Parent-Rated Anxiety Symptoms in Youth with ASD and Their Association with Problem Behaviors in an Inpatient Setting

Poster Presentation
Thursday, May 10, 2018: 5:30 PM-7:00 PM
Hall Grote Zaal (de Doelen ICC Rotterdam)
R. Mahajan1, H. Nichols1, B. Troen1 and C. A. Mazefsky2, (1)Sheppard Pratt Health System, Towson, MD, (2)Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA

Youth with autism spectrum disorder (ASD) are frequently diagnosed with anxiety disorders, which may have a significant negative impact on their functioning; these symptoms may also impede their development and learning. Furthermore, severe problem behaviors (PB; aggression, disruptive and self-injurious behaviors, SIB) in these youth, may require inpatient hospitalization for safety and stabilization. Due to their internalizing nature, anxiety symptoms may be overlooked by clinicians in contrast to externalizing behaviors. Even though anxiety disorders are among the most prevalent co-occurring psychiatric conditions in these youth, little is known about anxiety symptoms’ potential impact upon PB, in youth with ASD needing inpatient treatment.


This study aims to characterize parent-rated anxiety symptoms in youth with ASD in an inpatient setting, by examining the relationship between parent-rated anxiety symptoms, externalizing behaviors, and SIB.


Participants were 282 youth (78% male) ages 5-20 years (mean age 12.9 years; SD ±3.2), with ADOS-confirmed ASD, enrolled through the Autism Inpatient Collection (AIC), a multisite study of youth with ASD hospitalized on 6 specialized inpatient psychiatric units across the U. S. Data were collected from parents on the youth’s, communication, externalizing behaviors, emotion regulation, and SIB. Child and Adolescent Symptom Inventory (CASI-5) was used for parent-reported psychiatric symptoms including anxiety. Using previous research, 20 items from the original CASI-5 anxiety items were selected for analyses. Hierarchical linear regression and independent samples t-tests were used to determine the relationship between anxiety symptoms, externalizing behaviors, and self-injurious behaviors.


Prevalence of anxiety disorders was as follows: simple phobia (65%), generalized anxiety disorder (38%), somatization disorder (30%), panic disorder (28%), separation anxiety (21%), and social phobia (18%). Mean scores for externalizing behaviors were significantly higher for youth who met criteria for panic disorder (p < .001) and somatization disorder (p = .003). Mean scores for SIB were significantly higher for youth who met criteria for simple phobia (p = .005), social phobia (p = .031), and separation anxiety (p = .005). Separate regression models for each type of anxiety were conducted based on significant bivariate results and controlled for age, gender, race, income, and verbal ability. Both panic and somatization disorders were no longer significantly related to externalizing behaviors, after control variables were added. Simple phobia (b = .98, t (233) = 2.85, p =.005), social phobia (b = .40, t (240) = 2.08, p =.039), and separation anxiety (b = .30, t (240) = 3.96, p < .001), remained significant in their respective models predicting SIB.


Youth with ASD requiring inpatient stabilization for problem behavior may also experience significant anxiety symptoms. Presence of externalizing behaviors or SIB should prompt an assessment of specific anxiety disorders. Future research should explore whether anxiety is driving or maintaining problem behaviors.