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This study investigates the prevalence, phenomenology, and correlates of anxiety in preschool children with autism spectrum disorder (ASD) across a two-year period. Attention bias to threat, a potential objective marker of anxiety, also is examined using eye tracking methods.
Anxiety disorders in children with autism spectrum disorders (ASD) are one of the most prevalent and impairing co-occurring conditions, affecting approximately 40% of the population and causing major disruptions in school and family life. Research in typically developing (TD) children suggests that anxiety usually emerges in the preschool years (3-5 years) and can result in future psychopathology. Early detection and treatment of childhood anxiety in children with ASD can lead to improved clinical outcomes.
This study assesses the prevalence and phenomenology of anxiety in preschool children with ASD utilizing an established and comprehensive measure of anxiety in children with ASD across three time points (baseline, one year post, two years post).It also investigates the association of child (e.g., ASD features) and parent (e.g., mental health, caregiver strain) characteristics with anxiety cross-sectionally and longitudinally, to determine if certain correlates predict or maintain future anxiety. Attention bias to threat stimuli and its physiological correlates are also examined as potential objective markers of anxiety using eye tracking and pupillometry methods.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Assessment | Children with ASD ages 3-5 years at baseline |
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| Measure | Description | Time Frame |
|---|---|---|
| Anxiety diagnostic status as measured by Anxiety Disorders Interview Schedule with Autism Addendum | Gold-standard semi-structured interview for assessing anxiety disorders and the ASA, a supplement to the ADIS that facilitates the use of this tool in children with ASD; clinical severity ratings range from 0 to 3 or 0 to 8; higher scores indicate more impairment | Anxiety diagnostic status will be measured through study completion, up to 24 months |
| Attention to threat behavioral paradigms | Child's attention to threatening stimuli measured via eye tracking and correlated physiological response measures via pupillometry; more frequent saccades to threatening stimuli indicate higher attention bias to threat; greater pupil dilation indicates higher physiological arousal | Attention to threat and correlated physiological arousal will be measured across the final 12 months of the study |
| Measure | Description | Time Frame |
|---|---|---|
| Child Behavior Checklist | parent and teacher report scale that measures child anxiety and other psychiatric symptoms;T scores range from 20 to 100; Syndrome scales: T-scores over 65 indicate clinically significant symptoms | Anxiety and other psychiatric symptoms will be assessed through study completion, up to 24 months |
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Inclusion Criteria:
Exclusion Criteria:
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Clinical and community based sample
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| Name | Affiliation | Role |
|---|---|---|
| Roma A Vasa, M.D. | Hugo W. Moser Research Institute at Kennedy Krieger, Inc. | Principal Investigator |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Kennedy Krieger Institute | Baltimore | Maryland | 21211 | United States |
| PubMed Identifier | Type | Citation | Retractions |
|---|---|---|---|
| 29316350 | Background | Vasa RA, Kreiser NL, Keefer A, Singh V, Mostofsky SH. Relationships between autism spectrum disorder and intolerance of uncertainty. Autism Res. 2018 Apr;11(4):636-644. doi: 10.1002/aur.1916. Epub 2018 Jan 7. | |
| 29164436 | Background | Vasa RA, Keefer A, Reaven J, South M, White SW. Priorities for Advancing Research on Youth with Autism Spectrum Disorder and Co-occurring Anxiety. J Autism Dev Disord. 2018 Mar;48(3):925-934. doi: 10.1007/s10803-017-3320-0. |
| Label | URL |
|---|---|
| Study Flier | View source |
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| ID | Term |
|---|---|
| D001008 | Anxiety Disorders |
| D000067877 | Autism Spectrum Disorder |
| D001321 | Autistic Disorder |
| ID | Term |
|---|---|
| D001523 | Mental Disorders |
| D002659 | Child Development Disorders, Pervasive |
| D065886 | Neurodevelopmental Disorders |
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| Preschool Anxiety Scale - Revised |
parent and teacher report scale measuring levels of anxiety in preschool aged children; scores range from 0 to 112; higher scores indicate higher anxiety |
| Anxiety will be assessed through study completion, up to 24 months |
| Screen for Child Anxiety Related Disorders | parent and teacher report scale measuring levels of anxiety in children 6 or older; scores range from 0 to 114; higher scores indicate higher anxiety | Anxiety will be assessed through study completion, up to 24 months |
| Response to Uncertainty and Low Environmental Stability Scale | parent and teacher report scale measuring response to uncertainty and low environmental structure in children; scores range from 1 to 5; higher scores indicate higher intolerance of uncertainty | Intolerance of uncertainty will be assessed through study completion, up to 24 months |
| Social Responsiveness Scale | parent report scale that assesses the presence and severity of social impairment in children; T-scores range from 20 to 100; higher scores indicate higher ASD severity | ASD symptoms will be assessed through study completion, up to 24 months |
| Emotion Regulation Checklist | parent report scale that assesses emotion regulation capacities in children; scores range from 24 to 96; higher scores indicate higher impairment | Emotional regulation will be assessed through study completion, up to 24 months |
| The Children's Sleep Habits Questionnaire | parent report questionnaire that measures sleep habits in children; scores range from 45 to 135; higher scores indicate greater frequency of sleep problems | Sleep habits will be assessed across the final 12 months of the study |
| Hospital Anxiety and Depression scale | screening tool that will be used to capture clinical anxiety and depression in parents; scores range from 0 to 21; higher scores indicate higher anxiety and/or depression symptoms | Parental anxiety and depression will be assessed through the completion of the study, up to 24 months |
| Intolerance of Uncertainty Scale | scale that will be used to measure parental responses to uncertainty, ambiguous situations and the future; scores range from 12 to 60; higher scores indicate higher intolerance of uncertainty | Parental intolerance of uncertainty will be assessed through the completion of the study, up to 24 months |
| Family Accommodation Scale | assesses parental accommodation of child's interfering symptoms; scores range from 0 to 36; higher scores indicate higher parental accommodation | Parental accommodation will be assessed through the completion of the study, up to 24 months |
| Burden Assessment Scale | measures strain (thoughts, feelings, disruption) associated with having a child with a neurodevelopmental disorder; scores range from 19 to 76; higher scores indicate greater family burden | Parental strain will be assessed through study completion, up to 24 months |
| Broader Autism Phenotype | self-report scale that measures broader autism symptoms in the parent; scores range from 36 to 216; higher scores indicate greater severity of autism features | Parental autism features will be assessed through study completion, up to 24 months |