Abstract
Despite reports of high anxiety in children with autism spectrum disorders (ASD), there is controversy regarding differential diagnosis of ASD symptoms and anxiety symptoms. This study examined 88 children, aged 7–11 years, with ASD referred for concerns about anxiety. A multitrait-(social anxiety, separation anxiety, overall anxiety severity, and overall ASD severity), multimethod-(diagnostic interviews, parent-, and child-based measures) analysis was conducted. Results from structural equation modeling suggest statistical discrimination between anxiety and ASD severity and convergence among differing reports of two of the anxiety subdomains (separation anxiety and overall anxiety). These findings suggest that anxiety symptoms experienced by children with ASD are separate from ASD symptom severity and may instead reflect anxiety syndromes (e.g., separation anxiety) similar to those that occur in typically developing children.
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Achenbach, T. M., McConaughy, S. H., & Howell, C. T. (1987). Child/adolescent behavioral and emotional problems: Implications of cross-informant correlations for situational specificity. Psychological Bulletin, 101(2), 213–232.
American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders (4th edn., Text Rev.). Washington, D.C.: APA Press.
Arbuckle, J. L. (1996). Full information estimation in the presence of incomplete data. In G. A. Marcoulides & R. E. Schumacker (Eds.), Advanced structural equation modeling: Issues and techniques (pp. 243–277). Mahwah, NJ: Lawrence Erlbaum.
Bellini, S. (2004). Social skill deficits and anxiety in high-functioning adolescents with autism spectrum disorders. Focus on Autism & Other Developmental Disabilities, 19, 78–86.
Ben-Sasson, A., Cermak, S. A., Orsmond, G. I., Tager-Flusberg, H., Kadlec, M. B., & Carter, A. S. (2008). Sensory clusters of toddlers with autism spectrum disorders: Differences in affective symptoms. Journal of Child Psychology and Psychiatry, 49(8), 817–825.
Bentler, P. M. (2006). EQS 6 structural equations program manual. Encino, CA: Multivariate Software, Inc.
Byrne, B. M. (1994). Structural equation modeling with eqs and eqs/windows: Basic concepts, applications, and programming. Beverley Hills: Sage Publications.
Campbell, D. T., & Fiske, D. W. (1959). Convergent and discriminant validation by the multitrait-multimethod matrix. Psychology Bulletin, 56, 81–105.
Carper, R. A., & Courchesne, E. (2005). Localized enlargement of the frontal cortex in early autism. Biological Psychiatry, 57, 126–133.
Chang, Y., Quan, J., & Wood, J. J. (2012). Effects of anxiety disorder severity on social functioning in children with autism spectrum disorders. Journal of Developmental and Physical Disabilities, 24, 235–245.
Constantino, J. N. (2002). The social responsiveness scale. Los Angeles: Western Psychological Services.
Constantino, J. N., & Gruber, C. P. (2005). The social responsiveness scale (SRS) manual. Los Angeles: Western Psychological Services.
Corbett, B. A., Constantine, L. J., Hendren, R., Rocke, D., & Ozonoff, S. (2009). Examining executive functioning in children with autism spectrum disorder, attention deficit hyperactivity disorder and typical development. Psychiatry Research, 166, 210–222.
Craske, M. G. (1999). Anxiety disorders: Psychological approaches to theory and treatment. Boulder, CO: Westview Press.
de Bruin, E. I., Ferdinand, R. F., Meester, S., de Nijs, P. F., & Verheij, F. (2007). High rates of psychiatric co-morbidity in PDD-NOS. Journal of Autism and Developmental Disorders, 37, 877–886.
Eisenberg, N., Valiente, C., Spinrad, T. L., Cumberland, A., Liew, J., Reiser, M., et al. (2009). Longitudinal relations of children’s effortful control, impulsivity, and negative emotionality to their externalizing, internalizing, and co-occurring behavior problems. Developmental Psychology, 45(4), 988–1008.
Enders, C. K., & Bandalos, D. L. (2001). The relative performance of full information maximum likelihood estimation for missing data in structural equation models. Structural Equation Modeling, 8, 430–457.
EQS 6.2 for windows [computer program]. (2006). Version 6.2. Multivariate Software, Encino
Farrugia, S., & Hudson, J. (2006). Anxiety in adolescents with Asperger syndrome: Negative thoughts, behavioral problems, and life interference. Focus on Autism and Other Developmental Disabilities, 21, 25–35.
Gadow, K. D., DeVincent, C. J., & Pomeroy, J. (2006). ADHD symptom subtypes in children with pervasive developmental disorder. Journal of Developmental Disorders, 36, 271–283.
Gadow, K. D., Devincent, C. J., Pomeroy, J., & Azizian, A. (2005). Comparison of DSM-IV symptoms in elementary school-age children with PDD versus clinic and community samples. Autism, 9(4), 392–415.
Gillott, A., Furniss, F., & Walter, A. (2001). Anxiety in high-functioning children with autism. Autism, 5(3), 277–286.
Gillott, A., & Standen, P. J. (2007). Levels of anxiety and sources of stress in adults with autism. Journal of Intellectual Disabilities, 11(4), 359–370.
Green, S. A., & Ben-Sasson, A. (2010). Anxiety disorders and sensory over-responsivity in children with autism spectrum disorders: Is there a causal relationship? Journal of Autism and Developmental Disorders, 40, 1495–1504.
Green, J., Gilchrist, A., Burton, D., & Cox, A. (2000). Social and psychiatric functioning in adolescents with Asperger syndrome compared with conduct disorder. Journal of Autism and Developmental Disorders, 30, 279–293.
Kendall, P. C., Compton, S. N., Walkup, J. T., Birmaher, B., Albano, A. M., Sherrill, J., et al. (2010). Clinical characteristics of anxiety disordered youth. Journal of Anxiety Disorders, 24, 360–365.
Klin, A., Pauls, R., Schultz, R., & Volkmar, F. (2005). Three diagnostic approaches to Asperger syndrome: Implications for research. Journal of Autism and Developmental Disorders, 35, 221–234.
Langer, D. A., Wood, J. J., Bergman, R. L., & Piacentini, J. C. (2010). A multitrait-multimethod analysis of the construct validity of child anxiety disorders in a clinical sample. Child Psychiatry and Human Development, 41(5), 549–561.
Le Couteur, A., Lord, C., & Rutter, M. (2003). The autism diagnostic interview-revised. Los Angeles: Western Psychological Services.
Lecavalier, L., Aman, M. G., Scahill, L., McDougle, C. J., McCracken, J. T., Vitiello, B., et al. (2006). Validity of the autism diagnostic interview-revised. American Journal on Mental Retardation, 111(3), 199–215.
Lecavalier, L., Gadow, K. D., DeVincent, C. J., & Edwards, M. C. (2009). Validation of DSM-IV model of psychiatric syndromes in children with autism spectrum disorder. Journal of Autism and Developmental Disorders, 39, 278–289.
Liss, M., Saulnier, C., Fein, D., & Kinsbourne, M. (2006). Sensory and attention abnormalities in autistic spectrum disorders. Autism, 10(2), 155–172.
Lord, C., Risi, S., Lambrecht, L., Cook, E. H., Leventhal, B. L., DiLavore, P. C., et al. (2000). The autism diagnostic observation schedule—generic: A standard measure of social and communication deficits associated with the spectrum of autism. Journal of Autism and Developmental Disorders, 30(3), 205–223.
Lord, C., Rutter, M., DilLavore, P. C., & Risi, S. (2002). Autism diagnostic observation schedule. Los Angeles: Western Psychological Services.
March, J. (1998). Manual for the multidimensional anxiety scale for children. Toronto: Multi-Health Systems Inc.
March, J. S., Parker, J. D., Sullivan, K., Stallings, P., & Conners, C. K. (1997). The multidimensional anxiety scale for children (MASC): Factor structure, reliability, and validity. Journal of American Academy of Child and Adolescent Psychiatry, 36, 554–565.
Mason, J., & Scior, K. (2004). Diagnostic overshadowing amongst clinicians working with people with intellectual disabilities in the UK. Journal of Applied Research in Intellectual Disabilities, 17, 85–90.
Mazefsky, C. A., Oswald, D. P., Day, T. N., Eack, S. M., Minshew, N. J., & Lainhart, J. E. (2012). ASD, a psychiatric disorder, or both? Psychiatric diagnoses in adolescents with high-functioning ASD. Journal of Clinical Child & Adolescent Psychology, 41(4), 516–523.
Muris, P., Steerneman, P., Merckelbach, H., Holdrinet, I., & Meesters, C. (1998). Comorbid anxiety symptoms in children with pervasive developmental disorders. Journal of Anxiety Disorders, 12, 387–393.
Pfeiffer, B., Kinnealey, M., Reed, C., & Herzberg, G. (2005). Sensory modulation and affective disorders in children and adolescents with Asperger’s disorder. The American Journal of Occupational Therapy, 59, 335–345.
Rubin, D. B. (1976). Inference with missing data. Biometrika, 63, 581–592.
Schafer, J. L., & Graham, J. W. (2002). Missing data: Our view of the state of the art. Psychological Methods, 7, 147–177.
Shwartz, C. B., Henderson, H. A., Inge, A. P., Zahka, N. E., Coman, D. C., Kojkowski, N. M., et al. (2009). Temperament as a predictor of symptomotology and adaptive functioning in adolescents with high-functioning autism. Journal of Autism and Developmental Disorders, 39, 842–855.
Silverman, W. K., & Albano, A. M. (1996). The anxiety disorders interview schedule for DSM-IV—child and parent versions. San Antonio, TX: Graywind.
Simonoff, E., Pickles, A., Charman, T., Chandler, S., Loucas, T., & Baird, G. (2008). Psychiatric disorders in children with autism spectrum disorders: Prevalence, comorbidity, and associated factors in a population-derived sample. Journal of the American Academy of Child and Adolescent Psychiatry, 47, 921–929.
Spiker, M. A., Lin, C. E., Van Dyke, M., & Wood, J. J. (2012). Restricted interests and anxiety in children with autism. Autism, 16, 306–320.
Storch, E. A., Ehrenreich, M. J., Wood, J. J., Jones, A. M., De Nadal, A. S., Lewin, A. B., et al. (2012a). Multiple informant agreement on the anxiety disorders interview schedule in youth with autism spectrum disorders. Journal of Child and Adolescent Psychopharmacology, 22(4), 292–299.
Storch, E. A., Wood, J. J., Ehrenreich-May, J., Jones, A. M., Park, J. M., Lewin, A. B., et al. (2012b). Convergent and discriminant validity and reliability of the pediatric anxiety rating scale in youth with autism spectrum disorders. Journal of Autism and Developmental Disorders, 42(11), 2374–2382.
Sukhodolsky, D. G., Scahill, L., Gadow, K. D., Arnold, L. E., Aman, M. G., McDougle, C. J., et al. (2008). Parent-rated anxiety symptoms in children with pervasive developmental disorders: Frequency and association with core autism symptoms and cognitive functioning. Journal of Abnormal Child Psychology, 36, 117–128.
Tyson, K. E., & Cruess, D. G. (2012). Differentiating high-functioning autism and social phobia. Journal of Autism and Developmental Disorders, 42, 1477–1490.
Weisbrot, D. M., Gadow, K. D., DeVincent, C. J., & Pomeroy, J. (2005). The presentation of anxiety in children with pervasive developmental disorders. Journal of Child and Adolescent Psychopharmacology, 15(3), 477–496.
White, S. W., & Roberson-Nay, R. (2009). Anxiety, social deficits, and loneliness in youth with autism spectrum disorders. Journal of Autism and Developmental Disorders, 39, 1006–1013.
Witwer, A. N., & Lecavalier, L. (2010). Validity of comorbid psychiatric disorders in youngsters with autism spectrum disorders. Journal of Developmental and Physical Disabilities, 22(4), 367–380.
Wood, J. J., Drahota, A., Sze, K., Har, K., Chiu, A., & Langer, D. A. (2009a). Cognitive behavioral therapy for anxiety in children with autism spectrum disorders: A randomized, controlled trial. Journal of Child Psychology and Psychiatry, 50(3), 224–234.
Wood, J. J., Drahota, A., Sze, K., Van Dyke, M., Decker, K., Fujii, C., et al. (2009b). Brief report: Effects of cognitive behavioral therapy on parent-reported autism symptoms in school-age children with high-functioning autism. Journal of Autism and Developmental Disorders, 39(11), 1608–1612.
Wood, J. J., & Gadow, K. D. (2010). Exploring the nature and function of anxiety in youth with autism spectrum disorders. Clinical Psychology: Research and Practice, 17, 281–292.
Wood, J. J., Piacentini, J. C., Bergman, R. L., McCracken, J., & Barrios, V. (2002). Concurrent validity of the anxiety disorders section of the anxiety disorders interview schedule for DSM-IV: Child and parent versions. Journal of Clinical Child and Adolescent Psychology, 31, 335–342.
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This study was supported by grants awarded to Jeffrey J. Wood from the Cure Autism Now Foundation and the National Institute of Mental Health (MH075806). We are grateful to the participating families.
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Renno, P., Wood, J.J. Discriminant and Convergent Validity of the Anxiety Construct in Children with Autism Spectrum Disorders. J Autism Dev Disord 43, 2135–2146 (2013). https://doi.org/10.1007/s10803-013-1767-1
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DOI: https://doi.org/10.1007/s10803-013-1767-1