Relative Expressive Language Deficits Predict Anxiety in Youth with Autism Spectrum Disorder
Authors: Paul Young, Lee A. Santore, Christopher M. Esposito, Alan Gerber, Matthew D. Lerner
Affiliations: Stony Brook University
Background: Language deficits are characteristic of many youth with autism spectrum disorder (ASD; Van der Paelt et al. 2014), especially impairments in expressive language relative to receptive language (Grossman & Tager-Flusberg, 2012). Research indicates that expressive and receptive language deficits are associated with symptoms of anxiety, particularly social anxiety, in typically developing children (Snowling et al., 2006; Carson et al., 1998; Wadman et al., 2011). Anxiety disorders (AD), particularly social anxiety, are common in youth with ASD (Simonoff et al. 2008), and are strongly related to ASD symptom severity (Renno et al., 2014; Sukhodolsky et al., 2008). Thus, ASD symptom severity and expressive language deficits may both impact anxiety symptoms in ASD youth. However, whether relative expressive language deficits, controlling for ASD symptomatology, directly impact anxiety in ASD youth has not been tested.
Objectives: This study examined the relationship between relative expressive language deficits and elements of anxiety in ASD youth. We hypothesized that these deficits would be positively related to anxiety, specifically social anxiety, even after controlling for ASD symptom severity.
Methods: Fifty-six youth (Mage=12.43, SDage=2.78) with ADOS-2 (Lord et al., 2012) confirmed diagnoses completed the Kaufman Brief Intelligence Test-2 (KBIT-2; Kaufman, 1997) and the Multidimensional Anxiety Scale (MASC; March, 1997) to measure language ability and anxiety, respectively. The two verbal sub-scales of the KBIT-2 were used to represent measure receptive and expressive language skills, as the Verbal Knowledge sub-scale measures receptive vocabulary (Kaufman & Kaufman, 2004), and the Riddles sub-scale parallels the expressive language sub-scale used in the original KBIT (Bain & Jaspers, 2010). The standardized difference score method (De Los Reyes & Kazdin, 2004) was used to evaluate the difference between the KBIT-2 verbal knowledge and riddles sub-scales. This difference was used to quantify the relative impairment gap between receptive and expressive language. Parents completed the Social Responsiveness Scale-2 (SRS-2; Constantino & Gruber, 2012) as a measure of ASD symptoms.
Results: Hierarchical multiple regression controlling for SRS-2 revealed that expressive language deficits, relative to receptive language, predicted increased levels of self-reported anxiety (b=.629, p=.027), specifically generalized anxiety disorder symptoms and separation, humiliation and rejection, social, and physical anxieties (all bs<.770, ps<.043), while controlling for individual differences in ASD symptomatology. Neither receptive nor expressive language alone were predictors of anxiety (all ps>.051).
Conclusions: Deficits in expressive language, relative to receptive, predicted levels of anxiety in ASD youth. These results suggest a need for providers to be aware of these deficits, as they are important predictors of anxiety. These findings also better characterize the phenotype of ASD and comorbid AD by addressing the deficits which contribute to this relationship.