025-00744-1 · Cited by 5
“Autism spectrum disorder (ASD) is a neurodevelopmental disorder characterized by social interaction and communication as well as restricted behavior [1].”
Braus, N., Flückiger, C., Wichmann, J., Frankman, C., Gräfenkämper, R., Zemp, M., & Hunger‐Schoppe, C. (2025) · Psychotherapy Research · doi:10.1080/10503307.2025.2565236 · Cited by 5
“Given the limited attention this moderator has received in the existing literature, future research should explore its potential influence more systematically (Beelmann et al., 2023; Brown et al., 2017; van Steensel et al., 2011).”
Jachyra, P., Damme, T. V., Healy, S., Stubbs, B., Zhou, C., & Fabiano, N. (2025) · Journal of Physical Activity and Health · doi:10.1123/jpah.2025-0811 · Cited by 7
Cortisol in individuals with autism spectrum disorders – review
Lewandowska, Z., Mazur‐Melewska, K., & Figlerowicz, M. (2020) · Child Neurology · doi:10.20966/chn.2020.59.467 · Cited by 5
Pappagianopoulos, J. E., Rouch, E. F., & Mazurek, M. O. (2023) · Journal of Autism and Developmental Disorders · doi:10.1007/s10803-023-06158-5 · Cited by 7
“Additionally, autistic youth experience elevated levels of internalizing conditions (i.e., anxiety and depression) as compared to TD peers (Uljarević et al. 2016; van Steensel et al., 2011).”
David, A., Stolar, O. E., Berkovitch, M., Kohn, E., Hazan, A., Waissengreen, D., & Gal, E. (2024) · Cannabis and Cannabinoid Research · doi:10.1089/can.2024.0001 · Cited by 5
Goulding, K., Campbell, L., & Freeman, E. E. (2024) · European Journal of Investigation in Health Psychology and Education · doi:10.3390/ejihpe14090168 · Cited by 5
Pryor, F. C., Lincoln, A. J., Igelman, R. S., Toma, V., & Iravani, R. (2021) · Research in Autism · doi:10.1016/j.rasd.2021.101748 · Cited by 6
School Camp Refusal and Reluctance: The Role of the School Psychologist
Woods, M. C., & Burns, J. R. (2018) · Journal of Psychologists and Counsellors in Schools · doi:10.1017/jgc.2018.11 · Cited by 5
Review of Interventions for Inclusion of Children With ASD and Anxiety in Education
Syriopoulou–Delli, C. K., Polychronopoulou, S. A., Kolaitis, G. A., & Antoniou, A.-S. G. (2020) · Journal of Educational and Developmental Psychology · doi:10.5539/jedp.v10n1p1 · Cited by 7
“One of the first challenges identified in the review is related to the difficulties in the diagnosis and measurement of anxiety in children and young people with ASD, as there is overlap in the symptoms (vanSteensel et al., 2011).”
BackgroundAdams, D., & Malone, S. A. (2021) · Springer eBooks · doi:10.1007/978-3-030-74675-9_8 · Cited by 5
Lassen, J., Aggernæs, B., Foldager, M., Pedersen, J., Oranje, B., Kjær, T. W., Arnfred, S., & Vestergaard, M. (2022) · Research in Autism · doi:10.1016/j.rasd.2022.102040 · Cited by 5
Anti-Anxiety Medications and Novel Treatments for Autism
Deb, S. S., Roy, M., Limbu, B., & Bertelli, M. O. (2022) · Autism and child psychopathology series · doi:10.1007/978-3-030-88538-0_51 · Cited by 5
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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