Doctor of Philosophy in Psychology (PhD)
The development and impact of co-occurring anxiety and ADHD in autism
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Background: Evidence suggests anxiety is associated with greater social communication difficulties among autistic children; however, findings regarding the direction of this relationship are mixed. In addition, it is not yet established whether executive functions (EFs) act as a protective factor, by moderating these relationships. In this study, we examined these associations longitudinally in a community sample of autistic pre-adolescents. In particular, we: (1) investigated whether anxiety predicts greater social communication difficulties over time, or vice versa, and (2) assessed the moderating effect of EF.Methods:Participants were drawn from Pathways, a pan-Canadian, longitudinal cohort study of autistic children (N = 157; 15% female; mean FSIQ = 84.8). We focused on two time points during pre-adolescence (age 9: mean age = 9.7 years, and age 10: mean age = 10.7 years). A cross-lagged panel model tested whether levels of parent-reported anxiety at age 9 predicted teacher-reported social communication difficulties at age 10, and vice versa (cross-lagged pathways). Next, multigroup analyses tested for similarity in cross-lagged pathways across different levels of teacher-reported EF ability.Results:Within our sample, average levels of anxiety were relatively low, and levels of anxiety and social communication difficulties decreased from age 9 to age 10. Analyses in the whole sample indicated that there were no significant longitudinal associations between anxiety and social communication difficulties. However, multi-group analyses revealed that among participants with clinically elevated behavioural dysregulation only, lower age 9 anxiety predicted increased social communication difficulties at age 10. Conclusions:Our findings highlight the importance of considering the potentially beneficial role some anxiety may play in shaping autistic children’s social development. We suggest potential pathways by which anxiety may be associated with emergent social abilities for children with behavioural regulation difficulties. Further multi-method and longitudinal research is required to clarify the mechanisms underlying this relationship, in order to establish the clinical implications of these findings. Such research has the potential to enhance the precision of clinical care for autistic youth, with the ultimate goal of providing more individualized care to support both social and emotional wellbeing.
Social impairment, including deficits in social ability and poorer quality peer relationships, is elevated among children with ASD and anxiety disorders, and may influence the presentation of anxiety symptoms experienced by these children, particularly social anxiety. Most research to date has investigated this topic using only single-informant, broad measures of social functioning, limiting our understanding of how different aspects of social functioning relate to one another and to anxiety in this population. The current study sought to extend prior work by using a novel network analytic approach to examine how different facets of social ability (e.g., social communication, social motivation) and peer relationships (e.g., friendships, bullying) relate to one another and to anxiety severity and comorbidity in a large treatment-seeking sample of children with ASD and anxiety disorders. Additionally, this study sought to clarify the role of social functioning in the presentation of social and non-social anxiety symptoms in children with ASD. A sample of 200 children with ASD and anxiety disorders and their caregivers completed a clinical interview and a multi-informant battery of standard and clinically-informed measures of social functioning. The network analysis demonstrated strong connections among the core social deficits of ASD (i.e., social motivation, social communication), and among measures of social integration (i.e., conflict with peers, bullying), though there was little overlap between these two communities. Theory of Mind (ToM), or the ability to understand the thoughts and feelings of others, was positively associated with nearly every measure of social ability and peer relationships in the network, suggesting that this social-cognitive skill may play a central role in the social well-being of children with ASD and comorbid anxiety. ToM also appeared to play a role in the presentation of anxiety symptoms, whereby greater ToM impairment was associated with a distinct presentation of social anxiety (i.e., social fears without fear of negative evaluation). Findings suggest that difficulties in one area of social ability or peer relationships may be associated with difficulties in other, related areas of social functioning—particularly ToM, which may represent an optimal target for psychosocial treatments for children with ASD and anxiety disorders.
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