Autism Spectrum Traits in Children with Mood and Anxiety Disorders
Abstract
The autism spectrum disorders (ASDs) can present with symptoms commonly found in mood and anxiety disorders. The Social Communication Questionnaire (SCQ), Children's Communication Checklist (CCC-2), and the Social Reciprocity Scale (SRS) were used to screen children in a mood disorders research clinic setting for symptoms of ASD. Ninety-three patients (mean age, 12.7 +/- 2.8 years; percent male, 63%) completed at least one scale, and 50 children completed all three. The prevalence of those screening positive for a possible ASD on one instrument was 62% and on all three measures was 8%. Fifty-seven percent (n = 21/37; odds ratio, 4.59 [95% confidence interval (CI) = 1.40-15.11]) of those scoring in the "ASD-likely" range on the SRS scored in that range on the CCC-2. Only 16% (n = 6/37; odds ratio, not significant (NS)) of those scoring in the ASD-likely range on the SRS, and 14% (n = 5/37; odds ratio, NS) of those scoring in the ASD-likely range on the CCC-2, scored similarly on the SCQ. These results demonstrate a need to develop valid and reliable instruments to screen for ASDs in children presenting outside of ASD clinics.
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There are high rates of comorbidity between substance abuse and other Axis I conditions, between schizophrenia and bipolar disorder, and between ASD and mood and anxiety disorders.
“For example, there are high rates of comorbidity between substance abuse and other Axis I conditions [747-749], schizophrenia and bipolar disorder [750], and ASD and mood and anxiety disorders [751].”
From Reward circuitry dysfunction in psychiatric and neurodevelopmental disorders and genetic syndromes: animal models and clinical findings (2012) · cites this paper as [751]
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BackgroundCholemkery, H., Mojica, L., Rohrmann, S., Gensthaler, A., & Freitag, C. M. (2013) · Journal of Autism and Developmental Disorders · doi:10.1007/s10803-013-1979-4 · Cited by 83 · see citing works
“Other studies have likewise shown that children with mood and anxiety disorders, who never received an ASD diagnosis, obtained scores on the SRS within the range typically found in children with ASD diagnoses (Towbin et al. 2005; Pine et al. 2008; Aldridge et al. 2012).”
BackgroundMethodResultInfluentialAutistic-Like Traits in Adult Patients with Mood Disorders and Schizophrenia
Matsuo, J., Kamio, Y., Takahashi, H., Ota, M., Teraishi, T., Hori, H., Nagashima, A., Takei, R., Higuchi, T., Motohashi, N., et al. (2015) · PLoS ONE · doi:10.1371/journal.pone.0122711 · Cited by 82 · see citing works
“This finding suggests an aggregation of ALTs in individuals with adult-onset psychiatric disorders, and together with the findings about concurrent psychiatric disorders in clinical youths [7,8,16,29], implies a possible pathophysiological overlap between ASD and other psychiatric disorders.”
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Anterior cingulate volume in pediatric bipolar disorder and autism
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“In a study of young people aged 8 to 18 (N=93) with internalizing and mood disorders, Towbin and colleagues showed that 62% of their sample fulfilled criteria for an ASD on at least one screening questionnaire (Towbin et al. 2005).”
Wang, J. J., Lee, L.-C., Chen, Y. S., & Hsu, J.-W. (2012) · Journal of Autism and Developmental Disorders · doi:10.1007/s10803-012-1499-7 · Cited by 64 · see citing works
Differentiating High-Functioning Autism and Social Phobia
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Validity study of the Autism Spectrum Disorders-Diagnostic for Children (ASD-DC)
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Socio-emotional processing and functioning of youth at high risk for bipolar disorder
Whitney, J. E., Howe, M. E., Shoemaker, V., Li, S., Sanders, E. M., Dijamco, C., Acquaye, T., Phillips, J. M., Singh, M. K., & Chang, K. (2012) · Journal of Affective Disorders · doi:10.1016/j.jad.2012.08.016 · Cited by 64 · see citing works
“Youth with mood disorders (Pine et al., 2008; Towbin et al., 2005) including BD (Birmaher and Axelson, 2006; Judd et al., 2005) and offspring of parents with BD (Bella et al., 2011) can have significant impairments in social functioning as well as deficits in social reciprocity, which refers to the…”
BackgroundAutism Spectrum Traits in Children with Anxiety Disorders
van Steensel, F. J. A., Bögels, S. M., & Wood, J. J. (2012) · Journal of Autism and Developmental Disorders · doi:10.1007/s10803-012-1575-z · Cited by 64 · see citing works
“The study of Towbin et al. (2005) examined ASD traits in a sample of children with mood and anxiety disorders with three ASD measures, namely the Social Communication Questionnaire (SCQ; Berument et al. 1999), the Social Responsiveness Scale (SRS; Constantino et al. 2000), and the Children’s…”
InfluentialMelcangi, R. C., & García‐Segura, L. M. (2009) · Hormones and Behavior · doi:10.1016/j.yhbeh.2009.06.001 · Cited by 63 · see citing works
Rates of autism and potential risk factors in children with congenital heart defects
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“Diagnostic Interview, Revised), and has been used to characterize ASD prevalence in other patient groups.(20,21) According to the creators of the SCQ, a lower cutoff scores ( 12) could be considered for investigations with younger individuals and with informants who are less familiar with the traits/behaviors associat…”
Toward a Behavior of Reciprocity.
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Dell'Osso, L., Carpita, B., Cremone, I. M., Muti, D., Diadema, E., Barberi, F. M., Massimetti, G., Brondino, N., Petrosino, B., Politi, P., et al. (2019) · Psychiatry Research · doi:10.1016/j.psychres.2018.10.040 · Cited by 56 · see citing works
Reversed gender ratio of autism spectrum disorder in Smith-Magenis syndrome
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“The SRS places a heavier emphasis on the reciprocal social interaction trait in ASD, whereas the SCQ places a similar emphasis on all three ASD domains [45].”
BackgroundAssociation Between Autistic Traits in Preschool Children and Later Emotional/Behavioral Outcomes
Saito, A., Stickley, A., Haraguchi, H., Takahashi, H., Ishitobi, M., & Kamio, Y. (2017) · Journal of Autism and Developmental Disorders · doi:10.1007/s10803-017-3245-7 · Cited by 54 · see citing works
“Furthermore, previous research that has focused on children and adolescents with anxiety disorders and/or mood disorders has also shown that they have higher levels of autistic traits (Pine et al. 2008; Towbin et al. 2005; van Steensel et al. 2013), which suggests that masked autistic traits might underlie more visibl…”
BackgroundGilbert, J. P., O’Connor, M. G., Templet, S., Moghaddam, M., Ioschpe, A. D. V., Sinclair, A., Zhu, L., Xu, W., & Man, H. (2019) · Journal of Neuroscience · doi:10.1523/jneurosci.0222-19.2019 · Cited by 54 · see citing works
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“SRS may over-identify ASD in clinical populations [6, 8, 34].”
BackgroundFactor Structure of Autistic Traits in Children with ADHD
Martin, J., Hamshere, M., O'Donovan, M., Rutter, M., & Thapar, A. (2013) · Journal of Autism and Developmental Disorders · doi:10.1007/s10803-013-1865-0 · Cited by 59 · see citing works
“…Park, Denmark Hill, London SE5 8AF, UK children with suspected ASD (Eaves et al. 2006), children with ADHD (Kochhar et al. 2011; Kröger et al. 2011; Mulligan et al. 2009a) or other psychopathology (Pine et al. 2008; Towbin et al. 2005) and also in the general population (Mulligan et al. 2009b).”
BackgroundSettipani, C. A., Puleo, C. M., Conner, B. T., & Kendall, P. C. (2012) · Journal of Anxiety Disorders · doi:10.1016/j.janxdis.2012.01.010 · Cited by 48 · see citing works
“N IH -PA Author M anuscript N IH -PA Author M anuscript N IH -PA Author M anuscript (e.g., Pine et al., 2008; Puleo & Kendall, 2011; Reiersen et al., 2008; Towbin et al., 2005).”
BackgroundInfluentialDavis, T. E., Moree, B. N., Dempsey, T., Hess, J. A., Jenkins, W. S., Fodstad, J. C., & Matson, J. L. (2011) · Behavior Therapy · doi:10.1016/j.beth.2011.05.003 · Cited by 46 · see citing works
Assessing Childhood Psychopathology and Developmental Disabilities
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The relationship between autism and psychiatric disorders in Intellectually Disabled Adults
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Overlap between Autism Spectrum Disorder and Bipolar Affective Disorder
Skokauskas, N., & Frodl, T. (2015) · Psychopathology · doi:10.1159/000435787 · Cited by 45 · see citing works
ASD Traits Among Youth with Obsessive–Compulsive Disorder
Griffiths, D. L., Farrell, L. J., Waters, A. M., & White, S. W. (2017) · Child Psychiatry & Human Development · doi:10.1007/s10578-017-0714-3 · Cited by 41 · see citing works
Assessment of Social Anxiety in Children and Adolescents With Autism Spectrum Disorder
Kreiser, N. L., & White, S. W. (2014) · Clinical Psychology Science and Practice · doi:10.1111/cpsp.12057 · Cited by 39 · see citing works
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Affective prosody labeling in youths with bipolar disorder or severe mood dysregulation
Deveney, C. M., Brotman, M. A., Decker, A. M., Pine, D. S., & Leibenluft, E. (2011) · Journal of Child Psychology and Psychiatry · doi:10.1111/j.1469-7610.2011.02482.x · Cited by 32 · see citing works
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Elevated Autism Spectrum Disorder Traits in Young Children with OCD
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“Studies have demonstrated high ratings on the SRS and SCQ for youth with mood and anxiety disorders who did not have an ASD diagnosis [15, 16].”
Juybari, K. B., Sepehri, G., Meymandi, M. S., Shahrbabaki, S. S. V., Moslemizadeh, A., Saeedi, N., Aminzadeh, A., Nozari, M., Khaksari, M., Haghpanah, T., et al. (2020) · Neurotoxicology and Teratology · doi:10.1016/j.ntt.2020.106905 · Cited by 31 · see citing works
Social competence in children and young people treated for a brain tumour
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Pragmatics fragmented: the factor structure of the Dutch Children's Communication Checklist (CCC)
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Differentiation of autism spectrum disorder and mood or anxiety disorder
Wittkopf, S., Stroth, S., Langmann, A., Wolff, N., Roessner, V., Roepke, S., Poustka, L., & Kamp‐Becker, I. (2021) · Autism · doi:10.1177/13623613211039673 · Cited by 31 · see citing works
“…2013), avoidance of social situations, withdrawal, impairments in reciprocal social interaction and reduced eye contact (Hartley & Sikora, 2009; Towbin et al., 2005; Tyson & Cruess, 2012; van Steensel et al., 2013), and restricted, repetitive, and stereotyped behaviors (Hartley & Sikora, 2009;…”
InfluentialStickley, A., Tachibana, Y., Hashimoto, K., Haraguchi, H., Miyake, A., Morokuma, S., Nitta, H., Oda, M., Ohya, Y., Senju, A., et al. (2017) · Autism Research · doi:10.1002/aur.1742 · Cited by 29 · see citing works
Autism and social anxiety in children with sex chromosome trisomies: an observational study
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Exploring autistic traits in adults with chronic depression: A clinical study
Radtke, M., Wieczoreková, D., Normann, C., Humpolíček, P., Brakemeier, E., Bubl, E., van Elst, L. T., & Riedel, A. (2019) · Research in Autism · doi:10.1016/j.rasd.2019.04.006 · Cited by 22 · see citing works
Differential diagnosis of bipolar disorder in children and adolescents
Carlson, G. A. (2012) · World Psychiatry · doi:10.1002/j.2051-5545.2012.tb00115.x · Cited by 22 · see citing works
“with children with mania because of their emotion regulation problems (28).”
BackgroundCognitive Flexibility and Social Responsiveness in Children and Adolescents with Tourette Syndrome
Güler, A. S., Berkem, M., Yazgan, Y., & Kalaça, S. (2015) · Child Psychiatry & Human Development · doi:10.1007/s10578-015-0533-3 · Cited by 22 · see citing works
“responsiveness in children with mood and anxiety disorders [35, 85].”
BackgroundCaution When Screening for Autism among Socially Anxious Youth
Capriola-Hall, N. N., McFayden, T. C., Ollendick, T. H., & White, S. W. (2020) · Journal of Autism and Developmental Disorders · doi:10.1007/s10803-020-04642-w · Cited by 21 · see citing works
“2015) as well as youth with other disorders (Towbin et al. 2005), which might explain the lack of significant differences between the SAD only and ASD only groups in our study.”
BackgroundInfluentialTonge, N., Rodebaugh, T. L., Fernandez, K. C., & Lim, M. H. (2015) · Journal of Anxiety Disorders · doi:10.1016/j.janxdis.2015.12.005 · Cited by 21 · see citing works
Screening for autism identifies behavioral disorders in children functional defecation disorders
Kuizenga‐Wessel, S., Lorenzo, C. D., Nicholson, L., Butter, E. M., Ratliff-Schaub, K. L., Benninga, M. A., & Williams, K. C. (2016) · European Journal of Pediatrics · doi:10.1007/s00431-016-2775-x · Cited by 20 · see citing works
“[25] demonstrated that a substantial proportion of children with mood and anxiety disorders scored in the ASD-likely range of the SRS.”
BackgroundSharma, S., Woolfson, L. M., & Hunter, S. C. (2013) · Autism · doi:10.1177/1362361312472556 · Cited by 19 · see citing works
“For example, symptoms of autism were found to co-occur in 45 children and adults who had a diagnosis of anxiety disorder (Towbin et al., 2005).”
BackgroundUtility of Teacher-Report Assessments of Autistic Severity in Japanese School Children
Kamio, Y., Moriwaki, A., & Inada, N. (2013) · Autism Research and Treatment · doi:10.1155/2013/373240 · Cited by 19 · see citing works
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“Towbin et al. (2005) investigated ASD symptoms in clinically referred children with mood and anxiety disorders and found that almost half of the children with a depressed/anxious symptomatology showed symptoms of ASD, and another 15% had elevated ADHD symptomatology.”
Communication in fragile X syndrome: Patterns and implications for assessment and intervention
Hoffmann, A. (2022) · Frontiers in Psychology · doi:10.3389/fpsyg.2022.929379 · Cited by 18 · see citing works
“Increased rates of pragmatic deficits are also noted in populations with intellectual disability, language disorder, attention deficits, and other neurodevelopmental disorders (Tager-Flusberg, 2004; Towbin et al., 2005; Hoffmann et al., 2013; Smith et al., 2017; DiezItza et al., 2022).”
BackgroundMirror neuron system based therapy for emotional disorders
Yuan, T., & Hoff, R. (2008) · Medical Hypotheses · doi:10.1016/j.mehy.2008.07.004 · Cited by 18 · see citing works
“Consistently, patients with mood disorders show higher tendency to develop autism symptoms [28,29].”
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“B IPOLAR DISORDER (BD) in developmentally disabled children, particularly in children with Asperger’s disorder, remains largely un-derrecognized, although, with careful evaluation, it clearly occurs (DeJong and Frazier 2002; Towbin et al. 2005).”
When Autistic Behavior Suggests a Disease Other than Classic Autism
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Long-lasting Behavioral and Neuroanatomical Effects of Postnatal Valproic Acid Treatment
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Habituation of exploratory behaviour in VPA rats: animal model of autism
Olexová, L., Senko, T., Štefánik, P., Talarovičová, A., & Kršková, L. (2013) · Interdisciplinary Toxicology · doi:10.2478/intox-2013-0033 · Cited by 17 · see citing works
“, 2000), anxiety (Groden et al., 1994; Gillott et al., 2001; Towbin et al., 2005), decrease of motivation (American Interdiscip Toxicol.”
Zhao, G., Gao, J., Liang, S., Wang, X., Sun, C., Xia, W. T., Hao, Y., Li, X., Cao, Y., & Wu, L. (2015) · International Journal of Developmental Neuroscience · doi:10.1016/j.ijdevneu.2015.04.350 · Cited by 17 · see citing works
“Its hallmark symptoms are abnormalities in social interaction and communication, repetitive behaviors, and narrowed interests (Association, 2013), and these symptoms are accompanied by various neurobehavioral disorders, such as learning disability, hyperactivity and anxiety (O’Brien and Pearson, 2004; De Giacomo et al…”
BackgroundAssessment of childhood bipolar disorder.
Fields, B. W., & Fristad, M. A. (2009) · Clinical Psychology Science and Practice · doi:10.1111/j.1468-2850.2009.01156.x · Cited by 16 · see citing works
- Authors
- Towbin, K. E., Pradella, A., Gorrindo, T., Pine, D. S., & Leibenluft, E.
- Affiliations
- National Institutes of Health (US)
- Venue
- Journal of Child and Adolescent Psychopharmacology
- Publisher
- SAGE Publications
- Published
- 2005-06
- Volume
- 15
- Issue
- 3
- Pages
- 452-464
- ISSN
- 1044-5463 (ISSN-L)
- 1557-8992
- OpenAlex
- W2056544008
- Cited by
- 152
- References
- 44
- Citations by year
- 2026: 2 · 2025: 3 · 2024: 5 · 2023: 2 · 2022: 6 · 2021: 7 · 2020: 6 · 2019: 6 · 2018: 6 · 2017: 8 · 2016: 9 · 2015: 8 · 2014: 7 · 2013: 7 · 2012: 13
- FWCI
- 5.27
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Journal of Child and Adolescent Psychopharmacology (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Life Sciences › Neuroscience › Cognitive Neuroscience › Autism Spectrum Disorder Research
- Health Sciences › Medicine › Psychiatry and Mental health › Child Nutrition and Feeding Issues
- Social Sciences › Psychology › Clinical Psychology › Child and Adolescent Psychosocial and Emotional Development
- Keywords
- autism spectrum disorder, autistic traits, mood disorders, anxiety disorders, children, screening tool, Social Communication Questionnaire, Children's Communication Checklist, comorbidities, instrument validity and reliability
- MeSH terms
- Adolescent, Anxiety Disorders, Autistic Disorder, Bipolar Disorder, Child, Major Depressive Disorder, Emotions, Female, Humans, Interview, Psychological, Male, Neuropsychological Tests, Psychiatric Status Rating Scales, Surveys and Questionnaires, Social Behavior, Odds Ratio, Mood Disorders
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