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Variables Associated with Anxiety and Depression in Children with Autism

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Abstract

Mothers of 627 children with autism (ages 1–17, IQs 16–146) completed the Pediatric Behavior Scale. Maternal ratings of anxiety and depression increased with age and IQ, but were unrelated to gender, parent occupation, and race. Anxiety and depression were highly correlated with each other and with autism severity, somatic complaints, mood disturbance, and social problems. Remaining correlations with behavior problems, attention deficit, hyperactivity, and sleep problems were small. The strongest combined predictors of anxiety and depression were autism severity, verbal IQ, and age, explaining 25% and 23% of the variance. Findings suggest that anxiety and depression have a direct link with autism (increasing with autism severity) and a developmental component (increasing with age and IQ). Anxiety is present in most children with autism and depression is present in about half. Therefore, all children with autism should be screened for anxiety and depression and treated if indicated. Controlled studies are needed to determine what interventions are effective in reducing anxiety and depression in autism.

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References

  • Bellini, S. (2004). Social skills deficits and anxiety in high-functioning adolescents with autism spectrum disorders. Focus on Autism and Other Developmental Disorders, 19, 78–86.

    Article  Google Scholar 

  • Benjamin, R. S., Costello, E. J., & Warren, M. (1990). Anxiety disorders in a pediatric sample. Journal of Anxiety Disorders, 4, 293–316.

    Article  Google Scholar 

  • Brereton, A. V., Tonge, B. J., & Einfeld, S. L. (2006). Psychopathology in children and adolescents with autism compared to young people with intellectual disability. Journal of Autism and Developmental Disorders, 36, 863–870.

    Article  PubMed  Google Scholar 

  • Chalfant, A., Rapee, R., & Carroll, L. (2006). Treating anxiety disorders in children with high functioning autism spectrum disorders: a controlled trial. Journal of Autism and Developmental Disorders, 37, 1842–1857.

    Article  PubMed  Google Scholar 

  • Chaplan, T. M., Gillham, J. E., & Seligman, M. E. P. (2009). Gender, anxiety, and depressive symptoms: a longitudinal study of early adolescents. Journal of Early Adolescence, 29, 307–327.

    Google Scholar 

  • Compas, B. E., Oppedisano, G., Connor, J. K., Gerhardt, C. A., Hinden, B. R., Achenbach, T. M., et al. (1997). Gender differences in depressive symptoms in adolescence: comparison of national samples of clinically referred and nonreferred youths. Journal of Consulting and Clinical Psychology, 65, 617–626.

    Article  PubMed  Google Scholar 

  • Eisenmajer, R., Prior, M., Leekam, S., Wing, L., Gould, J., Welham, M., et al. (1996). Comparison of clinical symptoms in autism and Asperger’s disorder. Journal of the American Academy of Child and Adolescent Psychiatry, 35, 1523–1531.

    Article  PubMed  Google Scholar 

  • Farrugia, S., & Hudson, J. (2006). Anxiety in adolescents with Asperger’s syndrome: negative thoughts, behavioral problems, and life interference. Focus on Autism and Other Developmental Disabilities, 21, 25–35.

    Article  Google Scholar 

  • Frith, U. (2004). Emanuel Miller lecture: confusions and controversies about Asperger syndrome. Journal of Child Psychology and Psychiatry and Allied Disciplines, 45, 672–678.

    Article  Google Scholar 

  • Gadow, K. D., DeVincent, C. J., Pomeroy, J., & Azizian, A. (2005). Comparison of DSM-IV symptoms in elementary school-aged children with PDD versus clinic and community samples. Autism, 9, 392–415.

    Article  PubMed  Google Scholar 

  • Gadow, K. D., DeVincent, C., & Schneider, J. (2008). Predictors of psychiatric symptoms in children with an autism spectrum disorder. Journal of Autism and Developmental Disorders, 38, 1710–1720.

    Article  PubMed  Google Scholar 

  • Ghaziuddin, M., Weidmer-Mikhail, E., & Ghaziuddin, N. (1998). Comorbidity of Asperger syndrome: a preliminary report. Journal of Intellectual Disability Research, 42, 279–283.

    Article  PubMed  Google Scholar 

  • Gillott, A., Furniss, F., & Walter, A. (2001). Anxiety in high-functioning children with autism. Autism, 5, 277–286.

    Article  PubMed  Google Scholar 

  • Hankin, B. L., Abramson, L. Y., Moffitt, T. E., Silva, P. A., McGee, R., & Angell, K. E. (1998). Development of depression from preadolescence to young adulthood: emerging gender differences in a 10-year longitudinal study. Journal of Abnormal Psychology, 107, 128–140.

    Article  PubMed  Google Scholar 

  • Hartley, S. L., & Sikora, D. M. (2009). Sex differences in autism spectrum disorder: an examination of developmental functioning, autistic symptoms, and coexisting behavior problems in toddlers. Journal of Autism and Developmental Disorders, 39, 1715–1722.

    Article  Google Scholar 

  • Howlin, P. (2003). Outcome on high-functioning adults with autism with and without early language delays: implications for the differentiation between autism and Asperger syndrome. Journal of Autism and Developmental Disorders, 33, 3–13.

    Article  PubMed  Google Scholar 

  • Hurtig, T., Kuusikko, S., Mattila, M.-L., Haapsamo, H., Ebeling, H., Jussila, K., et al. (2009). Multi-informant reports of psychiatric symptoms among high-functioning adolescents with Asperger syndrome or autism. Autism, 13, 583–598.

    Article  PubMed  Google Scholar 

  • Kanne, S. M., Abbacchi, A. M., & Constantino, J. N. (2009). Multi-informant ratings of psychiatric symptom severity in children with autism spectrum disorders: the importance of environment context. Journal of Autism and Developmental Disorders, 39, 856–864.

    Article  PubMed  Google Scholar 

  • Kim, J. A., Szatmari, P., Bryson, S. E., Streiner, D. L., & Wilson, F. J. (2000). The prevalence of anxiety and mood problems among children with autism and Asperger syndrome. Autism, 4, 117–132.

    Article  Google Scholar 

  • Lemstra, M., Neudorf, C., D’Arcy, C., Kunst, A., Warren, L. W., & Bennett, N. R. (2008). A systematic review of depressed mood and anxiety by SES in youth aged 10–15 years. Canadian Journal of Public Health, 99, 125–129.

    Google Scholar 

  • Lewinsohn, P. M., Lewinsohn, M., Gotlib, I. A., Seeley, J. R., & Allen, N. B. (1998). Gender differences in anxiety disorders and anxiety symptoms in adolescents. Journal of Abnormal Psychology, 107, 109–117.

    Article  PubMed  Google Scholar 

  • Leyfer, O. T., Folstein, S. E., Bacalman, S., Davis, N. O., Dinh, E., Morgan, J., et al. (2006). Comorbid psychiatric disorders in children with autism: interview development and rates of disorders. Journal of Autism and Developmental Disorders, 36, 849–861.

    Article  PubMed  Google Scholar 

  • Lindgren, S. D., & Koeppl, G. K. (1987). Assessing child behavior problems in a medical setting: Development of the Pediatric Behavior Scale. In R. J. Prinz (Ed.), Advances in behavioral assessment of children and families (pp. 57–90). Greenwich: JAI.

    Google Scholar 

  • Macintosh, K. E., & Dissanayake, C. (2004). Annotation: the similarities and differences between autistic disorder and Asperger’s disorder: a review of the empirical evidence. Journal of Child Psychology and Psychiatry and Allied Disciplines, 45, 421–434.

    Article  Google Scholar 

  • MacNeil, B. M., Lopes, V. A., & Minnes, P. M. (2009). Anxiety in children and adolescents with autism spectrum disorders. Research in Autism Spectrum Disorders, 3, 1–21.

    Article  Google Scholar 

  • Manjiviona, J., & Prior, M. (1995). Comparison of Asperger syndrome and high-functioning autistic children on a test of motor impairment. Journal of Autism and Developmental Disorders, 25, 23–39.

    Article  PubMed  Google Scholar 

  • Matson, J. L., & Nebel-Schwalm, M. S. (2007). Comorbid psychopathology with autism spectrum disorder in children: an overview. Research in Developmental Disabilities, 28, 341–352.

    Article  PubMed  Google Scholar 

  • Max, J. E., Arndt, S., Castillo, C., Bokura, H., Robin, D. A., Lindgren, S. D., et al. (1997a). Attention-deficit hyperactivity symptomatology after traumatic brain injury: a prospective study. Journal of the American Academy of Child and Adolescent Psychiatry, 37, 841–847.

    Article  Google Scholar 

  • Max, J. E., Robin, D. A., Lindgren, S. D., Smith, W. L., Sato, Y., Mattheis, P. J., et al. (1997b). Traumatic brain injury in children and adolescents: psychiatric disorders at 2 years. Journal of the American Academy of Child and Adolescent Psychiatry, 36, 1278–1285.

    Article  Google Scholar 

  • Max, J. E., Robin, D. A., Lindgren, S. D., Smith, W. L., Sato, Y., Mattheis, P. J., et al. (1998). Traumatic brain injury in children and adolescents: psychiatric disorders at one year. The Journal of Neuropsychiatry and Clinical Neurosciences, 10, 290–297.

    PubMed  Google Scholar 

  • Mayes, S. D., & Calhoun, S. L. (1999). Symptoms of autism in young children and correspondence with the DSM. Infants and Young Children, 12, 90–97.

    Article  Google Scholar 

  • Mayes, S. D., & Calhoun, S. L. (2003). Relationship between Asperger syndrome and high-functioning autism. In M. Prior (Ed.), Learning and behavior problems in Asperger Syndrome (pp. 15–34). New York: Guilford.

    Google Scholar 

  • Mayes, S. D., & Calhoun, S. L. (2004). Influence of IQ and age in childhood autism: lack of support for DSM-IV Asperger’s disorder. Journal of Developmental and Physical Disabilities, 16, 257–272.

    Article  Google Scholar 

  • Mayes, S. D., & Calhoun, S. L. (2007). Learning, attention, writing, and processing speed in typical children and children with ADHD, autism, anxiety, depression, and oppositional-defiant disorder. Child Neuropsychology, 13, 469–493.

    Article  PubMed  Google Scholar 

  • Mayes, S. D., & Calhoun, S. L. (2009). Variables related to sleep problems in children with autism. Research in Autism Spectrum Disorders, 3, 931–941.

    Article  Google Scholar 

  • Mayes, S. D., Calhoun, S. L., & Crites, D. L. (2001). Does DSM-IV Asperger’s disorder exist? Journal of Abnormal Child Psychology, 29, 263–271.

    Article  PubMed  Google Scholar 

  • Mayes, S. D., Calhoun, S. L., Bixler, E. O., & Vgontzas, A. N. (2008). Nonsignificance of sleep relative to IQ and neuropsychological test scores in predicting academic achievement. Journal of Developmental and Behavioral Pediatrics, 29, 206–212.

    Article  PubMed  Google Scholar 

  • Mayes, S. D., Calhoun, S. L., Bixler, E. O., & Vgontzas, A. N. (2009a). Sleep problems in children with autism, ADHD, anxiety, depression, acquired brain injury, and typical development. Sleep Medicine Clinics, 4, 19–25.

    Article  Google Scholar 

  • Mayes, S. D., Calhoun, S. L., Bixler, E. O., Vgontzas, A. N., et al. (2009b). ADHD subtypes and comorbid anxiety, depression, and oppositional-defiant disorder: differences in sleep problems. Journal of Pediatric Psychology, 34, 328–337.

    Article  PubMed  Google Scholar 

  • Mayes, S. D., Calhoun, S. L., Chase, G. A., Mink, D. M., & Stagg, R. E. (2009c). ADHD subtypes and co-occurring anxiety, depression, and oppositional-defiant disorder: differences in Gordon Diagnostic System and Wechsler Working Memory and Processing Speed Index scores. Journal of Attention Disorders, 12, 540–550.

    Article  PubMed  Google Scholar 

  • Mayes, S. D., Calhoun, S. L., Murray, M. J., Morrow, J. D., Yurich, K. K. L., Mahr, F., et al. (2009d). Comparison of scores on the Checklist for Autism Spectrum Disorder, Childhood Autism Rating Scale (CARS), and Gilliam Asperger’s Disorder Scale (GADS) for children with low functioning autism, high functioning autism, Asperger’s disorder, ADHD, and typical development. Journal of Autism and Developmental Disorders, 39, 1682–1693.

    Article  Google Scholar 

  • Mayes, S. D., Calhoun, S. L., Murray, M. J., Ahuja, M., & Smith, L. A. (2010). Anxiety, depression, and irritability in children with autism relative to children with other neuropsychiatric disorders and typical development. Research in Autism Spectrum Disorders. doi:10.1016/j.rasd.2010.06.012.

    Google Scholar 

  • Miller, J. N., & Ozonoff, S. (1997). Did Asperger’s cases have Asperger disorder? A research note. Journal of Child Psychology and Psychiatry, 38, 247–251.

    PubMed  Google Scholar 

  • Miller, J. N., & Ozonoff, S. (2000). The external validity of Asperger disorder: lack of evidence from the domain of neuropsychology. Journal of Abnormal Psychology, 109, 227–238.

    Article  PubMed  Google Scholar 

  • Murray, M. J., Mayes, S. D., & Smith, L. A. (in press). Brief report: excellent agreement between two brief autism scales (Checklist for Autism Spectrum Disorder and Social Responsiveness Scale) completed independently by parents and the Autism Diagnostic Interview-Revised. Journal of Autism and Developmental Disorders.

  • Myhr, G. (1998). Autism and other pervasive development disorders: exploring the dimensional view. Canadian Journal of Psychiatry, 43, 589–595.

    Google Scholar 

  • Nichols, S., Mahoney, E. M., Sirois, P. A., Bordeaux, J. D., Stehbens, J. A., Loveland, K. A., et al. (2000). HIV-associated changes in adaptive, emotional, and behavioral functioning in children and adolescents with hemophilia: results from the Hemophilia Growth and Development Study. Journal of Pediatric Psychology, 25, 545–556.

    Article  PubMed  Google Scholar 

  • Ozonoff, S., South, M., & Miller, J. N. (2000). DSM-IV-defined Asperger syndrome: cognitive, behavioral and early history differentiation from high-functioning autism. Autism, 4, 29–46.

    Google Scholar 

  • Posey, D. J., Erickson, C. A., Stigler, K. A., & McDougle, C. J. (2006). The use of selective serotonin reuptake inhibitors in autism and related disorders. Journal of Child and Adolescent Psychopharmacology, 16, 181–186.

    Article  PubMed  Google Scholar 

  • Prior, M., Eisenmajer, R., Leekam, S., Wing, L., Gould, J., Ong, B., et al. (1998). Are there subgroups within the autistic spectrum: a cluster analysis of a group of children with autistic spectrum disorders. Journal of Child Psychology and Psychiatry, 39, 893–902.

    Article  PubMed  Google Scholar 

  • Russell, E., & Sofronoff, K. (2005). Anxiety and social worries in children with Asperger syndrome. The Australian and New Zealand Journal of Psychiatry, 39, 633–638.

    PubMed  Google Scholar 

  • Schopler, E. (1996). Are autism and Asperger syndrome (AS) different labels or different disabilities? Journal of Autism and Developmental Disorders, 26, 109–110.

    Article  PubMed  Google Scholar 

  • Schopler, E. (1998). Premature popularization of Asperger syndrome. In E. Schopler, G. B. Mesibov, & L. J. Kunce (Eds.), Asperger syndrome or high-functioning autism? (pp. 385–399). New York: Plenum.

    Google Scholar 

  • 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 and Adolescent Psychiatry, 47, 921–929.

    Article  PubMed  Google Scholar 

  • Sofronoff, K., Attwood, T., & Hinton, S. (2005). A randomized controlled trial of CBT intervention for anxiety in children with Asperger’s syndrome. Journal of Child Psychology and Psychiatry and Allied Disciplines, 46, 1152–1160.

    Article  Google Scholar 

  • Sukhodolsky, D. G., Scahill, L., Gadow, K. D., Arnold, L. E., Aman, M. G., McDougle, C. J., et al. (2008). Parent-rated anxiety symptoms in children with pervasive developmental disorders: frequency and association with core autism symptoms and cognitive functioning. Journal of Abnormal Child Psychology, 36, 117–128.

    Article  PubMed  Google Scholar 

  • Szatmari, P., Archer, L., Fisman, S., Streiner, D. L., & Wilson, F. (1995). Asperger’s syndrome and autism: differences in behavior, cognition, and adaptive functioning. Journal of the American Academy of Child and Adolescent Psychiatry, 34, 1662–1671.

    Article  PubMed  Google Scholar 

  • Tryon, P. A., Mayes, S. D., Rhodes, R., & Waldo, M. (2006). Can Asperger’s disorder be Differentiated from autism using DSM-IV criteria? Focus on Autism and Other Developmental Disabilities, 21, 2–6.

    Article  Google Scholar 

  • Twenge, J. M., & Nolen-Hoeksema, S. (2002). Age, gender, race, socioeconomic status, and birth cohert differences on the Children’s Depression Inventory: a meta-analysis. Journal of Abnormal Psychology, 111, 578–588.

    Article  PubMed  Google Scholar 

  • Vickerstaff, S., Heriot, S., Wong, M., Lopes, A., & Dossetor, D. (2007). Intellectual ability, self-perceived social competence, and depressive symptomatology in children with high-functioning autistic spectrum disorders. Journal of Autism and Developmental Disorders, 37, 1647–1664.

    Article  PubMed  Google Scholar 

  • Weisbrot, D. M., Gadow, K. D., DeVincent, C. J., & Pomeroy, J. (2005). The presentation of anxiety in children with pervasive developmental disorders. Journal of Child and Adolescent Psychopharmacology, 15, 477–496.

    Article  PubMed  Google Scholar 

  • West, L., Brunssen, S. H., & Waldrop, J. (2009). Review of the evidence for treatment of children with autism with selective serotonin reuptake inhibitors. Journal for Specialists in Pediatric Nursing, 14, 183–191.

    Article  PubMed  Google Scholar 

  • White, S. W., & Roberson-Nay, R. (2009). Anxiety, social deficits, and loneliness in youth with autism spectrum disorders. Journal of Autism and Developmental Disorders, 39, 1006–1013.

    Article  PubMed  Google Scholar 

  • White, S. W., Oswald, D., Ollendick, T., & Scahill, L. (2009). Anxiety in children and adolescents with autism spectrum disorders. Clinical Psychology Review, 29, 216–229.

    Article  PubMed  Google Scholar 

  • Wing, L. (1998). The history of Asperger syndrome. In E. Schopler, G. B. Mesibov, & L. J. Kunce (Eds.), Asperger syndrome or high-functioning autism? (pp. 11–28). New York: Plenum.

    Google Scholar 

  • Wolraich, M. L., Lindgren, S. D., Stumbo, P. J., Stegink, L. D., Appelbaum, M. I., & Kiritsy, M. C. (1994). Effects of diets high in sucrose or aspartame on the behavior and cognitive performance of children. The New England Journal of Medicine, 330, 301–307.

    Article  PubMed  Google Scholar 

  • Wood, J. J., Drahota, A., Sze, K., Har, K., Chiu, A., & Langer, D. A. (2009). Cognitive behavioral therapy for anxiety in children with autism spectrum disorders: a randomized, controlled trial. Journal of Child Psychology and Psychiatry, 50, 224–234.

    Article  PubMed  Google Scholar 

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Acknowledgements

We wish to thank Autism Speaks (Grant #2529) and the Children’s Miracle Network for their support of this study.

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Authors and Affiliations

  1. Department of Psychiatry, Penn State College of Medicine, Hershey, PA, USA

    Susan Dickerson Mayes, Susan L. Calhoun, Michael J. Murray & Jahanara Zahid

  2. Department of Psychiatry H073, Milton S. Hershey Medical Center, 500 University Dr., Hershey, PA, 17033, USA

    Susan Dickerson Mayes

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  1. Susan Dickerson Mayes
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  2. Susan L. Calhoun
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  3. Michael J. Murray
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  4. Jahanara Zahid
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Correspondence to Susan Dickerson Mayes.

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Mayes, S.D., Calhoun, S.L., Murray, M.J. et al. Variables Associated with Anxiety and Depression in Children with Autism. J Dev Phys Disabil 23, 325–337 (2011). https://doi.org/10.1007/s10882-011-9231-7

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