Does the Presence of Anxiety and ADHD Symptoms Add to Social Impairment in Children with Autism Spectrum Disorder?

Abstract

Children with autism spectrum disorder (ASD) experience internalizing and externalizing problems at higher rates than typically developing children, which could worsen social impairment. The present study compared impairment scores (social responsiveness scale, 2nd edition; SRS-2 scores) in 57 children (3-17 years, 82.5% male) with ASD, either with or without heightened levels of anxiety or ADHD symptoms, all per parent report. Children with heightened anxiety problems showed higher scores on four SRS-2 subscales (Social Cognition, Social Communication, Social Motivation, and Restricted Interests and Repetitive Behavior). Children with heightened ADHD traits showed higher scores on two subscales (Social Communication and Social Awareness). These findings suggest similarities and differences in how social deficits in ASD may worsen with anxiety or ADHD symptoms.

The Triple Network Model, Insight, and Large-Scale Brain Organization in Autism

“…Internalizing symptoms, including anxiety, phobias, somatization, and excessive worry, are prominent in autism spectrum disorders and can exacerbate primary autism symptom severity (6). Drawing on the triple network model, Hogeveen et al .…”

Effects of the Co‐occurrence of Anxiety and Attention‐Deficit/Hyperactivity Disorder on Intrinsic Functional Network Centrality among Children with Autism Spectrum Disorder

“…This might be related to our finding that lower centrality of the left SFG is associated with higher severity of social interaction problems in children with ASD. A previous study also reported that in children with ASD clinical ADHD was associated with increased social awareness deficits (deficits initiating social interaction) but clinical anxiety was not [Factor et al, ]. Among the four groups, the ASD + ADHD group had the highest DC in the left SFG, which was not related to anxiety.…”

“…Nonetheless, clinical anxiety and ADHD are commonly experienced by individuals with ASD and are associated with disrupted adaptive functioning and exacerbated social difficulties [Factor et al, ; Kerns et al, , ; Solomon, Miller, Taylor, Hinshaw, & Carter, ; South et al, ; van Steensel et al, ; van Steensel, Bogels, & de Bruin, ]. A recent investigation suggested a twofold increased risk of mortality in patients with mental/behavioral comorbidities and ASD compared with those with ASD only [Schendel et al, ].…”

“…Indeed, up to 40% of children with ASD have a comorbid anxiety diagnosis [Kern et al, 2015;van Steensel, Bogels, & Perrin, 2011;White et al, 2014]. Furthermore, high levels of anxiety have been posited to exacerbate ASD symptom severity [Factor, Ryan, Farley, Ollendick, & Scarpa, 2017;Wood & Gadow, 2010]. In addition, between 30% and 50% of individuals diagnosed with ASD also exhibit elevated levels of ADHD symptoms [Gadow, Devincent, & Pomeroy, 2006;Goldstein & Schwebach, 2004].…”

“…Some estimates suggest that 30%-80% of individuals with ASD have comorbid ADHD [Jang et al, 2013;Rommelse, Franke, Geurts, Hartman, & Buitelaar, 2010]. Furthermore, previous studies suggest that the co-occurrence of anxiety and ADHD leads to worse symptoms in children with ASD, including social deficits [Factor et al, 2017;South, Carr, Stephenson, Maisel, & Cox, 2017;Sprenger et al, 2013] and executive dysfunction [Demetriou et al, 2018;Gardiner & Iarocci, 2018;Lawson et al, 2015;Wallace et al, 2016], both of which have been associated with brain alterations. It thus remains unclear if the co-occurrence of anxiety and ADHD affects neural networks in children with ASD.…”