Objectives : The purpose of this investigation is to examine anxiety symptoms in a well-characterized sample of children with ASD and to determine if there are associations between repetitive/stereotyped behaviors and specific anxiety symptom domains.
Methods : Participants included children with ASD between the age of 3 and 12 years. ASD diagnosis was based on the Autism Diagnostic Observation Schedule (ADOS), Autism Diagnostic Interview Revised (ADI-R) and expert clinical opinion. Parents completed the Repetitive Behavior Scale-Revised (RBS-R) and behavioral measures assessing anxiety symptoms including the Spence Children's Preschool Anxiety Scale (SCPAS) or Spence Children's Anxiety Scale (SCAS), and the Early Childhood Inventory- 4 (ECI-4) for ages 3 to 5 or Child Symptom Inventory-4 (CSI-4) for ages 6 to 12. Spearman’s rho correlations were performed to examine associations between specific anxiety symptoms and repetitive behaviors.
Results : To date, behavioral data and anxiety symptom measures have been collected on 48 children with ASD (mean age: 7.7 ± 2.4). All of the RBS-R subscales were significantly associated with at least one anxiety domain. Stereotyped Behavior was positively associated with Specific Phobia (r=.334; p=.008), Injury Fears (r=.251; p=.049) Separation Anxiety (r=.310; p=.014), Generalized Anxiety (GAD) (r=.523; p=<.001), Social Phobia (r=.330; p=.008) and Compulsions (r=.408; p=.001). Self-Injurious Behavior was correlated with GAD (r= .405; p= .001), Obsessions (r=.301; p=.017), and OCD (r=.269; p=.034). Compulsive Behavior, as measured by the RBS-R, was associated with dimensional scoring of the CSI-4/ECI-4 on GAD (r=.289; p=.022) and Compulsions (r=.431; p=<.001). Additionally, Ritualistic Behavior was associated with several domains including Injury Fears (r=.261; p=.040), Generalized Anxiety on both the SCAS/SCPAS (r=.284; p=.025) and on the CSI-4/ECI-4 (r=.388; p= .002). Interestingly, Restricted Behaviors were only associated with GAD (r=.313; p=.013) and Compulsions (r=.388; p=.002). Finally, Sameness Behaviors was associated with several symptoms including higher Panic (r=.477; p=.001); Injury Fears (r=.275; p=.031) and GAD on the SCAS/SCPAS (r=.408; p= .001) and on CSI-4/ECI-4 (r=.555; p=<.001), Social Phobia (r=.333; p=.008) and Specific Phobia (r=.338; p=.007). In contrast, the Separation Anxiety domain on the SCAS/SCPAS was not significantly associated with any of the RBS-R subscales.
Conclusions: These preliminary data suggest that many anxiety symptom domains are correlated with repetitive behaviors in children with ASD supporting the hypothesis of a common pathogenic mechanism for these clinical features. Overall, severe stereotyped, sameness, and restricted behaviors may be better predictors of higher anxiety symptoms. Further studies with larger sample sizes and a wider age range are warranted to determine the correlates of repetitive behaviors and co-occurring anxiety symptoms which may allow for more targeted diagnostic tools and treatments for individuals with these debilitating symptoms.
See more of: Psychiatric/Behavioral Comorbidities
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