Autism and Anxiety Disorders: Part Two: Diagnosing and Treating Anxiety in People with Autism

Autism and Anxiety Disorders: Part Two: Diagnosing and Treating Anxiety in People with Autism

Wendy Chung, MD

Wendy Chung MD

Wendy Chung serves as the principal investigator of SPARK, overseeing all aspects of SPARK development, with an emphasis on genetic research components of the project. She is also the P.I. for the Simons Variation in Individuals Project, which characterizes behavior and brain structure and function in participants with genetic variants believed to play a role in autism spectrum disorders. As principal investigator of SPARK, she is leading the effort to build a community of individuals with autism and their families, working with them to better understand the causes of autism and to develop better means of supporting individuals with the condition. She evaluates opportunities to develop new treatments and supports for autism and new outcome measures to evaluate the efficacy of these treatments.

A clinical and molecular geneticist, Chung received a B.A. in biochemistry and economics from Cornell University, an M.D. from Cornell University Medical College, and a Ph.D. in genetics from Rockefeller University. She is currently the Kennedy Family Associate Professor of Pediatrics and Medicine at Columbia University, where she directs the clinical genetics program and performs human genetics research. At Columbia, she clinically assesses children with autism spectrum disorders and intellectual disabilities and uses advanced genomic diagnostic methods, including whole-exome sequencing, to identify the underlying genetic basis for neurological conditions. In her work, she strives to facilitate the integration of genetic medicine into all areas of healthcare in a medically, scientifically, and ethically sound, accessible, and cost-effective manner.

Chung has received the American Academy of Pediatrics Young Investigator Award, the Medical Achievement Award from Bonei Olam, and a career development award from Doris Duke Charitable Foundation and is a member of the Dade County Hall of Fame. A renowned teacher and mentor, she is a member of the Glenda Garvey Teaching Academy and has won many awards for teaching, including the Charles W. Bohmfalk Award for Distinguished Contributions to Teaching, the American Medical Women’s Association Mentor Award, and the Columbia University Presidential Award for Outstanding Teaching. In 2014, Chung delivered a frequently viewed TED Talk, “What We Know About Autism.”

Autism and Anxiety Disorders: Part Two: Diagnosing and Treating Anxiety in People with Autism

Share
No
Anxiety and Autism Spectrum Disorders SPARK

April is world autism awareness month, and so there is no better time to bring to light not only the challenges associated with autism, but also the most common conditions that impact this community. Children and adults on the autism spectrum are more likely to have an anxiety disorder than others. And research suggests they also may face challenges with getting an anxiety diagnosis and treatment.

The social and communication challenges at the heart of autism may complicate the process of being diagnosed with anxiety which, in part, relies on patients’ ability to describe their symptoms. Some children have language or learning problems that make it harder for them to discuss their symptoms and emotions. Even those who speak fluently may have trouble identifying and describing their feelings, a condition called alexithymia.

Also, the standard assessments used to diagnose anxiety may not work as well in youth who have autism spectrum disorder (ASD). As a study concluded in 2014, “measuring anxiety in ASD is fraught with uncertainty.”

Fortunately, researchers are developing tools that will help doctors distinguish between often overlapping symptoms to make it easier to diagnose anxiety in children and teens on the spectrum, says Roma A. Vasa, M.D., a child psychiatrist who specializes in both anxiety and autism at the Kennedy Krieger Institute in Maryland.

Among people with autism, about 40 percent of youth – and up to half of adults – meet the clinical criteria of an anxiety disorder vs. 7 percent of children and 19 percent of adults in the general population, according to U.S. government health statistics.

To help doctors, Vasa and doctors in the Autism Treatment Network published recommendations for diagnosing and treating anxiety in youth who have autism including:

●    Look for physical signs, such as tremors, restlessness, sweating, body aches, and sleep problems.
●    Ask the child, parents, and teachers about possible signs of anxiety. Does the child’s behavior change in certain situations?
●    Address school and home problems that trigger anxiety. Bullying, learning and speech problems, and inadequate help at school may be fueling anxiety.
●    Address medical conditions, such as insomnia, or medications that may fuel anxiety.
●    Consider how much anxiety interferes with daily life, and whether it occurs in different places.

Once someone is diagnosed with an anxiety disorder, the next step is finding treatment. Do anxiety medications and therapies, which were developed for people who do not have autism, work equally well for people on the spectrum?

That question is hard to answer. Research into anxiety treatments for those on the spectrum is limited. There are proven protocols as to which medications work best, for which symptoms, and in which patients who have autism. Of course, that does not mean that effective treatment is not available.

In a medical journal article, Vasa and other pediatric doctors offered advice for treating children and teenagers. For anxiety symptoms, they identified four possible selective serotonin reuptake inhibitor antidepressants, based upon data for typically developing youth. While encouraging,“We don’t have much data about how we should go about prescribing these medications in autism, so we recommended ‘starting low and going slow,'” and monitoring the child’s reactions, Vasa explains. “These kids are very vulnerable to side effects.”

Researchers are also adapting Cognitive behavioral therapy (CBT) to address some of the common characteristics of autism. These changes include using pictures, concrete language, lists, videos, or social stories, and tapping into the special interests that many people with autism have. An analysis of 14 studies involving autistic youth who did not have intellectual disabilities, found that individual and group CBT therapy decreased anxiety symptoms moderately. In another study of adapted CBT, almost a third of children with autism who completed group therapy were found to be “free of their primary anxiety diagnoses. ”What’s been exciting is that other research groups are now trying to extend this therapy and adapt it for people with intellectual disability and for younger populations,” Vasa says.

Researchers are also looking at two characteristics that may fuel anxiety: having trouble with regulating emotions and with tolerating uncertainty which may improve treatment results, Vasa says. A small study of autistic adults found a link between higher anxiety levels and difficulties with regulating, identifying, and understanding their emotions. Those researchers said that therapies based on mindfulness may help. In mindfulness treatment, people may learn special breathing and relaxation techniques, meditation, and other exercises.

A few studies suggest that mindfulness and CBT are promising anxiety treatments for autistic adults. But more work needs to be done, according to two researchers in the UK who recommended focusing more research attention on treatment, particularly for adults and for people who also have intellectual disability.

This blog post is extracted from original material written by Marina Sarris, SPARK Staff writer.

Please also read SPARK's Autism and Anxiety Disorders blog post.


About SPARK

SPARK is an online, research study for all individuals with a professional diagnosis of autism and their family members as is designed to provide much needed answers. The SPARK study collects a wealth of data including information on the presence of co-occurring mental health conditions including anxiety. April is world autism awareness month, and so there is no better time to bring to light not only the challenges associated with autism, but also the most common conditions that impact this community.

Wendy Chung, MD

Wendy Chung MD

Wendy Chung serves as the principal investigator of SPARK, overseeing all aspects of SPARK development, with an emphasis on genetic research components of the project. She is also the P.I. for the Simons Variation in Individuals Project, which characterizes behavior and brain structure and function in participants with genetic variants believed to play a role in autism spectrum disorders. As principal investigator of SPARK, she is leading the effort to build a community of individuals with autism and their families, working with them to better understand the causes of autism and to develop better means of supporting individuals with the condition. She evaluates opportunities to develop new treatments and supports for autism and new outcome measures to evaluate the efficacy of these treatments.

A clinical and molecular geneticist, Chung received a B.A. in biochemistry and economics from Cornell University, an M.D. from Cornell University Medical College, and a Ph.D. in genetics from Rockefeller University. She is currently the Kennedy Family Associate Professor of Pediatrics and Medicine at Columbia University, where she directs the clinical genetics program and performs human genetics research. At Columbia, she clinically assesses children with autism spectrum disorders and intellectual disabilities and uses advanced genomic diagnostic methods, including whole-exome sequencing, to identify the underlying genetic basis for neurological conditions. In her work, she strives to facilitate the integration of genetic medicine into all areas of healthcare in a medically, scientifically, and ethically sound, accessible, and cost-effective manner.

Chung has received the American Academy of Pediatrics Young Investigator Award, the Medical Achievement Award from Bonei Olam, and a career development award from Doris Duke Charitable Foundation and is a member of the Dade County Hall of Fame. A renowned teacher and mentor, she is a member of the Glenda Garvey Teaching Academy and has won many awards for teaching, including the Charles W. Bohmfalk Award for Distinguished Contributions to Teaching, the American Medical Women’s Association Mentor Award, and the Columbia University Presidential Award for Outstanding Teaching. In 2014, Chung delivered a frequently viewed TED Talk, “What We Know About Autism.”

Use of Website Blog Commenting

Use of Website Blog Commenting

ADAA provides this Website blogs for the benefit of its members and the public. The content, view and opinions published in Blogs written by our personnel or contributors – or from links or posts on the Website from other sources - belong solely to their respective authors and do not necessarily reflect the views of ADAA, its members, management or employees. Any comments or opinions expressed are those of their respective contributors only. Please remember that the open and real-time nature of the comments posted to these venues makes it is impossible for ADAA to confirm the validity of any content posted, and though we reserve the right to review and edit or delete any such comment, we do not guarantee that we will monitor or review it. As such, we are not responsible for any messages posted or the consequences of following any advice offered within such posts. If you find any posts in these posts/comments to be offensive, inaccurate or objectionable, please contact us via email at [email protected] and reference the relevant content. If we determine that removal of a post or posts is necessary, we will make reasonable efforts to do so in a timely manner.

ADAA expressly disclaims responsibility for and liabilities resulting from, any information or communications from and between users of ADAA’s blog post commenting features. Users acknowledge and agree that they may be individually liable for anything they communicate using ADAA’s blogs, including but not limited to defamatory, discriminatory, false or unauthorized information. Users are cautioned that they are responsible for complying with the requirements of applicable copyright and trademark laws and regulations. By submitting a response, comment or content, you agree that such submission is non-confidential for all purposes. Any submission to this Website will be deemed and remain the property of ADAA.

The ADAA blogs are forums for individuals to share their opinions, experiences and thoughts related to mental illness. ADAA wants to ensure the integrity of this service and therefore, use of this service is limited to participants who agree to adhere to the following guidelines:

1. Refrain from transmitting any message, information, data, or text that is unlawful, threatening, abusive, harassing, defamatory, vulgar, obscene, that may be invasive of another 's privacy, hateful, or bashing communications - especially those aimed at gender, race, color, sexual orientation, national origin, religious views or disability.

Please note that there is a review process whereby all comments posted to blog posts and webinars are reviewed by ADAA staff to determine appropriateness before comments are posted. ADAA reserves the right to remove or edit a post containing offensive material as defined by ADAA.

ADAA reserves the right to remove or edit posts that contain explicit, obscene, offensive, or vulgar language. Similarly, posts that contain any graphic files will be removed immediately upon notice.

2. Refrain from posting or transmitting any unsolicited, promotional materials, "junk mail," "spam," "chain mail," "pyramid schemes" or any other form of solicitation. ADAA reserves the right to delete these posts immediately upon notice.

3. ADAA invites and encourages a healthy exchange of opinions. If you disagree with a participant 's post or opinion and wish to challenge it, do so with respect. The real objective of the ADAA blog post commenting function is to promote discussion and understanding, not to convince others that your opinion is "right." Name calling, insults, and personal attacks are not appropriate and will not be tolerated. ADAA will remove these posts immediately upon notice.

4. ADAA promotes privacy and encourages participants to keep personal information such as address and telephone number from being posted. Similarly, do not ask for personal information from other participants. Any comments that ask for telephone, address, e-mail, surveys and research studies will not be approved for posting.

5. Participants should be aware that the opinions, beliefs and statements on blog posts do not necessarily represent the opinions and beliefs of ADAA. Participants also agree that ADAA is not to be held liable for any loss or injury caused, in whole or in part, by sponsorship of blog post commenting. Participants also agree that ADAA reserves the right to report any suspicions of harm to self or others as evidenced by participant posts.

RESOURCES AND NEWS
Evidence-based Tips & Strategies from our Member Experts
RELATED ARTICLES
Block reference
TAKING ACTION
Through years of sharing one anxiety-ridden saga after another, we’ve come to learn that, though…

Advertisement