Exploring Anxiety and Executive Function Among School-Aged Children with ASD

Background: The prevalence of anxiety in children with autism spectrum disorder (ASD) is higher than that of the general population. Previous research has found that between 22-84% of children with ASD are affected by at least one anxiety disorder (Vasa & Mazurek, 2015). Many individuals with ASD also exhibit significant difficulties with executive function (EF). To our knowledge, only two studies have investigated the connection between anxiety symptoms and EF in children with ASD, one of which included adolescents aged 14-16 years (Hollocks, et al. 2014) and the other used only parent report measures (Lawson, et al., 2015). 

Objectives: The first objective was to determine whether diagnostic groups of school-aged children differed on a parent reported measure of children’s anxiety. A second goal was to explore the relation between EF performance and anxiety symptoms in children ages 7-11 with ASD.  

Methods: Participants included 28 children with ASD and 33 children with typical development (TD) all between 7-11 years of age. The groups were age, sex, and IQ-matched. Executive function was measured using parent report from the Behavioral Rating Inventory of Executive Function (BRIEF) and two computer-based tasks, the Change Task and Stroop Task. The Change Task included “Go” trials, which were a two-choice reaction time task, and “Change” trials, which added an additional stop signal that designated when children should stop and press a third button. During the Stroop Task, words were presented in pseudo-random order in red, green, yellow, and blue and children responded to the color the word was written in, even when the word introduced conflicting information (e.g., blue written in red). Anxiety was measured via parent report on the Child Behavior Checklist (CBCL). 

Results: Groups differed significantly on scales of anxiety, t(58) = 4.02,  p < .001, anxious depression, t(58) = 3.29,  p = .002, and internalizing problems, t(58) = 4.00, p< .001, with parents of children with ASD reporting higher scores on all three measures. Within the ASD group, children with worse BRIEF shifting scores were rated as being more anxious, r = .44, p = .02. Stop signal reaction time, which indicates latency of inhibition, was correlated with CBCL subscales of anxiety, r = .41, p = .05, anxious depression, r = .57, p = .004, and internalizing problems, r = .50, p = .01. Lower inhibition on the Stroop Task was also correlated with higher reported anxiety symptoms, r  = -.48, p= .02. 

Conclusions: We found that children with ASD had significantly higher ratings of anxiety when compared to TD children, which supports previous research that individuals with autism are affected by comorbid anxiety. Additionally, within the group with ASD, measures of EF, specifically inhibition and shifting, were correlated with parent reported levels of child anxiety. This relationship may indicate that inhibition and shifting play a role in the behavioral functionality of individuals with ASD, which is exhibited as anxiety.  We expect to have data for approximately 20 more children with ASD by May.