Lower Lifetime ASD Symptom Severity Predicts Increase in Separation Anxiety with Age in Adolescents with ASD
Separation Anxiety (SA) has a distinct presentation in youth with autism spectrum disorder (ASD; White et al., 2014). SA symptoms reliably decline in typically developing (TD) populations throughout childhood (Copeland et al., 2014; Allen et al., 2010). However, previous research in adolescents suggests the opposite pattern in ASD, wherein greater age predicted greater self-reported SA symptoms (Sommer et al., 2016). This presentation may reflect difficulty transitioning social support from parents to peers, as seen in TD populations (Lieberman et al., 1999). Additionally, in ASD populations, past research has shown ASD symptoms predict atypical presentations of anxiety (Kerns et al., 2014). However, whether this relationship between symptom severity and anxiety accounts for the typical trajectory of SA in ASD over time remains unknown.
This study examined the relationship between age and SA symptoms as a function of ASD symptom severity in adolescents with ASD. It was hypothesized that greater age would predict increased SA, and that this effect would be moderated by ASD symptom severity, such that individuals with more severe ASD symptoms would report a stronger relationship between age and SA.
56 youth (Mage= 12.168, SDage= 2.897, 41 male) with ADOS-2 confirmed (Lord et al., 2012) ASD completed a measure of self-reported anxiety (MASC-2; March, 2012). Parents completed a lifetime measure of ASD symptoms (SCQ; Rutter et al., 2003).
Age predicted greater SA (b = 1.388, p = 0.02). This relationship was moderated by ASD symptoms (b = -0.28, p = 0.0098), such that it was evident only among those with fewer symptoms (b = 2.83, p < 0.001). Probing of the SCQ subscales revealed this effect was driven by the reciprocal social interaction domain (b= -0.42, p = 0.018). No other SCQ subscale moderated the relation between age and anxiety for any other anxiety subscale (all p > 0.07)
Results suggest, contrary to the robust normative decrease in SA seen in TD populations, ASD adolescents may struggle to separate from their parents with age. This effect was augmented by parent-reported SCQ scores, specifically in the reciprocal social interactions domain, but was only significant for youth with lower scores, or perceived better social interaction skills. Adolescents with confirmed ASD diagnoses but fewer parent-reported social deficits may reflect the phenomenon of social camouflage (Head et al., 2014), in which – typically beginning in adolescence (Lai et al., 2016) – individuals with ASD learn to mask their symptoms and mimic normative behaviors of peers. It may be that doing this exerts a cost on the individual with ASD – specifically in terms of their ability to shift to normative reliance on peers for social support and separate from their parents. This is consistent with findings that youth with ASD and anxiety often exhibit greater parent-reported communication skills (Kerns et al., 2015). Thus, the moderating effect here may represent a mechanism by which this occurs. These findings further highlight the importance of understanding the heterogeneity of phenotypic expressions of SA in adolescents with ASD.