The Longitudinal Association between Anxiety and Restricted/ Repetitive Behaviour in Autism Spectrum Disorder

Background: Autism spectrum disorder (ASD) affects 1-2% of children. The core symptoms include (1) social communication deficits and (2) restricted and repetitive patterns of behaviour. Autistic children experience high rates of co-occurring anxiety; anxiety disorders are estimated to affect 40%. Previous data suggest that restricted/repetitive behaviour severity correlates with anxiety levels in cross-sectional samples. The nature of the longitudinal relationship between anxiety and restricted/repetitive behaviour in ASD is unknown. Methods: In a cohort of autistic children followed between ages 3 and 11 years (n = 421), anxiety was measured longitudinally using a parent report measure (Childhood Behavior Checklist - anxiety problems subscale). Restricted/repetitive behaviour was measured using a standardized parent interview (Autism Diagnostic Interview - Revised) and a parent survey (Repetitive Behavior Scale - Revised). The longitudinal association between anxiety and restricted/ repetitive behaviour was explored using three different analytic approaches: (1) multivariable logistic regression (Study 1), (2) group-based trajectory modelling (Study 2), and (3) cross-lagged panel modelling (Study 3). Results: In study 1, preschool restricted/ repetitive behaviour severity was an independent predictor of clinically elevated anxiety symptoms in middle childhood. Sameness and restricted behaviour subtypes appeared to be the most predictive of future anxiety. In study 2, four anxiety trajectories and three insistence on sameness behaviour trajectories were identified, with mostly stable or increasing symptoms. Sameness and anxiety trajectories were similar in severity and direction for two-thirds of the sample. ‘High-peaking’ insistence on sameness trajectory membership was associated with clinically elevated anxiety trajectories. In study 3, cross-lagged panels supported a model where a rise in sameness behaviours precedes a rise in anxiety symptoms; within time associations also appeared to lessen with age. Conclusion: In ASD, restricted/repetitive behaviour and anxiety are related symptom domains, especially in early childhood. Elevated or increasing restricted/repetitive behaviour severity, especially level of insistence on sameness behaviour, is a predictor of future anxiety problems. Longitudinal anxiety symptoms and insistence on sameness behaviours often mirror each other and should be assessed concurrently. Therapeutic interventions including participants with high or increasing sameness behaviours in early to middle childhood may help reduce or prevent anxiety disorders in ASD.

Department dc:contributor.department

Dalla Lana School of Public Health

Year dc:date.issued

2022

Author dc:creator

• Baribeau, Danielle Andrea

Advisor dc:contributor.advisor

• Vigod, Simone

• anxiety
• autism
• insistence on sameness
• repetitive behaviour

Handle dc:identifier.uri

http://hdl.handle.net/1807/125561

OAI identifier oai:identifier

oai:utoronto.scholaris.ca:1807/125561