Anxiety is significantly more prevalent amongautistic individualscompared to the general population. This heightened prevalence may be due to various factors, including sensory sensitivities, difficulties withsocial communication, and challenges in adapting to change.
A key concept in understandinganxiety in autismis Theory of Mind (ToM) – the ability to understand others’ thoughts, feelings, and intentions.
Impaired ToM, often observed in autism, can lead to social difficulties and misunderstandings, potentially contributing to anxiety.
Anxiety in autism can present in both typical and atypical ways, ranging from excessive worry to increased repetitive behaviors or meltdowns.
Recognizing and addressing anxiety, while considering ToM abilities, is crucial for improving overall quality of life for autistic individuals.
Key Points
Rationale
Autistic children often experience significant challenges in social functioning, including difficulties with social communication, understanding others’ perspectives, and developing positive peer relationships (Chevallier et al., 2012; Kimhi, 2014).
The researchers were particularly interested in identifying which aspects of social functioning are most strongly associated with anxiety and with each other, as this information could help inform more targeted interventions.
Additionally, the study sought to explore how social functioning profiles may relate to distinct presentations of social anxiety in autistic youth, an area that has received limited attention in previous research.
Method
The study used a multimethod, multi-informant approach to assess various aspects of social functioning and anxiety in a sample of autistic children with co-occurring anxiety disorders.
Procedure
Sample
The final sample included 191 autistic children (ages 7-13) with co-occurring anxiety disorders and their caregivers.
Participants were predominantly male (79.1%) and White (76.7%), with varied autism and anxiety symptom severity and mildly impaired to superior intellectual functioning.
Measures
Statistical measures
The study employed Bayesian network analytics using the R package BGGM. This approach allowed for examining unique associations among specific elements of social functioning while controlling for other variables in the model.
Pairwise comparisons of edges between nodes were conducted to identify the strongest relationships. Binary logistic regressions were used to examine how social functioning related to different presentations of social anxiety.
Results
Insight
This study provides a nuanced understanding of how different aspects of social functioning relate to each other and to anxiety in autistic children.
The emergence of social motivation as a central factor suggests that interventions focusing on increasing children’s interest in social interactions may have cascading positive effects on other areas of social functioning.
The finding that ToM was highly interconnected with other social variables highlights its potential importance in social skill development and peer relationships for autistic youth with anxiety.
The distinct communities of social functioning identified in the network analysis suggest that difficulties in one area of social functioning (e.g., social communication) may be closely linked to challenges in related areas (e.g., friendship quality).
This underscores the potential value of comprehensive social skills interventions that address multiple facets of social functioning simultaneously.
The association between bullying experiences and multiple anxiety disorders highlights the need for targeted interventions to address peer victimization in autistic youth. Future research could explore the effectiveness of anti-bullying programs specifically tailored for autistic children in reducing anxiety symptoms.
The finding that autistic children with distinct social fears (not related to fear of negative evaluation) showed more difficulty with ToM compared to those with traditional social anxiety disorder suggests that different mechanisms may underlie various presentations ofsocial anxiety in autism.
This has implications for tailoring anxiety interventions to address the specific cognitive processes involved in an individual’s anxiety presentation.
Strengths
This study had several methodological strengths, including:
Limitations
This study also had several methodological limitations, including:
Implications
The findings have several important implications for clinical practice and future research:
References
Primary reference
Hunsche, M. C., Cervin, M., Storch, E. A., Kendall, P. C., Wood, J. J., & Kerns, C. M. (2022). Social functioning and the presentation of anxiety in children on the autism spectrum: A multimethod, multiinformant analysis.Journal of Psychopathology and Clinical Science, 131(2), 198–208.https://doi.org/10.1037/abn0000724
Other references
Chang, Y. C., Quan, J., & Wood, J. J. (2012). Effects of anxiety disorder severity on social functioning in children with autism spectrum disorders.Journal of Developmental and Physical Disabilities,24, 235-245.https://doi.org/10.1007/s10882-012-9268-2
Chevallier, C., Kohls, G., Troiani, V., Brodkin, E. S., & Schultz, R. T. (2012). The social motivation theory of autism.Trends in cognitive sciences,16(4), 231-239.https://doi.org/10.1016/j.tics.2012.02.007
Duvekot, J., van der Ende, J., Verhulst, F. C., & Greaves‐Lord, K. (2018). Examining bidirectional effects between the autism spectrum disorder (ASD) core symptom domains and anxiety in children with ASD.Journal of Child Psychology and Psychiatry,59(3), 277-284.https://doi.org/10.1111/jcpp.12829
Kerns, C. M., Rast, J. E., & Shattuck, P. T. (2020). Prevalence and correlates of caregiver-reported mental health conditions in youth with autism spectrum disorder in the United States.The journal of clinical psychiatry,82(1), 11637.
Kimhi, Y. (2014). Theory of mind abilities and deficits in autism spectrum disorders.Topics in Language Disorders,34(4), 329-343.
McVey, A. J., Schiltz, H. K., Haendel, A. D., Dolan, B. K., Willar, K. S., Pleiss, S. S., … & Van Hecke, A. V. (2018). Social difficulties in youth with autism with and without anxiety and ADHD symptoms.Autism Research,11(12), 1679-1689.https://doi.org/10.1002/aur.2039
Simonoff, E., Pickles, A., Charman, T., Chandler, S., Loucas, T., & Baird, G. (2008). Psychiatric disorders in children with autism spectrum disorders: prevalence, comorbidity, and associated factors in a population-derived sample.Journal of the American Academy of Child & Adolescent Psychiatry,47(8), 921-929.https://doi.org/10.1097/CHI.0b013e318179964f
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Saul McLeod, PhD
BSc (Hons) Psychology, MRes, PhD, University of Manchester
Saul McLeod, PhD., is a qualified psychology teacher with over 18 years of experience in further and higher education. He has been published in peer-reviewed journals, including the Journal of Clinical Psychology.
Olivia Guy-Evans, MSc
BSc (Hons) Psychology, MSc Psychology of Education
Olivia Guy-Evans is a writer and associate editor for Simply Psychology. She has previously worked in healthcare and educational sectors.
