Network Analysis of Anxiety in the Autism Realm

  • Farhad Montazeri
  • Annelies de Bildt
  • Vera Dekker
  • George M. Anderson
Original Paper


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.


Network 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.

Author Contributions

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.


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 funded by the Netherlands Organization for Health Research and Development (ZonMw, nr 157003005).

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.

Ethical Approval

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

Informed consent was obtained from all individual participants included in the study.

Supplementary material

10803_2018_3474_MOESM1_ESM.docx (1.9 mb)
Supplementary material 1 (DOCX 1944 KB)


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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  • Farhad Montazeri
    • 1
  • Annelies de Bildt
    • 2
    • 3
  • Vera Dekker
    • 2
    • 3
  • George M. Anderson
    • 1
  1. 1.Child Study CenterYale University School of MedicineNew HavenUSA
  2. 2.Department of Child and Adolescent PsychiatryUniversity of Groningen Medical Center, University of GroningenGroningenThe Netherlands
  3. 3.Accare, Child and Adolescent PsychiatryGroningenThe Netherlands

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