Heightened Neural Processing of Errors Uniquely Relates to Social Anxiety Symptoms in Youth with ASD

Background: Individuals with autism spectrum disorder (ASD) often experience symptoms associated with generalized anxiety disorder (GAD), obsessive-compulsive disorder (OCD), and social anxiety disorder (SA; Hallett et al., 2013). In other populations, these symptoms are associated with a larger error-related negativity (ERN; Weinberg, Riesel, & Hajcak, 2012), an event-related potential in the scalp-derived electroencephalogram (EEG) that indexes endogenous threat sensitivity (Weinberg, Riesel, & Hajcak, 2012). As such, the ERN may relate to the clinical presentation of anxiety in ASD. However, studies examining these associations in youth with ASD have yielded mixed results (see Hüpen, Groen, Gaastra, Tucha, & Tucha, 2016). This may be due to a focus on broad measures of anxiety, rather than specific symptoms associated with the ERN. In addition, factors known to affect ERN magnitude, such as depression, age, and verbal abilities (Henderson et al., 2006; Meyer, Weinberg, Klein, & Hajcak, 2012), are rarely modeled in this literature.

Objectives: Therefore, the present study aimed to extend this literature by clarifying the relationship between the ERN and anxiety in ASD. This was achieved by examining the relation of the ERN to specific anxiety symptoms, as well as relevant demographic and clinical variables that could affect this relationship, among youth with ASD.

Methods: Fifty-one youth (38 males), ages 8-17 (M_age = 12.15, SD_age = 2.94) with Autism Diagnostic Observation Schedule – 2 (ADOS-2; Lord et al., 2012) confirmed ASD diagnoses and FSIQ ≥ 70 (per the Kaufman Brief Intelligence Test-2; Kaufman & Kaufman, 2004) completed a modified Flanker task, from which the ERN component was obtained (see Figure 1). Parents and children reported on anxiety, depression, and ASD symptoms (see Table 1).

Results: Of the anxiety scales examined, the ERN_Res only correlated with self-reported SA symptoms (see Table 1). The relation between SA symptoms and the ERN_Res was evident for the SA performance fears subscale, and not the SA humiliation rejection fears subscale. The relation between performance fears and the ERN_Res was robust to controlling for self-reported depression symptoms, parent-reported ASD symptoms, verbal IQ, and age in a hierarchical regression, with a medium effect (B = -.26, p < .01).

Conclusions: Self-reported performance fears related to a larger ERN_res; this relation was robust to controlling for age, verbal IQ, depression, and ASD symptoms. Findings suggest that heightened threat sensitivity may be representative of the ambiguous SA presentation in ASD, characterized by social fearfulness and discomfort without fear of negative evaluation (Kerns, Kendall, et al., 2016). Interestingly, no associations were found between the ERN_res and GAD or OCD symptoms. In some youth with ASD, obsessive and compulsive behaviors are more closely related to restricted interests and repetitive behaviors (Spiker, Lin, Van Dyke, & Wood, 2012) rather than anxiety (Kerns et al., 2014), while GAD symptoms may more specifically relate to intense preoccupations (Kerns et al., 2016). Thus, self-reported OCD and GAD symptoms in youth with ASD may reflect a different etiopathology than that which drives the OCD- and GAD-ERN associations in typically developing individuals.