Network Analysis of Anxiety in the Autism Realm
The anxiety and autism realms are each complicated and heterogeneous, and relationships between the two areas are especially complex. Network analysis offers a promising approach to the phenotypic complexities of typical and atypical human behavior. The Revised Children’s Anxiety and Depression Scale (RCADS) was used to assess anxiety in 126 high-functioning 9–13 year-olds with ASDs. Network graphs of Autism Diagnostic Observation Schedule items and RCADS anxiety total score, social, generalized, panic and separation anxiety subscores consistently found the anxiety node (score) to be highly peripheral. Also, the networks of RCADS anxiety items themselves were similar for the ASDs group and a general population comparison group (n = 2017). The results suggest anxiety is not a central part of autism and that anxiety is dynamically similar (aspects of anxiety relate to one another in a similar manner) in high-functioning autism and the general population.
KeywordsNetwork analysis Autism Diagnostic Observation Schedule Behavior ADOS item scores Anxiety Revised Children’s Anxiety and Depression Scale
The current study is based on data from the Efficacy of Social Skills Training in Autism (ESTIA) study, conducted by Accare Center for Child and Adolescent Psychiatry and financed by the Netherlands Organization for Health Research and Development (ZonMw, nr 157003005). The study also used data from the TRacking Adolescents’ Individual Lives Survey (TRAILS). Participating centers of TRAILS include various departments of the University Medical Center and University of Groningen, the Erasmus University Medical Center Rotterdam, the University of Utrecht, the Radboud Medical Center Nijmegen, and the Parnassia Bavo group, all in the Netherlands. TRAILS has been financially supported by various grants from the Netherlands Organization for Scientific Research (NWO), ZonMW, GB-MaGW, the Dutch Ministry of Justice, the European Science Foundation, BBMRI-NL, the participating universities, and Accare Center for Child and Adolescent Psychiatry. We are grateful to all children, their parents, and teachers who participated in this research, and to everyone who worked on this project and made it possible.
GMA conceived the project, oversaw the data analysis, and wrote the paper. FM performed data analysis and wrote the paper. AdB oversaw all clinical aspects of the project, and wrote the paper. VD contributed to the patient assessment and methodological aspects of the paper.
Compliance with Ethical Standards
Conflict of interest
Author FM declares he has no conflict of interest. Author AdB is first author on the Dutch ADOS manual for which her institution (Accare) receives remuneration. Author VD declares she has no conflict of interest. Author GMA has received remuneration from the law firm Pepper Hamilton LLP, Philadelphia, PA, for consultation regarding their representation of the pharmaceutical firm Eli Lilly & Co.
Author AdB received a grand by the Netherlands Organization for Health Research and Development (ZonMw, nr 157003005) which funded this study. The agency had no role in the data analyses, the decision to publish, or the preparation of the manuscript.
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.
Informed consent was obtained from all individual participants included in the study.
- Cholemkery, H., Mojica, L., Rohrmann, S., Gensthaler, A., & Freitag, C. M. (2014). Can autism spectrum disorders and social anxiety disorders be differentiated by the social responsiveness scale in children and adolescents? Journal of Autism and Developmental Disorders, 44(5), 1168–1182.CrossRefPubMedGoogle Scholar
- Dekker, V., Nauta, M. H., Mulder, E. J., Timmerman, M. E., & de Bildt, A. (2014). A randomized controlled study of a social skills training for preadolescent children with autism spectrum disorders: Generalization of skills by training parents and teachers? BMC Psychiatry, 14, 189.CrossRefPubMedPubMedCentralGoogle Scholar
- Duifhuis, E. A., den Boer, J. C., Doornbos, A., Buitelaar, J. K., Oosterling, I. J., & Klip, H. (2017). The effect of pivotal response treatment in children with autism spectrum disorders: A non-randomized study with a blinded outcome measure. Journal of Autism and Developmental Disorders, 47, 231–242.CrossRefPubMedGoogle Scholar
- Hallett, V., Ronald, A., Colvert, E., Ames, C., Woodhouse, E., Lietz, S., Garnett, R., Gillan, N., Rijsdijk, F., Scahill, L., Bolton, P., & Happé, F. (2013). Exploring anxiety symptoms in a large-scale twin study of children with autism spectrum disorders, their co-twins and controls. Journal of Child Psychology and Psychiatry, 54, 1176–1185.CrossRefPubMedGoogle Scholar
- Kerns, C. M., Kendall, P. C., Berry, L., Souders, M. C., Franklin, M. E., Schultz, R. T., Miller, J., & Herrington, J. (2014). Traditional and atypical presentations of anxiety in youth with autism spectrum disorder. Journal of Autism and Developmental Disorders, 44, 2851–2861.CrossRefPubMedPubMedCentralGoogle Scholar
- Kobourov, S. G. (2012). Spring embedders and force-directed graph drawing algorithms. http://arxiv.org/abs/1201.3011.
- Lee, M., Aggen, S. H., Otowa, T., Castelao, E., Preisig, M., Grabe, H. J., Hartman, C. A., Oldehinkel, A. J., Middeldorp, C. M., Tiemeier, H., & Hettema, J. M. (2016). Assessment and characterization of phenotypic heterogeneity of anxiety disorders across five large cohorts. International Journal of Methods in Psychiatric Research, 25(4), 255–266.CrossRefPubMedPubMedCentralGoogle Scholar
- Lord, C., Rutter, M., DiLavore, P. C., & Risi, S. (1999). ADOS Autism Diagnostic Observation Schedule Manual. Los Angeles: WPS.Google Scholar
- Lord, C., Rutter, M., DiLavore, P. C., Risi, S., Gotham, K., & Bishop, S. (2012). Autism diagnostic observation schedule, second edition (ADOS-2) manual (Part I): Modules 1–4. Torrance, CA: Western Psychological Services.Google Scholar
- Rutter, M., Le Couteur, A., & Lord, C. (2003). ADI-R Autism Diagnostic Interview Revised Manual. Los Angeles: Western Psychological Services.Google Scholar
- 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.CrossRefPubMedGoogle Scholar
- South, M., & Rodgers, J. (2017). Sensory, emotional and cognitive contributions to anxiety in autism spectrum disorders. Frontiers in Human Neuroscience, 24, 11–20.Google Scholar
- Sparrow, S. S., Balla, D., & Cicchetti, D. V. (1984). Vineland Adaptive Behavior Scales (Survey ed.). Circle Pines, MN: American Guidance Service.Google Scholar
- Sukhodolsky, D. G., Scahill, L., Gadow, K. D., Arnold, L. E., Aman, M. G., McDougle, C. J., McCracken, J. T., Tierney, E., White, W., Lecavalier, S. L., & Vitiello, B. (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(1), 117–128.CrossRefPubMedGoogle Scholar
- Ung, D., Wood, J. J., Ehrenreich-May, J., Arnold, E. B., Fuji, C., Renno, P., Murphy, T. K., Lewin, A. B., Mutch, P. J., & Storch, E. A. (2013). Clinical characteristics of high-functioning youth with autism spectrum disorder and anxiety. Neuropsychiatry (London), 3(2). https://doi.org/10.2217/npy.13.9
- Wechsler, D. (1999). Wechsler Intelligence Scale for Children, 3rd edn. San Antonio, TX: Psychological Corporation.Google Scholar
- White, S. W., Mazefsky, C. A., Dichter, G. S., Chiu, P. H., Richey, J. A., & Ollendick, T. H. (2014). Social-cognitive, physiological, and neural mechanisms underlying emotion regulation impairments: Understanding anxiety in autism spectrum disorder. International Journal of Developmental Neuroscience, 39, 22–36.CrossRefPubMedPubMedCentralGoogle Scholar
- Wood, J. J., & Gadow, K. D. (2010). Exploring the nature and function of anxiety in youth with autism spectrum disorders. Clinical Psychology: Science and Practice, 17(4), 281–292.Google Scholar