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Clinically Significant Anxiety in Children with Autism Spectrum Disorder and Varied Intellectual Functioning

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Kerns, Connor M., Winder-Patel, Breanna, Iosif, Ana Maria, Nordahl, Christine Wu, Heath, Brianna, Solomon, Marjorie, Amaral, David G.·2021·Journal of Clinical Child & Adolescent Psychology

DOI 10.1080/15374416.2019.1703712PMC PMC9372909

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Abstract

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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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: Kerns, Connor M.
Iosif, Ana Maria
Nordahl, Christine Wu
Heath, Brianna
Solomon, Marjorie
Amaral, David G.
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
DOI: 10.1080/15374416.2019.1703712
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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Clinically Significant Anxiety in Children with Autism Spectrum Disorder and Varied Intellectual Functioning

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