The Overlap Between Autism and Anxiety Disorders (Advance Script)

Hey everybody, Ultimate Oddball here. I decided to take a couple weeks off from my blog as I’ve been a bit swamped lately with various things, but I plan on getting right back at it. Here’s an early look at the script for tomorrow’s ‘Thoughts On the Spectrum’ video.

Today I’m going to discuss a study from 2009 which reviewed forty reports published between 1990 and 2008 referencing autism spectrum disorder and anxiety. The results indicated anxiety is common in autistic children and adolescents. The researchers state that anxiety is likely to express atypically in autistic individuals, and thus assessment should include a variation of methods and information. They also note that there aren’t enough studies on the subject, and provide recommendations for future research. In addition, I’ll be pointing out the irrationality of thinking anxiety is predominantly something which affects individuals considered clinically to be “high functioning” and further share my thoughts on the subject.

This report by Susan W. White, Donald Oswald, Thomas Ollendick, and Lawrence Scahill reviewed forty studies, with results indicating that somewhere between 11% and 84% of autistic children experience symptoms of anxiety. Two of the studies directly looked at individuals with a diagnosis of anxiety disorder and autism spectrum disorder: “deBruin et al. (2006) found that slightly more than 55% of the sample met criteria for at least one anxiety disorder and Simonoff et al. (2008) reported an overall anxiety disorder diagnosis rate of almost 42%.” Compare that to the prevalence of anxiety disorders among the United States population, which the NIMH says is 18.1%.(1) Even considering the likelihood of the national rate being higher due to cases of lack of diagnosis due to stigma or for economic reasons, it’s unlikely to reach the percentages mentioned in the referenced studies seen in autistic people.

Another important topic brought up is the expressional overlap between autism and other disorders. Axis I anxiety disorders, including social phobia and obsessive-compulsive disorder, are rarely diagnosed in autistic people, they point out, with the symptoms being attributed to the autism spectrum disorder of the individual. There is a lack of agreement among clinicians as to whether various comorbid conditions should be considered separate from or a part of an individual’s autism. Currently there are many disorders which won’t usually be diagnosed in autistic people but would be diagnosed if that person weren’t diagnosed with autism spectrum disorder. As we’ve seen time and time again, there is still a fundamental confusion as to where autism starts, where it ends, and what exactly it includes. Unfortunately I think it’s very likely that the persistent focus on getting rid of autism and the accompanying research funding which has been spent on looking for a “cure” is holding us back scientifically from gaining a better grasp of autism.

As I’ve pointed out in the past, the lack of an assumption of competence in non-speaking autistic individuals as well as other bias can potentially skew the perceptions of clinicians during assessment. Because of this, there seems to be an assumption that anxiety and other psychiatric comorbid disorders are far more prevalent in individuals referred to by clinicians as “high functioning. Another study referenced, written by Gadow and colleagues, showed some interesting and relevant results. “The authors reported that severity of ASD appeared to be negatively associated with psychiatric symptoms such that children with AD were generally rated as having fewer and less severe psychiatric symptoms (e.g., anxiety, depression) than children with PDD-NOS or AS. Of the three subtypes (AD (autism spectrum disorder), AS (asperger syndrome), PDD-NOS (pervasive developmental disorder not otherwise specified), the children with AS were rated by parents and teachers as the most psychiatrically impaired.” I believe these results may indicate that diagnosis is affected by the same misconception which perpetuates the idea that those deemed “low functioning” by clinicians are unaware of the world around them.

More research needs to include all autistic people, rather than allowing bias to dictate the format of studies. We need a fuller understanding of autism and the comorbid conditions associated with being autistic in order to better help and find accommodations for autistic people in general. Hopefully as research priorities shift alongside shifting social perceptions, we will see more of a focus on these things and less on eradicating autistic people from the Earth. Well, thanks for coming by, and have a great day.

Anxiety in Children and Adolescents with Autism Spectrum Disorders’ Susan W. White, Donald Oswald, Thomas Ollendick, and Lawrence Scahill: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2692135/pdf/nihms113987.pdf

(1) http://www.nimh.nih.gov/health/statistics/prevalence/any-anxiety-disorder-among-adults.shtml

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