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Biophysiology and Standardized Measures of Anxiety in Adolescents with ASD
Current estimates place the comorbidity of anxiety and autism spectrum disorder (ASD) between 11% and as high as 84% (White et al. 2009). Comorbid anxiety may compound difficulties in social relatedness inherent in ASD and lead to further isolation and social awkwardness (Myles et al. 2001). But the relationship between biophysiologic markers of anxiety, children’s self-reported anxiety levels, and parental perceptions of their child’s anxiety levels is poorly understood. Current data indicate both a difference in parent- and self-reported anxiety levels of children with ASD (Steensel, et al. 2012), and an unclear relationship between social stressors and biophysiologic signs of arousal (Levine et al., 2012).
Objectives:
To analyze biophysiologic markers of arousal in response to the Trier Social Stress Test (TSST, Kirschbaum et al. 1993), as well as the relationship between parent- and child-reported anxiety levels in children with and without ASD.
Methods:
Participants were 12 children with ASD and 28 TD children, matched for age (mean 13:6, range 10:8-17:9), sex, IQ, and language ability. All participants completed the Brief Fear of Negative Evaluation Straightforward Items questionnaire (BFNE, Carleton et al. 2006) and parents and children completed the Screen for Child Anxiety Related Emotional Disorders (SCARED, Birmaher et al. 1999).
The TSST involves two tasks: A story telling activity, where participants must prepare and then present an imaginative narrative based on a short story fragment, and a math task, requiring sequential subtraction of 13 from 1,022. Participants must complete both tasks in front of a panel of non-responsive judges and are told that their performance will be assessed and compared to the performance of all other children who have participated in this task. We used a Biopac system to record electrodermal activity and extracted the number of skin conductivity responses during each of the TSST tasks as well as a low-anxiety baseline.
Results:
Preliminary analysis of 6 participant in each diagnostic cohort shows significantly higher rates of skin conductivity responses indicating heightened anxiety levels in both groups during the story and math sections of the TSST as compared to baseline (p < 0.05 for all comparisons) and no significant between-group differences for any of the measured activities.
Analysis of the standardized measures revealed no significant between-group differences in reported anxiety for the BFNE or the SCARED. However, within-group correlations revealed significantly greater agreement between scores on the parent and child forms of the SCARED in the ASD compared to the TD group (p = 0.015)
Conclusions:
The lack of between-group differences on standardized tests of anxiety and biophysiologic measures suggests that children with high-functioning autism respond comparably to their TD peers when asked to perform in a socially stressful environment. Interestingly, parents of children with ASD appear to be more aware of their children’s anxiety levels, as indicated by high correlations between parent and child SCARED scores, while parents of TD children – who presumably spend less time worrying about their children’s ability to function in a social context – tend to over- or under-estimate their children’s anxiety levels.