Anxiety in high-functioning autism: A pilot study of experience sampling using a mobile platform
Abstract
Anxiety and stress are everyday issues for many people with high-functioning autism, and while cognitive-behavioural therapy is the treatment of choice for the management of anxiety, there are challenges in using it with people with high-functioning autism. This study used modified experience sampling techniques to examine everyday anxiety and stress in adults with high-functioning autism and to explore the feasibility of delivering real-time stress management techniques using a mobile platform. High levels of anxiety were found to be characterised by worry, confusing thoughts and being alone but was not associated with internal focus, imagery or rumination. Participants reported improved mood and less worry and anxious thinking in the active phase of the study. These results support previous studies indicating that people with high-functioning autism differ in their experience of anxiety and provided preliminary data on the feasibility of real-time stress management. The limitations of this approach are discussed together with considerations for future work in the area of developing clinical interventions on mobile platforms.
Integrity signals
Registry
Cites
Statistics
Claims the paper makes
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
Autistic people are less likely to receive effective mental health support.
“but are less likely to receive effective mental health support.2”
From Approaches to improving mental healthcare for autistic people: Systematic review (2024) · cites this paper as [2]
Cites
The Hospital Anxiety and Depression Scale
Zigmond, A. S., & Snaith, R. P. (1983) · Acta Psychiatrica Scandinavica · doi:10.1111/j.1600-0447.1983.tb09716.x · Cited by 47,139 · see citing works
Baron-Cohen, S., Wheelwright, S., Skinner, R., Martin, J., & Clubley, E. (2001) · Journal of Autism and Developmental Disorders · doi:10.1023/a:1005653411471 · Cited by 6,450 · cited 3× · see citing works
“A cut-off score of 32 is taken as identifying adults with HFA within the general population (Baron-Cohen et al., 2001), although a more conservative threshold (26) has been suggested for use in ‘clinic referred populations’ (Woodbury-Smith et al., 2005).”
BackgroundMethodWechsler Abbreviated Scale of Intelligence
Wechsler, D. (1999) · PsycTESTS Dataset · doi:10.1037/t15170-000 · Cited by 4,681 · see citing works
A farewell to Bonferroni: the problems of low statistical power and publication bias
Nakagawa, S. (2004) · Behavioral Ecology · doi:10.1093/beheco/arh107 · Cited by 2,102 · see citing works
Anxiety Disorders in Children and Adolescents with Autistic Spectrum Disorders: A Meta-Analysis
van Steensel, F. J. A., Bögels, S. M., & Perrin, S. (2011) · Clinical Child and Family Psychology Review · doi:10.1007/s10567-011-0097-0 · Cited by 1,463 · cited 1× · see citing works
“Anxiety disorders are the most prevalent mental health problem in both children (Van Steensel et al., 2011) and adults (Skokauskas and Gallagher, 2010).”
BackgroundHeron, K. E., & Smyth, J. M. (2010) · British Journal of Health Psychology · doi:10.1348/135910709x466063 · Cited by 1,438 · see citing works
Anxiety in children and adolescents with autism spectrum disorders
White, S. W., Oswald, D., Ollendick, T., & Scahill, L. (2009) · Clinical Psychology Review · doi:10.1016/j.cpr.2009.01.003 · Cited by 1,427 · cited 2× · see citing works
“People with autism spectrum conditions (ASCs) have a lifelong vulnerability to health difficulties, including anxiety, mood disorders and psychosis (Skokauskas and Gallagher, 2010), a tendency that increases in people with high-functioning autism1 (HFA; White et al., 2009), possibly due to increased expressive abiliti…”
BackgroundExperience Sampling Method: Measuring the Quality of Everyday Life
Hektner, J. M., Schmidt, J. A., & Csíkszentmihályi, M. (2006) · Cited by 1,239 · see citing works
Hektner, J., Schmidt, J., & Csikszentmihalyi, M. (2007) · doi:10.4135/9781412984201 · Cited by 1,174 · see citing works
Experience Sampling: Promises and Pitfalls, Strengths and Weaknesses
Scollon, C. N., Kim‐Prieto, C., & Diener, E. (2003) · Journal of Happiness Studies · doi:10.1023/a:1023605205115 · Cited by 827 · see citing works
Woodbury-Smith, M. R., Robinson, J., Wheelwright, S., & Baron-Cohen, S. (2005) · Journal of Autism and Developmental Disorders · doi:10.1007/s10803-005-3300-7 · Cited by 771 · see citing works
Strategies for analyzing ecological momentary assessment data.
Schwartz, J. E., & Stone, A. A. (1998) · Health Psychology · doi:10.1037//0278-6133.17.1.6 · Cited by 631 · see citing works
Innovative technology-based interventions for autism spectrum disorders: a meta-analysis
Grynszpan, O., Weiss, P. L. (., Perez-Diaz, F., & Gal, E. (2014) · Autism · doi:10.1177/1362361313476767 · Cited by 621 · cited 2× · see citing works
“…with everyday issue in everyday contexts (Gaus, 2011), the use of technology-based interventions, ranging from virtual reality environments to mobile platforms (Grynszpan et al., 2014) to mobile technology such as the personal digital assistant (PDA), would appear to be worthy of consideration.”
BackgroundStrategies for analyzing ecological momentary assessment data.
Schwartz, J. E., & Stone, A. A. (1998) · Health Psychology · doi:10.1037/0278-6133.17.1.6 · Cited by 484 · see citing works
Newman, M. G., Szkodny, L. E., Llera, S. J., & Przeworski, A. (2011) · Clinical Psychology Review · doi:10.1016/j.cpr.2010.09.008 · Cited by 480 · see citing works
Mobile Therapy: Case Study Evaluations of a Cell Phone Application for Emotional Self-Awareness
Morris, M. E., Kathawala, Q., Leen, T. K., Gorenstein, E. E., Guilak, F., Labhard, M., & Deleeuw, W. (2010) · Journal of Medical Internet Research · doi:10.2196/jmir.1371 · Cited by 384 · see citing works
Assessing schizophrenia in daily life : the experience sampling method
Delespaul, P. (1995) · doi:10.26481/dis.19950504pd · Cited by 349 · see citing works
Psychological Disorder in Adolescents and Adults with Asperger Syndrome
Tantam, D. (2000) · Autism · doi:10.1177/1362361300004001004 · Cited by 316 · see citing works
Evaluation of exposure-specific risks from two independent samples: A simulation study
Reichmann, W. M., GAGNON, D. R., Horsburgh, C. R., & Losina, E. (2011) · BMC Medical Research Methodology · doi:10.1186/1471-2288-11-1 · Cited by 310 · see citing works
Simner, J. (2010) · British Journal of Psychology · doi:10.1348/000712610x528305 · Cited by 293 · see citing works
Experience sampling research in individuals with mental illness: reflections and guidance
Palmier-Claus, J. E., Myin-Germeys, I., Barkus, E., Bentley, L., Udachina, A., Delespaul, P. A. E. G., Lewis, S. W., & Dunn, G. (2011) · Acta Psychiatrica Scandinavica · doi:10.1111/j.1600-0447.2010.01596.x · Cited by 287 · see citing works
Sterling, L., Dawson, G., Estes, A., & Greenson, J. (2008) · Journal of Autism and Developmental Disorders · doi:10.1007/s10803-007-0477-y · Cited by 263 · see citing works
Moree, B. N., & Davis, T. E. (2010) · Research in Autism Spectrum Disorders · doi:10.1016/j.rasd.2009.10.015 · Cited by 220 · cited 2× · see citing works
“PDAs are ideal in that they can readily accommodate suggested modifications for working therapeutically with individuals with autism spectrum (AS) (Moree and Davis, 2010), are primarily a visual medium and allow individuals to have control to work at their own pace.”
BackgroundWhite, S. W., Albano, A. M., Johnson, C. R., Kasari, C. L., Ollendick, T. H., Klin, A., Oswald, D. P., & Scahill, L. D. (2010) · Clinical Child and Family Psychology Review · doi:10.1007/s10567-009-0062-3 · Cited by 218 · see citing works
Sampling the form of inner experience in three adults with Asperger syndrome
Hurlburt, R. T., Happé, F., & Frith, U. (1994) · Psychological Medicine · doi:10.1017/s0033291700027367 · Cited by 215 · see citing works
Newman, M. G., Erickson, T., Przeworski, A., & Dzus, E. (2003) · Journal of Clinical Psychology · doi:10.1002/jclp.10128 · Cited by 206 · see citing works
From Environment to Therapy in Psychosis: A Real-World Momentary Assessment Approach
Myin‐Germeys, I., Birchwood, M. J., & Kwapil, T. R. (2011) · Schizophrenia Bulletin · doi:10.1093/schbul/sbq164 · Cited by 177 · see citing works
Autism: Preparing for Adulthood
Howlin, P. (1996) · Medical Entomology and Zoology · Cited by 163 · see citing works
Skokauskas, N., & Gallagher, L. (2009) · Psychopathology · doi:10.1159/000255958 · Cited by 159 · see citing works
Cognitive-Behavioral Treatment of Obsessive- Compulsive Disorder in a Child with Asperger Syndrome
Reaven, J., & Hepburn, S. (2003) · Autism · doi:10.1177/1362361303007002003 · Cited by 153 · see citing works
Howlin, P. (2004) · Routledge eBooks · doi:10.4324/9780203426913 · Cited by 143 · see citing works
Cognitive behaviour therapy for children and adults with Asperger’s syndrome
Attwood, T. (2004) · Behaviour Change · doi:10.1375/bech.21.3.147.55995 · Cited by 131 · see citing works
Technological adjuncts to increase adherence to therapy: A review
Clough, B. A., & Casey, L. M. (2011) · Clinical Psychology Review · doi:10.1016/j.cpr.2011.03.006 · Cited by 125 · see citing works
Cognitive Behaviour Therapy for People with Asperger Syndrome
Anderson, S., & Morris, J. (2006) · Behavioural and Cognitive Psychotherapy · doi:10.1017/s1352465805002651 · Cited by 113 · see citing works
A Palmtop Computer Program for the Treatment of Generalized Anxiety Disorder
Newman, M. G., Consoli, A. J., & Taylor, C. B. (1999) · Behavior Modification · doi:10.1177/0145445599234005 · Cited by 100 · see citing works
Cardaciotto, L., & Herbert, J. D. (2004) · Cognitive and Behavioral Practice · doi:10.1016/s1077-7229(04)80009-9 · Cited by 86 · see citing works
Cognitive-Behavioral Therapy for Adult Asperger Syndrome
Gaus, V. L., & Persons, J. B. (2007) · Cited by 70 · see citing works
Weiss, J. A., & Lunsky, Y. (2010) · Clinical Psychology & Psychotherapy · doi:10.1002/cpp.694 · Cited by 67 · see citing works
The emotional hearing aid: an assistive tool for children with Asperger syndrome
el Kaliouby, R., & Robinson, P. (2005) · Universal Access in the Information Society · doi:10.1007/s10209-005-0119-0 · Cited by 63 · see citing works
Abell, F., & Hare, D. J. (2005) · Autism · doi:10.1177/1362361305057857 · Cited by 60 · see citing works
Self-citationAdult Asperger Syndrome and the Utility of Cognitive-Behavioral Therapy
Gaus, V. L. (2010) · Journal of Contemporary Psychotherapy · doi:10.1007/s10879-010-9159-8 · Cited by 48 · see citing works
Chen, Y.-W. R., Cordier, R., & Brown, N. (2013) · Developmental Neurorehabilitation · doi:10.3109/17518423.2013.855274 · Cited by 47 · see citing works
The use of hand-held computers as an adjunct to cognitive-behavior therapy
Newman, M. G., Kenardy, J. A., Herman, S., & Taylor, C. B. (1996) · Computers in Human Behavior · doi:10.1016/0747-5632(95)00024-0 · Cited by 46 · see citing works
Social needs in daily life in adults with Pervasive Developmental Disorders
Hintzen, A., Delespaul, P., van Os, J., & Myin‐Germeys, I. (2010) · Psychiatry Research · doi:10.1016/j.psychres.2010.06.014 · Cited by 43 · see citing works
Broderick, J. E., & Stone, A. A. (2006) · Psychological Methods · doi:10.1037/1082-989x.11.1.106 · Cited by 35 · see citing works
Anxiety in Asperger’s syndrome: Assessment in real time
Hare, D. J., Wood, C. S., Wastell, S., & Skirrow, P. M. (2014) · Autism · doi:10.1177/1362361314531340 · Cited by 28 · see citing works
Self-citationThe Treatment of Social Phobia in a Young Boy With Asperger's Disorder
Schleismann, K. D., & Gillis, J. L. (2011) · Cognitive and Behavioral Practice · doi:10.1016/j.cbpra.2010.08.004 · Cited by 15 · see citing works
Ekberg, J., Timpka, T., Bång, M., Fröberg, A., Halje, K., & Eriksson, H. (2011) · BMC Medical Research Methodology · doi:10.1186/1471-2288-11-3 · Cited by 14 · see citing works
Asperger Syndrome and Anxiety: A Guide to Successful Stress Management
Dubin, N. (2009) · Cited by 11 · see citing works
Towards a handy interactive persuasive diary for teenagers with a diagnosis of autism
Ranfelt, A. M., Wigram, T., & Øhrstrøm, P. (2009) · International Conference on Persuasive Technology · doi:10.1145/1541948.1541953 · Cited by 10 · see citing works
Developing Psychotherapeutic Interventions for People with Autism Spectrum Disorders
Hare, D. J. (2012) · Wiley eBooks · doi:10.1002/9781118329252.ch12 · Cited by 9 · see citing works
Self-citationCellular phones for reducing battlefield stress: rationale and a preliminary research.
Riva, G., Grassi, A., Villani, D., & Preziosa, A. (2007) · PubMed · Cited by 9 · see citing works
Flagged first, then by citations
Cited by
Sorted by citations
Hwang, Y. I. (., Arnold, S., Srasuebkul, P., & Trollor, J. (2020) · Autism · doi:10.1177/1362361319868907 · Cited by 141 · see citing works
Technology use as a support tool by secondary students with autism
Hedges, S. H., Odom, S. L., Hume, K., & Sam, A. M. (2017) · Autism · doi:10.1177/1362361317717976 · Cited by 84 · see citing works
Zimmerman, D., Ownsworth, T., O’Donovan, A., Roberts, J., & Gullo, M. J. (2016) · Journal of Intellectual & Developmental Disability · doi:10.3109/13668250.2016.1262010 · Cited by 32 · see citing works
Shoham, A., Hadash, Y., & Bernstein, A. (2018) · Clinical Psychological Science · doi:10.1177/2167702618770446 · Cited by 29 · see citing works
Wilson, N. J., Chen, Y.-W. R., Mahoney, N., Buchanan, A., Marks, A., & Cordier, R. (2020) · Journal of Applied Research in Intellectual Disabilities · doi:10.1111/jar.12753 · Cited by 21 · see citing works
Approaches to improving mental healthcare for autistic people: Systematic review
Loizou, S., Pemovska, T., Stefanidou, T., Foye, U., Cooper, R., Kular, A., Greenburgh, A., Baldwin, H., Griffiths, J., Saunders, K. R. K., et al. (2024) · BJPsych Open · doi:10.1192/bjo.2024.707 · Cited by 22 · see citing works
“52 Another study demonstrated limited feasibility and acceptability of bespoke RTSM, 53 as the unpredictability of the intervention led to frustration and interference with life.”
InfluentialDeveloping Valid and Feasible Measures of Sexual Consent for Experience Sampling Methodology
Willis, M., Jozkowski, K. N., Bridges, A. J., Davis, R. E., & Veilleux, J. C. (2021) · The Journal of Sex Research · doi:10.1080/00224499.2021.1907526 · Cited by 19 · see citing works
Laarhoven, T. R. V., Johnson, J. W., Andzik, N. R., Fernandes, L., Ackerman, M., Wheeler, M., Melody, K., Cornell, V., Ward, G., & Kerfoot, H. L. (2021) · Advances in Neurodevelopmental Disorders · doi:10.1007/s41252-020-00191-6 · Cited by 16 · see citing works
Cognitive processes in autism: Repetitive thinking in autistic versus non-autistic adults
Cooper, K., Russell, A., Calley, S., Chen, H., Kramer, J., & Verplanken, B. (2022) · Autism · doi:10.1177/13623613211034380 · Cited by 14 · see citing works
“…and participants were able to use the alert system to notice and report thought form and content in the moment, allowing us to gain insights into the internal experience of autistic people, as in previous studies (Chen et al., 2016; Hare et al., 2016; Hintzen et al., 2010; Kovac et al., 2016).”
MethodResultEvers, K., Gijbels, E., Maljaars, J., Rumball, F., Spain, D., Happe, F. G. E., & Noens, I. L. J. (2022) · Autism · doi:10.1177/13623613221119749 · Cited by 10 · see citing works
Adams, L., Valmaggia, L., & Simonoff, E. A. (2021) · Review Journal of Autism and Developmental Disorders · doi:10.1007/s40489-021-00275-6 · Cited by 7 · see citing works
Approaches to improving mental health care for autistic people: a systematic reviewPreprint
Loizou, S., Pemovska, T., Stefanidou, T., Foye, U., Cooper, R. E., Kular, A., Greenburgh, A., Baldwin, H., Griffiths, J., Saunders, K. R. K., et al. (2023) · medRxiv · doi:10.1101/2023.03.10.23287101 · Cited by 5 · see citing works
Wearable Technologies: A New Way to Address Student Anxiety
Johnson, J. W., Conderman, G., Laarhoven, T. R. V., & Liberty, L. M. (2022) · Kappa Delta Pi Record · doi:10.1080/00228958.2022.2076531 · Cited by 4 · see citing works
O’Neill, S. J., & Smyth, S. (2023) · Assistive Technology · doi:10.1080/10400435.2023.2230480 · Cited by 6 · see citing works
Temple, J., Cherry, M. G., Gray, V., Jones, A., & Fisher, P. (2023) · Epilepsy & Behavior · doi:10.1016/j.yebeh.2023.109599 · Cited by 4 · see citing works
Hussain, A. (2018) · Journal of Knowledge & Communication Management · doi:10.5958/2277-7946.2018.00014.1 · Cited by 1 · see citing works
Technology Use as a Support Tool by Secondary Students with Autism: A Mixed Methods Investigation
Hedges, S. H. (2019) · Carolina Digital Repository (University of North Carolina at Chapel Hill) · doi:10.17615/1050-yy23 · Cited by 1 · see citing works
Serratore, T., Berdelmann, K., & Schmiedek, F. (2024) · doi:10.31234/osf.io/xjn3f · Cited by 1 · see citing works
Temple, J. (2019) · University of Liverpool · doi:10.17638/03033174
Serratore, T., Berdelmann, K., & Schmiedek, F. (2024) · doi:10.31219/osf.io/bp26a
Nardacchione, G., & Doronzo, F. (2025) · Springer eBooks · doi:10.1007/978-3-031-40858-8_387-1
Nardacchione, G., & Doronzo, F. (2026) · Springer eBooks · doi:10.1007/978-3-032-11375-7_387
- Authors
- Hare, D. J., Gracey, C., & Wood, C.
- Affiliations
- Cardiff University (GB)
- Homerton University Hospital NHS Foundation Trust (GB)
- National Health Service (GB)
- Corresponding author
- Hare, Dougal Julian
- Venue
- Autism
- Publisher
- SAGE Publications
- Published
- 2015-10-29
- Volume
- 20
- Issue
- 6
- Pages
- 730-743
- ISSN
- 1362-3613 (ISSN-L)
- 1461-7005
- OpenAlex
- W2270714771
- Cited by
- 22
- References
- 52
- Citations by year
- 2026: 1 · 2025: 1 · 2024: 3 · 2023: 3 · 2022: 2 · 2021: 4 · 2020: 1 · 2019: 3 · 2018: 2 · 2017: 1 · 2016: 1
- FWCI
- 0.80
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Autism (publishedVersion)
- PubMed (publishedVersion)
- ORCA Online Research @Cardiff (Cardiff University) (submittedVersion)
- Topics
- Life Sciences › Neuroscience › Cognitive Neuroscience › Autism Spectrum Disorder Research
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Mental Health Research Topics
- Keywords
- high-functioning autism, anxiety, stress, worry, mobile platforms, cognitive behavioral therapy, ecological momentary assessment, rumination, mood, autistic adults
- MeSH terms
- Ecological Momentary Assessment, Adolescent, Adult, Aged, Anxiety Disorders, Autistic Disorder, England, Female, Humans, Male, Middle Aged, Pilot Projects, Surveys and Questionnaires, Computers, Handheld, Young Adult
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
Are you an author, or do you see a problem with this page? Request a review