Anxiety and Autism

We have identified 21 research reviews of anxiety in people on the autism spectrum published in peer-reviewed journals.

Some of the reviews looked only at studies which included autistic people; others looked at studies which included people with a range of conditions including autism and learning disabilities
Some of the reviews looked only at individuals from a specific age range -such as children, adolescents or adults. Other reviews looked at individuals from across the age range
Most of the reviews looked at issues other than intervention, such as the assessment and prevalence of anxiety
Some of the studies looked at the causes of anxiety and/or the associations with other problems
Some of the reviews looked only at a wide range of interventions while others looked only at particular types of intervention (such as cognitive behavioural therapy or medications)
The most commonly assessed interventions were psychological interventions (such as cognitive behavioural therapy and specific behavioural techniques) or medications (such as antidepressants).

Some of the reviews reported some benefits from specific types of intervention. For example,

Hagopian and Jennett (2008) reported on the positive benefits of a range of behavioural techniques based on applied behaviour analysis
Reaven (2011) reported on the positive benefits of cognitive behavioural therapy

Some of the reviews reported that there was currently mixed or insufficient evidence to support the use of some interventions. For example,

Vasa et al (2014) reported “Four psychopharmacological, nine cognitive behavioral therapy (CBT), and two alternative treatment studies met inclusion criteria. Psychopharmacological studies were descriptive or open label, sometimes did not specify the anxiety phenotype, and reported behavioral activation. Citalopram and buspirone yielded some improvement, whereas fluvoxamine did not. Non-psychopharmacological studies were mainly randomized controlled trials (RCTs) with CBT demonstrating moderate efficacy for anxiety disorders in youth with high functioning ASD. Deep pressure and neurofeedback provided some benefit.”

Some of the reviews reported that some interventions were more effective for some individuals than for others. For example

Lang et al (2011) reported “Systematic reviews and randomized clinical trials suggest that cognitive behavior therapy in tandem with direct instruction of social skills using applied behavior analysis intervention components may be effective for treating anxiety in individuals with high functioning ASD. For individuals with ASD, an anxiety disorder, and an intellectual disability, systematic desensitization may be effective”.

Some of the reviews reported that some types of intervention could be potentially hazardous. For example

Vasa et al (2014) reported “…youth with ASD may be particularly vulnerable to behavioral activation with certain [antidepressant] SSRIs. Behavioral activation is a well-known side effect of SSRIs in children and is characterized by a cluster of symptoms including increased activity level, impulsivity, insomnia, or disinhibition without manic symptoms. Other treatment data in youth with ASD similarly show high rates of SSRI-induced behavioral activation. The SSRIs are amongst the most commonly prescribed medications in youth with ASD. There are, however, no large scale RCTs examining their efficacy for treatment of anxiety in youth with ASD, and as such, there are no data to guide evidence based prescribing of these medications. Concern therefore exists regarding the overprescribing of SSRIs and risk of subjecting children to potential side effects, especially activation.”

There are limitations in most of the research reviews we have identified to date and in most of the studies included in those reviews

Some of the reviews were limited to people on the autism spectrum of a specific age. For example,

Grondhuis and Aman (2012) and van Steensel et al. (2011) looked only at children and adolescents on the autism spectrum.

Some of the reviews were limited to people on the autism spectrum with additional conditions. For example,

Hagopian and Jennett (2008) looked only at people on the autism spectrum with learning disabilities.

Some of the reviews looked at issues other than interventions. For example,

Kerns and Kendall (2012) looked at the symptoms and classification of anxiety, while Wigham S. McConachie H. (2014) looked only at assessment tools.

Some of the reviews were limited to specific types of intervention or specific forms of anxiety. For example,

Hagopian and Jennett (2008) looked only at behavioural interventions designed to treat phobias and Nadeau et al (2011) looked only at cognitive behavioural therapy and antidepressants.

Most of the reviews identified only low quality studies or did not report on the quality of the studies.For example

Hagopian and Jennett (2008) reported that half of the studies they identified were uncontrolled case reports
Vasa et al (2014) reported that the studies of alternative treatments “... were short-term and included small sample sizes.”

Some of the reviews were written by authors involved in the development or use of specific types of intervention.

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