Research on anxiety in children and adolescents with autism spectrum disorder (ASD) has burgeoned in the past 15 years. Most of the research has focused on school-age children, ages 6 to 18 years. Yet, recent studies suggest that anxiety can emerge in young children, under 6 years, with ASD. This scoping review synthesized the literature on anxiety in young children with ASD. Three domains of anxiety research were reviewed: (a) prevalence/severity, phenomenology, and course; (b) correlates; and (c) treatment. Four online databases were searched from the start of the database until March 2020. Keywords pertaining to anxiety, autism, and young children were entered. The search identified 44 articles for inclusion. These studies varied with respect to sample source, informants, and measures to assess anxiety. The overall prevalence of anxiety ranged from 1.6 to 62%. Sixteen of 17 studies found that young children with ASD had higher levels of anxiety compared to various control groups. A variety of DSM anxiety symptoms and disorders were present in young children with the most common symptoms being specific, social, and generalized fears. Correlates of anxiety included sensory over-responsivity, sleep disturbance, aggression/defiance, and attention deficit/hyperactivity disorder. Three cognitive behavioral treatment studies for anxiety and one developmental intervention targeting ASD symptoms showed promise in reducing anxiety. Findings indicate an early emergence of anxiety in some children with ASD. Further research on the measurement, pathophysiology, and treatment of anxiety in early childhood is critical to improving outcomes in children with ASD.

Abstract. We conducted a systematic review of longitudinal theory of mind (ToM) studies, focusing on the precursors to and functional outcomes of ToM in typically-developing samples. Our search yielded 87 longitudinal studies, all of which involved children and adolescents. Early attention skills, executive function development, and the use of language are precursors to ToM development. Additionally, quality interaction with parents and older siblings can foster early improvements in ToM. Healthy ToM development improves social relationships with peers and produces greater desire to engage in prosocial behaviors. However, victimized individuals with highly-developed ToM may engage in increased aggression. Future longitudinal research is needed to investigate the functional outcomes resulting from ToM changes in adulthood.

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Co-occurring anxiety in children on the autism spectrum is associated with greater social challenges, including poorer social skills and relationships, which may influence the severity and presentation of anxiety symptoms, particularly social anxiety. The current study used Bayesian network analytics (Williams & Mulder, 2020) and a multimethod approach to examine (a) how different facets of social functioning relate to one another and to anxiety severity and comorbidity, (b) which facet(s) are most influential and thus may represent optimal targets for intervention, and (c) how social functioning relates to the presentation of social fears in a large treatment-seeking sample of autistic children with anxiety disorders (n = 191, 7-13 years). Results indicated strong associations among measures of social ability (i.e., theory of mind [ToM], social motivation, friendship attainment) and among measures of social integration (i.e., bullying, interpersonal and peer difficulties), with only bullying demonstrating a significant association with anxiety. ToM was the most interconnected variable in the network, and social motivation demonstrated the strongest individual connections with other variables, particularly with other facets of social ability. Socially anxious children with impaired ToM were less likely to express fears of negative evaluation, resulting in a distinct diagnostic presentation of social fears. Findings suggest that social motivation and ToM may represent important targets for intervention for autistic children with co-occurring anxiety. Further, social-cognitive difficulties associated with autism, like ToM, may play a role in distinct manifestations of anxiety in these youth. General Scientific SummaryAutistic children with co-occurring anxiety disorders tend to experience significant difficulties with social skills (e.g., perspective taking, social communication) and interpersonal relationships (e.g., friendships, bullying), and those social difficulties may in turn influence how anxiety, particularly social anxiety, is expressed in these youth. This study demonstrates that autistic children with difficulties in one area of social well-being are likely to have difficulties across many other, related areas of social well-being; in particular, children with more limited perspective-taking ability and/or less interest in social interaction are likely to have fewer reciprocal friendships and greater difficulty with social communication. Findings also suggest that differences in perspective-taking ability might explain a unique presentation of social anxiety in autistic individuals, whereby socially anxious children who have more difficulty understanding the thoughts, feelings, and intentions of others might become anxious due to confusion and uncertainty in social situations rather than fear of being judged (the key criteria for a diagnosis of social anxiety disorder).

IntroductionLongitudinal trajectory methods, featuring outcome assessments at three or more time points, are increasingly being used as appropriate approaches to understand developmental pathways of people on the autism spectrum across the lifespan. Understanding the scope of this rapidly expanding body of research can help inform future trajectory studies and identify areas for potential meta-analysis as well as key evidence gaps. We present the protocol for a scoping review whose objective is to identify and summarise the scope of research that uses a longitudinal trajectory study design to examine development in children diagnosed with autism. Specifically, we will identify outcome domains and age intervals that have been well characterised, areas where further research is needed and the historical use of various longitudinal trajectory analytical approaches.Methods and analysisWe outline the methods for the proposed scoping review according to the framework outlined by Arksey and O’Malley, with subsequent clarifications and enhancements by other authors. Using a search strategy developed by a medical librarian, we will search six databases for relevant publications. Titles and abstracts will be screened in duplicate, followed by full-text screening. Data extraction fields developed predominantly a priori from a set of guiding subquestions will be used to chart relevant data. The findings will include quantitative aggregate summaries, narrative summaries, and appraisal of trajectory studies according to our methodological subquestions. We will consult autistic self-advocate and parent–caregiver stakeholders to facilitate interpretation of the findings.Ethics and disseminationResearch ethics approval is not required for this scoping review. The results will be presented to researcher, care professional, policy-maker and stakeholder audiences at local and international conferences, other dissemination activities and published in a peer-reviewed journal.