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.

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