Common and ASD-Distinct Anxiety Presentations and Their Association with Individual Characteristics in a Large Pooled Database of Young People with ASD

Background: Clinically elevated anxiety symptomatology and disorders occur in high rates in young people with ASD. Anxiety symptoms in young people with ASD can be consistent with those found in DSM-5 (also termed as “common” anxieties), while a substantial number may also present with anxiety symptoms that are qualitatively different and more distinct to ASD (“ASD-distinct”).

Objectives: Few studies have systematically examined the phenomenology of anxiety in ASD and only one study to date has explored the associations between different individual characteristics with common and ASD-distinct anxiety presentations. Most current anxiety measurement tools are designed for individuals without ASD and thus, have been inadequate in capturing possible qualitative differences of anxiety in ASD. This research study aims to extend on limited existing literature that examines emerging themes of anxiety symptomatology in ASD, as well as investigating possible associations between individual characteristics and presentations of common and ASD-distinct anxieties.

Methods: Participants were 870 6-18 years old young people with ASD from UK (n=465), Singapore (n=241), and USA (n=164) from an international multi-site pooled database. Caregivers completed the Spence Children’s Anxiety Scale – Parent Version (SCAS-P). Open-ended responses to item 39 (“Is there anything else your child is afraid of?”) were coded, and thematically and quantitatively analyzed to investigate (i) differential presentations of anxiety in ASD and (ii) associations between age, gender, cognitive functioning and autism symptom severity and ASD-distinct anxieties.

Results: Nearly half (47.6%) of the 545 responses obtained from 287 participants in the open-ended optional item 39 were found to be ASD-distinct anxieties. Of those, 54% were sensory, 28.2% were specific unusual phobias; 16% were fears about change/ unpredictability/ routine disruption; and 2.1% were relating to ASD specific social demands. Individuals of younger ages, lower overall cognitive functioning, and higher autism symptom severity tended to present with more ASD-distinct anxieties as compared to common anxieties, while age and autism severity were found to be significant independent predictors of reported ASD-distinct anxieties in subsequent regression analyses.

Conclusions: The results appear to support a profile of both common and ASD-distinct anxiety phenomenology amongst young people with ASD. Future clinical assessments or measures of anxiety should aim to routinely include questions, probes and clarifications to enquire about, and disentangle, both common and ASD-distinct anxieties.