Teasing Apart Anxiety and Autism in Kids

Identifying and treating anxiety in children with autism can be difficult, since anxiety behaviors are often masked by symptoms of autism. Now, a professor at Drexel University has made changes to a pre-existing anxiety assessment tool so that it can accurately detect anxiety in children with autism spectrum disorder (ASD).

Since children with autism may have difficulty expressing themselves, it is often up to their parents to discern whether their behavior is actually a symptom of autism or of anxiety. But since those symptoms are sometimes difficult to differentiate, even for the child’s parent, clear clinical guidelines would greatly improve the ability to reliably diagnose anxiety issues.

“For example, a child may avoid a social situation because they are not socially motivated — a symptom of autism spectrum disorder — or because they are afraid of being socially rejected — a symptom of anxiety,” said assessment developer Connor Kerns, Ph.D., an assistant research professor at the A.J. Drexel Autism Institute at Drexel University’s Dornsife School of Public Health.

With a correct diagnosis of anxiety, many children with ASD could begin crucial treatment.

“While autism may make it difficult for you to know what to do in social situations, anxiety makes it difficult to look at your strengths and challenges in an even way,” Kerns said.

“This is a particularly pernicious threat, in my opinion, because it can prevent individuals from coping with and, eventually, overcoming real challenges in their lives and seeking out opportunities and experiences, such as education, social interaction, and employment, that are crucial to their development.”

“Put another way, when your anxiety is high, you are focusing on surviving rather than living, and this has real consequences on your mental, emotional, and physical health,” she added.

Kerns’ Autism Spectrum Addendum (ASA) — the new addition to the Anxiety Disorders Interview Schedule (ADIS) — incorporates new questions into the original interview to help determine which behaviors might be part of the child’s autism and which might be related to anxiety.

Kerns first developed the ASA method in 2014. She recently tested it in a study of 69 children with autism who had a concern about anxiety, but no prior diagnosis. The study results are published in the Journal of Clinical Child and Adolescent Psychology.

“All children interested in the study completed a comprehensive evaluation to determine if they did, in fact, demonstrate clinically significant symptoms of anxiety and autism according to the ADIS/ASA interview,” Kerns said.

“All ADIS/ASA interviews were video- or audio-recorded and listened to a second time by a blind assessor, who came to their own conclusions about the child’s diagnosis.”

Those results were also run against other measures of anxiety to make sure they came to the same conclusions, further confirming the new addition’s reliability as a diagnostic tool.

“These findings are extremely important to those who may wish to use the ADIS/ASA in their research or in their clinical work with youth on the spectrum,” Kerns said.

Finally, Kerns emphasized the importance of treating ASD children with anxiety.

“Treating anxiety is important in autism spectrum disorder because anxiety is associated with significantly more impairment for the child and their family,” Kerns explained. “That can include more stress, more self-injurious behavior and depression, and more social difficulties and physical ailments.”

Source: Drexel University