Many gifted scientists and artists have recognized autism, often associated with severe or impairing conditions. Today we will be discussing “autism spectrum disorder” or ASD. This term acknowledges the complexity and heterogeneity of a lifelong situation whose symptoms are a continuum and can vary significantly from one patient to another. Various medical and psychological comorbidities, including OCD, ADHD, OCD, anxiety disorders, and gastrointestinal disorders, complicate this condition.
Anxiety disorders are the most common comorbid conditions among ASD patients, even though it is not considered a core feature. These patients need to be aware of their anxiety symptoms and treated accordingly.
ASD Core Aspects and Their Clinical Presentation
According to the Diagnostic and Statistical Manual of Mental Disorders-5th Edition, ASD’s core symptom domains are characterized by deficits in social communication in multiple contexts (obligations of social-emotional mutuality, nonverbal communication, and developing relations) and restricted and repetitive patterns of behavior and interest.
These symptoms should be evident in the early stages of development, but they might only appear later in life.
- Social communication deficiencies
- In early childhood, atypical or absent eye contact is a common symptom. Atypical facial expressions can be hard to read. Vocal characteristics such as monotonous or flat vocals, exaggerated voices, and a lack of pointing may also be unusual. These children may have difficulty reading facial expressions, gestures, and emotions from others. This, along with language delays, can lead to problems in social interaction.
- Repetitive behavior patterns, limited interests, and resistance to change
- ASD children often have a lack of interest in other people. They may prefer objects that can be used nonplay stereotypically or for self-stimulation. Sometimes, they also show unusual reactions to sounds, sights, smells, and textures. The rigidity can include rigid habits, such as eating the same foods daily and restricting interests. This unusually intense interest in an object or topic leads to activities with no functionality (e.g., a preoccupation with cars and memorizing all makes and models). Children can react with anger and aggression to any deviation from their routines, such as when they travel.
Why Do These Patients Need Help?
ASD patients seek treatment for two main reasons. They are two distinct sub-groups.
- Behavior issues include aggression, irritability, and self-injurious behaviors. These issues are closely linked to the core aspects of repetitive and compulsive behaviors and compulsivity. They mainly concern the subgroup that has intellectual disabilities and language problems.
- Internalizing symptoms are depression and anxiety that ASD may cause in patients with high-functioning autism, particularly those with ASD who have a continued lack of social communication skills.
Is anxiety a significant problem in autism?
While anxiety is not a hallmark of ASD, 40% have anxiety disorders or clinically elevated levels.
ASD anxiety is a severe condition that requires treatment. It can lead to social withdrawal and repetitive behavior, making it difficult for people with ASD to recognize and manage their anxiety.
Untreated comorbid anxiety can lead to aggression, depression, and self-injury in ASD. However, early treatment and recognition may help improve the prognosis.
Anxiety in ASD and How to Recognize It
Because of the overlapping symptoms and altered presentation, it can be challenging to identify anxiety in ASD patients.
Patients who are not verbally able to communicate their inner states (e.g., worry) may instead display anxiety through disruptive behavior. Others may be verbally fluent but have difficulty understanding and expressing one’s emotions.
ASD can present with anxiety with different symptoms at different times and with various environmental demands.
- Specific Phobia: This fear causes high anxiety about something that does not pose any danger. It can develop early in ASD due to oversensitivity to sensory stimulation, such as loud environments, advertisement jingles, balloon popping, vacuum cleaners, and alarms at school. However, it may also include fears common to developing youth (e.g., of the dark, insects, or needles).
- Obsessive-compulsive Disorder: OCD is characterized by intrusive and unwanted thoughts and compulsive and compulsive behaviors. It is essential to identify comorbid OCD. Although the repetitive behavior expected with ASD is unrelated to distress, compulsions can be used as a coping mechanism for anxiety.
- Social anxiety: As the patient gets older and the environment becomes more challenging, social communication impairment can be a sign of social anxiety. This is especially true if the patient has high-functioning social skills and is aware of their social incompetence. Social anxiety is extreme anxiety or fear of being negatively evaluated in a social or performance situation. This can lead to avoiding social problems and reducing the patient’s ability to practice social skills. It may also make it more difficult for the patient to deal with bullying and other adverse reactions.
- Separation anxiety: Social impairment can lead to overprotective responses from parents, which may increase avoidance behavior in the child. This separation anxiety could occur when the patient must separate from their attachment figures, such as when moving away from the family to go to college.
- ASD youths may also experience other symptoms, such as anxiety due to extreme distress or environmental changes.
How to Treat Anxiety in ASD. A Personalized Approach
Evidence pointing to the effect of anxiety on ASD progression highlights the importance of treating anxiety issues promptly to improve the overall functioning of people with ASD.
Although anxiety is not an aspect of ASD core, it can be treated as a separate disorder that arises during ASD. However, treatments must be tailored to the population.
This is a specific approach to treating anxiety in this population: