Abstract
Anxiety seems to occur frequently in individuals with autism, but varying prevalence estimates indicate uncertainties in identifying anxiety, especially in those with intellectual disability (ID). The present study explores the recognition of anxiety symptoms and aims to provide suggestions for the assessment of anxiety in individuals with autism and ID.
Two separate samples, a community sample of 62 individuals and a clinical sample of 9 individuals, were assessed with anxiety items from a screening checklist. Each item's scores were analyzed. In addition, in the clinical sample, checklist results were compared with clinical assessments.
The results indicate that anxiety can be recognized by symptoms similar to those in non-autistic individuals, but signs of physiological arousal seem difficult to recognize in this population. The results imply inclusion of general adjustment problems in order to identify individuals with anxiety problems by using a checklist. For diagnostic purposes, the use of an individual anxiety assessment seems indicated.
Anxiety is assumed to occur frequently in individuals with autism1 (Ghaziuddin, 2005, Howlin, 2000, Lainhart, 1999, Luscre and Center, 1996 and Tantam, 2000). Reports of high prevalence rates have contributed to the growing awareness of anxiety as disorders separate from autism, and to the important implications of identifying anxiety disorders in addition to the diagnosis of autism for the conceptualization and treatment of these individuals (Gillott et al., 2001, Green et al., 2000, Matson and Nebel-Schwalm, 2007 and Morgan, 2006). Overall, the most frequently occurring anxiety disorders in children and adolescents with autism appears to be specific phobia, generalized anxiety disorder, separation anxiety, obsessive compulsive disorder, and social phobia (MacNeil et al., 2009 and White et al., 2009). However, the prevalence estimates of anxiety disorders in people with autism vary extensively (Kim, Szatmari, Bryson, Streiner, & Wilson, 2000). For example, vary reported rates in two recently published review studies between 7% and 84% (MacNeil et al., 2009 and White et al., 2009). Thus, there seem to be differences and uncertainties about how anxiety may be recognized and diagnosed in these individuals.
The close relationship between autism and anxiety (Morgan, 2006 and Weisbrot et al., 2005) has led to diagnostic overshadowing (i.e. the tendency to overlook comorbid mental health problems in the presence of a disability; Mason & Scior, 2004). The tendency to attribute anxiety symptoms such as distress symptoms to the autism condition per se may indicate that these symptoms are overlooked, considered as less significant than the effect of the disability, or misinterpreted (Lainhart, 1999 and MacNeil et al., 2009). For example, anxiety symptoms such as panic attacks and obsessions may be misinterpreted as behavior problems that are directly related to autism (Tsai, 2006), and frequent and repetitive questioning may be interpreted as signs of anxiety, or verbal rituals, or abnormal communication (Ghaziuddin, Alessi, & Greden, 1995).
