Factors Associated with Anxiety In Children with ASD

Background: Parental anxiety, parental rearing, and family (dys-)functioning are found to be associated with anxiety in typically developing children (e.g. Bögels & Brechman-Toussaint, 2006). In accordance, a study of Kelly, Garnett, Attwood, and Peterson (2008) found that family conflict predicted anxiety/depression in children with ASD. Anxiety/depression in turn predicted ASD-severity. Besides parental anxiety, parental rearing and family (dys-)functioning, we hypothesized that anxiety in children with ASD might be associated with externalizing behaviors. That is, because of their difficulties in emotion regulation (e.g. Laurent & Rubin, 2004), children with ASD may respond to anxiety with more acting out behaviors (White, Oswald, Ollendick, & Scahill, 2009).

Objectives: The aim of this study was to examine which factors are associated with anxiety in children with ASD.

Methods: In total 201 children participated in the study; 85 Children with ASD and comorbid anxiety disorders (further referred to as ASD-sample) and 116 children with anxiety disorders without ASD (further referred to as AD-sample). In addition, 194 mothers and 147 fathers participated. Interviews to measure anxiety disorders, and questionnaires measuring psychopathology symptoms in children and parents, as well as parental rearing and family functioning, were administered.

Results: It was found that anxiety in the ASD-sample was positively correlated with maternal anxiety, ASD-symptoms, and with two family functioning scales, namely Enmeshment (mother report) and Control (father report). For the AD-sample, anxiety was found to be associated with parental anxiety, ASD-symptoms, and with four family functioning scales, namely Conflict (mother report), External locus of control, Enmeshment, and Control (father report). Further, a significant correlation was found between anxiety and externalizing behaviors for both samples. Regression analyses revealed that parental anxiety and family functioning predicted anxiety symptoms in children; however, different significant predictors were identified for respondents (fathers and mothers) and for the two samples. Next, for both samples, anxiety symptoms were found to predict externalizing problems as well as ASD-symptomatology; however, the reverse was also found. That is, ASD-symptomatology significantly predicted anxiety symptoms and externalizing problems. 

Conclusions: Parental (maternal) anxiety and family factors seem to be associated with anxiety symptoms in children with ASD. The results of this study also suggest a bi-directional relation between ASD-symptomatology and symptoms of comorbidity. That is, anxiety symptoms may enhance ASD-symptomatology, while (certain) ASD-symptoms may also increase comorbidity. Interesting, this result was found for the ASD- as well as the AD-sample.