Clinically Significant Anxiety in Children with Autism Spectrum Disorder and Varied Intellectual Functioning
Open accessAbstract
Objective: To evaluate how distinct presentations of anxiety symptoms and intellectual impairment influence the measurement and estimated rate of clinically significant anxiety in autism spectrum disorder (ASD).Method: The sample included 75 children (ages 9–13 years) with ASD and varied IQ and 52 typically developing (TD) controls and parents. Parents completed anxiety symptom scales and a diagnostic interview, designed to (1) differentiate anxiety and ASD and (2) examine DSM-specified and unspecified (“distinct”) anxiety presentations in each child, including fears of change, special interests, idiosyncratic stimuli and social confusion rather than evaluation. Children completed standard intellectual and ASD diagnostic assessments.Results: 69% of those with ASD had clinically-significant anxiety, including 21% DSM-specified anxiety disorders, 17% distinct anxiety, and 31% both. Only 8% of TD children had clinically-significant anxiety, all DSM-specified. DSM-specified anxiety disorders in children with ASD and intellectual impairment (IQ<70) were predominantly specific phobias. DSM-specified anxiety other than specific phobia was significantly less common in children with, versus without, intellectual impairment; this was not the case for distinct anxiety. The sensitivities of anxiety scales were moderate to poor, particularly in cases with intellectual impairment.Conclusions: ASD is associated with more frequent and varied presentations of clinical anxiety, which may align with and differ from the specified anxiety disorders of the DSM. Standard parent report anxiety scales have reduced sensitivity to detect clinical anxiety in ASD, particularly in children with intellectual impairment.
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A prospective study from 2021 demonstrated that 69% of youth with ASD had clinically significant anxiety, compared to 8% of typically developing children.
“A prospective study from 2021 demonstrated that 69% of youth with ASD had clinically significant anxiety, compared to 8% of typically developing children [92].”
From Pharmacological treatment in autism: a proposal for guidelines on common co-occurring psychiatric symptoms (2025) · cites this paper as [92]
Co-occurring anxiety is common among children and adolescents with ASD.
“Co-occurring anxiety is common among children and adolescents with ASD.”
From Pharmacological treatment in autism: a proposal for guidelines on common co-occurring psychiatric symptoms (2025) · cites this paper as [92]
The anxiety signs and symptoms observed among children with ASD were highly varied, both corresponding and contrasting with the specified anxiety disorders of the DSM.
“The anxiety signs and symptoms observed among children with ASD were highly varied, both corresponding and contrasting with the specified anxiety disorders of the DSM [68, 70, 92].”
From Pharmacological treatment in autism: a proposal for guidelines on common co-occurring psychiatric symptoms (2025) · cites this paper as [92]
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- Authors
- Kerns, C. M., Winder-Patel, B., Iosif, A. M., Nordahl, C. W., Heath, B., Solomon, M., & Amaral, D. G.
- Affiliations
- University of British Columbia (CA)
- The MIND Institute, UC Davis
- University of California System (US)
- University of California, Davis (US)
- Corresponding author
- Kerns, Connor M.
- ORCID
- Venue
- Journal of Clinical Child & Adolescent Psychology
- Publisher
- Informa UK Limited
- Published
- 2020-01-23
- Volume
- 50
- Issue
- 6
- Pages
- 780-795
- ISSN
- 1537-4416 (ISSN-L)
- 1537-4424
- PMC
- PMC9372909
- OpenAlex
- W3002322091
- Cited by
- 156
- References
- 68
- Citations by year
- 2026: 18 · 2025: 29 · 2024: 32 · 2023: 28 · 2022: 27 · 2021: 15 · 2020: 7
- FWCI
- 10.34
- Type
- journal article
- Language
- en
- Update notices
- correction (2020-03-27)
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Journal of Clinical Child & Adolescent Psychology (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- eScholarship (California Digital Library) (submittedVersion)
- Funders
- Eunice Kennedy Shriver National Institute of Child Health and Human Development (K23 HD087472, P50HD093079, U54HD079125)
- National Institute of Mental Health (1R01MH103371)
- 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, intellectual disability, children, specific phobia, scale sensitivity, interest groups, fear of change
- MeSH terms
- Autism Spectrum Disorder, Adolescent, Anxiety, Anxiety Disorders, Child, Cognition, Humans, Phobic Disorders
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