Date Presented 03/28/20
Comorbid anxiety and hyperarousal in youths with ASD provides additional challenges to occupational participation and competence, and thus occupational adaptation. By studying the effect of anxiety and arousal on competence, we found contrary trends for controls and ASD, suggesting less resilient behavior to anxiety in ASD and lower anxiety-mediated competence in older youths with ASD. This provides foundational knowledge for the design of pragmatic OT interventions.
Primary Author and Speaker: Aditya Jayashankar
Contributing Authors: Christiana Butera, Laura Harrison, Emily Kilroy, Alexis Nalbach, Anusha Hossain, Lisa Aziz-Zadeh
PURPOSE: For individuals with ASD, social communication and sensory modulation difficulties often can limit participation in positive occupations (Reynolds et al, 2011). Additionally, prevalent comorbidity with anxiety disorders (White et al, 2009) and physiological hyperarousal (Thibodeau, Gómez-Pérez, & Asmundson, 2012) further complicates the ability for occupational competence. The latter is of greater concern in adolescents as anxiety symptoms tend to increase with age (White et al, 2009). This study aims – to (1) model the relationship between self-reported Screen for Child Anxiety Related Disorders (SCARED) and Physiological Hyperarousal Scale (PH-C) measures with parent-reported CBCL (Child Behavior Checklist) competence scores (combined metric for social relations, activity participation and school performance) in youth with and without ASD; and (2) to assess their effect on competence outcomes across development. Recognizing the modulatory nature of anxiety and hyperarousal on occupational competence is essential for pragmatic and client-centered intervention designs, since occupational competency yields positive outcomes for occupational adaptation through sustained participation.
DESIGN: Participants were recruited through local schools, parent groups, community centers, and social media. Participants were aged 8–17 years old, English speaking, right-handed and had full-scale IQ>80. Due to recent evidence of similar impacts of anxiety disorders and hyperarousal in youths with and without ASD (Ollendick & White, 2012), participants were analyzed as one group on an anxiety spectrum.
METHOD: 20 high-functioning youth with ASD (mean age= 12.1±2.2; M:F=4:1) and 22 typically developing (TD) controls (mean age= 12.2±2.6; M:F=7:4) participated. SCARED, PH-C and CBCL metrics were collected for each participant. Clinical ASD diagnosis was coded as a binary indicator. Univariate and multivariate statistical analysis were performed using Stata 15. Pearson’s bivariate correlation was used to determine pairwise relationships between variables. Multiple linear regression was used to construct the main effects model, and relevant interaction terms were included in the final model. Model diagnostics and collinearity tests were used to validate the fit of the final model.
RESULTS: Across participants, CBCL competence scores were found to have significant negative correlations with clinical ASD diagnosis (R=-.67, p<.001) and SCARED (R=-.33, p=.03), and positive correlations with IQ (R=.45, p=.003). SCARED was significantly positively correlated with PH-C (R=.5, p=.001), and confounded the SCARED-competence association. Final model estimated the dependent term (CBCL) significantly, explaining 65.7% of its variance (p<.001) using SCARED (β=-.33, p=.04), IQ (β=.36, p=.001), age, PH-C and ASD diagnosis. Significant interaction terms included diagnosis with both SCARED (p=.04) and age (p=.02). Interaction plots showed upward trends for competence across age for lower anxiety in TDs, but the opposite trend for ASDs.
CONCLUSION: For TDs, older ages with lower trait anxiety resulted in better competency outcomes. For ASDs, competence estimates fell within the borderline and clinical ranges. However, unlike TDs, in ASD, younger ages with higher trait anxiety resulted in the best outcomes. These findings replicated results showing anxiety may be less a factor on competence at younger ages, but may impact competence as youths grow older. It also suggests more resilient behavior towards anxiety across time in TDs versus ASDs. These results provide a new look into the ASD-anxiety link and lays the foundation for occupational therapists to address resiliency in client-centered interventions across time for anxiety in ASD.
References
Ollendick, T. H., & White, S. W. (2012). The Presentation and Classification of Anxiety in Autism Spectrum Disorder: Where to From Here? Clinical Psychology: Science and Practice, 19(4), 352–355. https://doi.org/10.1111/cpsp.12013
Reynolds, S., Bendixen, R. M., Lawrence, T., & Lane, S. J. (2011). A Pilot Study Examining Activity Participation, Sensory Responsiveness, and Competence in Children with High Functioning Autism Spectrum Disorder. Journal of Autism and Developmental Disorders, 41(11), 1496–1506. https://doi.org/10.1007/s10803-010-1173-x
Thibodeau, M. A., Gómez-Pérez, L., & Asmundson, G. J. G. (2012). Objective and perceived arousal during performance of tasks with elements of social threat: The influence of anxiety sensitivity. Journal of Behavior Therapy and Experimental Psychiatry, 43(3), 967–974. https://doi.org/10.1016/j.jbtep.2012.03.001
White, S. W., Oswald, D., Ollendick, T., & Scahill, L. (2009). Anxiety in children and adolescents with autism spectrum disorders. Clinical Psychology Review, 29(3), 216–229. https://doi.org/10.1016/j.cpr.2009.01.003
