Abstract
Autism spectrum disorders (ASD) have been shown to be highly comorbid with other psychological disorders. Currently, there is a dearth of research examining how comorbidity impacts the assessment of core symptoms and co-occurring problem behaviors in children with ASD. The present study evaluated the rates of comorbid symptoms in children with ASD and children with anxiety disorders. Participants included 29 children with ASD, 25 children with anxiety disorders, and 31 children with no psychological disorder who served as the control group. Commonly co-occurring internalizing and externalizing symptoms were assessed with the Autism Spectrum Disorders-Comorbidity for Children (ASD-CC). Multivariate and univariate main effect analyses with post-hoc comparisons were conducted on seven symptom subscales (tantrum behaviors, repetitive behaviors, worry/depressed symptoms, avoidant behaviors, under-eating, overeating, and conduct problems). Children with ASD evinced higher rates of comorbid symptoms than children with anxiety disorders. Additionally, both children with ASD and those with anxiety disorders exhibited more comorbid symptoms than children in the control group. Our findings support the importance of conducting broadband assessments for comorbid symptoms when evaluating children with atypical development. Implications of these findings will be discussed in the context of previous research.
Similar content being viewed by others
References
Achenbach, T. M., & Rescorla, L. A. (2001). Manual for the ASEBA school-age forms and profiles. Burlington: University of Vermont, Department of Psychiatry.
Albano, A. M., Chorpita, B. F., & Barlow, D. H. (2003). Childhood anxiety disorders. In E. J. Mash & R. A. Barkley (Eds.), Child psychopathology (2nd ed., pp. 279–329). New York: The Guilford Press.
Association, A. P. (2000). Diagnostic and statistical manual of mental disorders (4th Ed. With Text Revisions). Washington: APA.
Anderson, J. C., Williams, S., McGee, R., & Silva, P. A. (1987). DSM-III disorders in preadolescent children: prevalence in a large sample from the general population. Archives of General Psychiatry, 44, 69–76.
Baghdadli, A., Picot, M. C., Pascal, C., Pry, R., & Aussilloux, C. (2003). Relationship between age of recognition of first disturbances and severity of young children with autism. European Journal of Child and Adolescent Psychiatry, 12, 122–127.
Barrett, P. M., Duffy, A. L., Dadds, M. R., & Rapee, R. M. (2001). Cognitive-behavioral treatment of anxiety disorders in children: long-term (6-year) follow-up. Journal of Consulting and Clinical Psychology, 69, 135–141.
Bittner, A., Egger, H. L., Erkanli, A., Costello, E. J., Foley, D. L., & Angold, A. (2007). What do childhood anxiety disorders predict? Journal of Child Psychology and Psychiatry, 48, 1174–1183.
Brawman-Mintzer, O., Lydiard, B. R., Emmanuel, N., Payeur, R., Johnson, M., Roberts, J., et al. (1993). Psychiatric comorbidity in patients with generalized anxiety disorder. The American Journal of Psychiatry, 150, 1216–1218.
Brown, T. A. (2002). Classification of anxiety disorders. In D.J. Stein & E. Hollander (Eds.), Textbook of anxiety disorders (pp. 13–27). Washington D.C.: American Psychiatric Publishing, Inc.
Brown, T. A., & Barlow, D. H. (1992). Comorbidity among anxiety disorders: Implications for treatment and DSM-IV. Journal of Consulting and Clinical Psychology, 60, 835–844.
Chowdhury, M., Benson, B. A., & Hillier, A. (2010). Changes in restricted repetitive behaviors with age: a study of high-functioning adults with autism spectrum disorders. Research in Autism Spectrum Disorders, 4, 210–216.
Chung, S. Y., Luk, S. L., & Lee, P. W. H. (1990). A follow-up study of infantile autism in Hong Kong. Journal of Autism and Developmental Disorders, 20, 221–232.
Compton, S. N., March, J. S., Brent, D., Albano, A. M., Weersing, R., & Curry, J. (2004). Cognitive-behavioral psychotherapy for anxiety and depressive disorders in children and adolescents: An evidence-based medicine review. Journal of the American Academy of Child and Adolescent Psychiatry, 43, 930–959.
Costello, E. J., Angold, A., Burns, B. J., Erkanli, A., Stangl, D. K., & Tweed, D. L. (1996). The Great Smoky Mountains study of youth: functional impairment and serious emotional disturbance. Archives of General Psychiatry, 53, 1137–1143.
Davis, T. E., III, Ollendick, T. H., & Nebel-Schwalm, M. (2008). Intellectual ability and achievement in anxiety-disordered children: a clarification and extension of the literature. Journal of Psychopathology and Behavioral Assessment, 30, 43–51.
De Bruin, E. L., Ferdiand, R. F., Meester, S., de Nijs, F. A., & Verheij, F. (2007). Higher rates of psychiatric co-morbidity in PDD-NOS. Journal of Autism and Developmental Disorders, 37, 877–886.
Duffy, C., & Healy, O. (2011). Spontaneous communication in autism spectrum disorder: a review of topographies and intervention. Research in Autism Spectrum Disorders, 5, 977–983.
Fodstad, J. C., Matson, J. L., Hess, J. A., & Neal, D. (2009). Social and communication behaviours in infants and toddlers with autism and pervasive developmental disorder-not otherwise specified. Developmental Neurorehabilitation, 12, 152–157.
Fujiwara, T., Okuyama, M., & Funahashi, K. (2011). Factors influencing time lag between first parental concern and first visit to child psychiatric services in children with autism spectrum disorders in Japan. Research in Autism Spectrum Disorders, 5, 584–591.
Gillott, A., Furniss, F., & Walter, A. (2001). Anxiety in high functioning children with autism. Autism, 5, 277–286.
Grills, A., & Ollendick, T. H. (2002). Peer victimization, global self-worth, and anxiety in middle-school children. Journal of Clinical Child and Adolescent Psychology, 31, 59–68.
Kendall, P. C., Brady, E. U., & Verduin, T. L. (2001). Comorbidity in childhood anxiety disorders and treatment outcome. Journal of the American Academy of Child and Adolescent Psychiatry, 40, 787–794.
Klein, R. G., & Pine, D. S. (2002). Anxiety disorders. In M. Rutter & E. Taylor (Eds.), Child and adolescent psychiatry: modern approaches (4th ed., pp. 486–509). Cambridge: Blackwell Science.
Kovacs, M., Gatsonis, C., Paulauskas, S., & Richards, C. (1989). Depressive disorders in childhood: IV. A longitudinal study of comorbidity with and risk for anxiety disorders. Archives of General Psychiatry, 46, 776–782.
Krug, D. A., & Arick, J. R. (2003). Krug Asperger’s disorder index. Austin: Pro-Ed.
Last, C. G., Hansen, C., & Franco, N. (1997). Anxious children in adulthood: a prospective study of adjustment. Journal of the American Academy of Child and Adolescent Psychiatry, 36, 645–652.
Leyfer, O. T., Folstein, S. E., Bacalman, S., Davis, N. O., Dinh, E., Morgan, J.,… Lainhart, J. E. (2006). Comorbid psychiatric disorders in children with autism: interview development and rates of disorders. Journal of Autism and Developmental Disorders, 36, 849–861.
Lord, C., Rutter, M., & LeCouteur, A. (1994). Autism diagnostic interview-revised: a revised version of a diagnostic interview for caregivers of individuals with possible pervasive developmental disorders. Journal of Autism and Developmental Disorders, 24, 659–685.
LoVullo, S. V., & Matson, J. L. (2009). Comorbid psychopathology in adults with autism spectrum disorders and intellectual disabilities. Research in Developmental Disabilities, 30, 1288–1296.
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.
Maski, K. P., Jeste, S. S., & Spence, S. J. (2011). Common neurological co-morbidities in autism spectrum disorders. Current Opinion in Pediatrics, 23, 609–615.
Matson, J. L. (2007). Current status of differential diagnosis for children with autism spectrum disorders. Research in Developmental Disabilities, 28, 109–118.
Matson, J. L., Baglio, C. S., Smiroldo, B. B., Hamilton, M., Packlowskyj, T., Williams, D., et al. (1996). Characteristics of autism as assessed by the Diagnostic Assessment for the Severely Handicapped-II (DASH-II). Research in Developmental Disabilities, 17, 135–143.
Matson, J. L., & Boisjoli, J. A. (2007). Differential diagnosis of PDDNOS in children. Research in Autism Spectrum Disorders, 1, 75–84.
Matson, J. L., Carlisle, C. B., & Bamburg, J. W. (1998). The convergent validity of the Matson Evaluation of Social Skills for Individuals with Severe Retardation (MESSIER). Research in Developmental Disabilities, 19, 493–500.
Matson, J. L., & Gonzalez, M. L. (2007a). Autism spectrum disorders – comorbidity – child version. Baton Rouge: Disability Consultants, LLC.
Matson, J. L., & Gonzalez, M. L. (2007b). Autism spectrum disorders – diagnostic – child version. Baton Rouge: Disability Consultants, LLC.
Matson, J. L., & Love, S. R. (1990). A comparison of parent reported fear for autistic and non-handicapped age-matched children and youth. Australia and New Zealand Journal of Developmental Disabilities, 16, 257–349.
Matson, J. L., LoVullo, S. V., Rivet, T. T., & Boisjoli, J. A. (2009). Validity of the Autism Spectrum Disorder-Comorbid for Children (ASD-CC). Research in Autism Spectrum Disorders, 3, 345–357.
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.
Matson, J. L., & Smith, K. R. M. (2008). Current status of intensive behavioral interventions for young children with autism and PDD-NOS. Research in Autism Spectrum Disorders, 2, 60–74.
Matson, J. L., & Wilkins, J. (2008). Reliability of the Autism Spectrum Disorders-Comorbidity for Children (ASD-CC). Journal of Developmental and Physical Disabilities, 20, 155–165.
McGee, R., Feehan, M., Williams, S., & Anderson, J. (1992). DSM-III disorders from age 11 to 15 years. Journal of the American Academy of Child and Adolescent Psychiatry, 31, 50–59.
Ming, X., Brimacombe, M., Chaaban, J., Zimmerman-Bier, B., & Wagner, G. C. (2008). Autism spectrum disorders: concurrent clinical disorders. Journal of Child Neurology, 23, 6–13.
Moree, B., & Davis, T. E., III. (2010). Cognitive-behavioral therapy for anxiety in children diagnosed with autism spectrum disorders: modification trends. Research in Autism Spectrum Disorders, 4, 346–354.
Muris, P., Steerneman, P., Merckelbach, H., Holdrinet, I., & Meesters, C. (1998). Comorbid anxiety symptoms in children with pervasive developmental disorders. Journal of Anxiety Disorders, 12, 387–393.
Rapee, R. M., Kennedy, S., Ingram, M., Edwards, S., & Sweeney, L. (2005). Prevention and early intervention of anxiety disorders in inhibited preschool children. Journal of Consulting and Clinical Psychology, 73, 488–497.
Reynolds, C. R., & Kamphaus, R. W. (2004). Behavioral assessment system for children manual (2nd ed.). Circle Pines: AGS Publishing.
Russell, A. J., Mataix-Cols, D., Anson, M., & Murphy, D. G. (2005). Obsessions and compulsions in Asperger syndrome and high-functioning autism. The British Journal of Psychiatry, 186, 525–528.
Schopler, E., Reichler, R. J., DeVellis, R. F., & Daly, K. (1980). Toward objective classification of childhood autism: Childhood Autism Rating Scale (CARS). Journal of Autism and Developmental Disorders, 10, 91–103.
Silverman, W. K., & Albano, A. M. (1996). Anxiety disorders interview schedule for DSM- IV (Child and Parent Versions). San Antonio: Psychological Corporation.
Silverman, W., & Ollendick, T. H. (2008). Child and adolescent anxiety disorders. In J. Hunsley & E. J. Mash (Eds.), A guide to assessments that work (pp. 181–206). New York: Oxford University Press.
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.
Sipes, M., Matson, J. L., Worley, J. A., & Kozlowski, A. M. (2011). Gender differences in symptoms of autism spectrum disorders in toddlers. Research in Autism Spectrum Disorders, 5, 1465–1470.
Sofronoff, K., Attwood, T., & Hinton, S. (2005). A randomized controlled trial of a CBT intervention for anxiety in children with Asperger syndrome. Journal of Child Psychology and Psychiatry, 46, 1152–1160.
Sparrow, S. S., Balla, D. A., & Cicchetti, D. V. (2005). Vineland adaptive behavior scales (2nd ed.). Circle Pines: American Guidance Service.
Steinhausen, H. C., & Merzke, C. (2004). Differentiating the behavioral profile in autism and mental retardation and testing of a screener. European Child & Adolescent Psychiatry, 13, 214–220.
Stewart, M. E., Barnard, L., Pearson, J., Hasan, R., & O’Brien, G. (2006). Presentation of depression in autism and Asperger syndrome: a review. Autism, 10, 103–116.
Thorson, R. T., & Matson, J. L. (2012). Cutoff scores for the Autism Spectrum Disorder-Comorbid for Children (ASD-CC). Research in Autism Spectrum Disorders, 6, 556–559.
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.
World Health Organization. (1992). International classification of diseases (10th ed.). Geneva: Author.
Declaration of Interests
The authors report no conflicts of interests and are solely responsible for the content and writing of this paper.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Tureck, K., Matson, J.L., May, A. et al. Comorbid Symptoms in Children with Anxiety Disorders Compared to Children with Autism Spectrum Disorders. J Dev Phys Disabil 26, 23–33 (2014). https://doi.org/10.1007/s10882-013-9342-4
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10882-013-9342-4