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Forest plot of the random effects model of meta-analysis 1 -on correlations between IQ and anxiety in autistic children. Data are split by subgroups ('byvar') based on whether studies included participants with intellectual disabilities.
Source publication
Lay abstract:
Autistic children often experience higher levels of anxiety than their peers. It can be difficult to diagnose and treat anxiety disorders in autistic children, in part because of the high degree of variability in their underlying abilities and presentations. Some evidence suggests that autistic children with higher intelligence (as m...
Contexts in source publication
Context 1
... of the REM indicated that there was a small but significant positive correlation between IQ scores and anxiety scores in autistic children, r = 0.10, 95% confidence interval (CI): [0.04-0.16] (see forest plot, Figure 2). A high level of heterogeneity was observed, Higgins I 2 = 81%. ...
Context 2
... this study, marginally lowered the overall estimate, narrowed the CIs and reduced heterogeneity somewhat, r = 0.08, 95% CI: Subgroup analysis. To understand the relationship between the findings and the inclusion or exclusion of children with ID, subgroup analysis was performed (Figure 2). In all, 15 papers included children with ID, 11 did not include children with ID and for 5 papers it was unclear. ...
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Background
Intellectual disability affects approximately one third of individuals with autism spectrum disorder (autism). Yet, a major unresolved neurobiological question is what differentiates autistic individuals with and without intellectual disability. Intelligence quotients (IQs) are highly variable during childhood. We previously identified t...
Several studies suggest that a valuable tool to examine linguistic skills in communication disorders is offered by procedures of narrative discourse assessment. Following this line of research, we present an exploratory study aimed to investigate storytelling abilities of autistic children to better define the characteristics of their story product...
Introduction
Autism spectrum disorder (ASD) is a neurological and developmental disorder, which poses challenges to social communication and behavior, particularly affecting social functioning. Individuals with ASD face significant social challenges, including difficulty understanding social cues and body language, limited ability to engage in reci...
There are noteworthy sex disparities in the prevalence of autism spectrum disorders (ASD), while findings regarding the sex differences in core symptoms are inconsistent. There are few relevant studies on sex differences in mainland China. This study was dedicated to a deeper understanding of the impact of sex differences on the clinical presentati...
Objectives
The aim of this work was to perform an audiological evaluation on a group of children with autistic features and to correlate the results with the intelligent quotient, communication skills, and sensory integration function of these children.
Study design
Descriptive cross-sectional study.
Patients and methods
The study was carried out o...
Citations
... Accurate assessments of anxiety are therefore needed to identify and monitor symptoms of anxiety in children living with NDDs. However, there are challenges to assessing anxiety in children with NDDs, including overlapping features of NDDs and anxiety that can confound the assessment of anxiety and lead to misinterpretation of anxiety-related signs and symptoms (8,9). Indeed, there is considerable overlap in diagnostic symptom criteria for ADHD and anxiety, including restlessness and distractibility (8). ...
... Indeed, there is considerable overlap in diagnostic symptom criteria for ADHD and anxiety, including restlessness and distractibility (8). In ASD, deficits in social interactions and stereotyped, repetitive motor movements too can be misinterpreted as anxiety and vice versa (9). These challenges are particularly difficult given co-occurring intellectual disabilities and language impairments (9). ...
... In ASD, deficits in social interactions and stereotyped, repetitive motor movements too can be misinterpreted as anxiety and vice versa (9). These challenges are particularly difficult given co-occurring intellectual disabilities and language impairments (9). ...
Anxiety is common in neurodevelopmental disorders (NDD). The parent version of the Spence Children’s Anxiety Scale (SCAS-P) is a widely used measure to assess anxiety across a broad range of childhood populations. However, assessment of the measurement properties of the SCAS-P in NDDs have been limited. The present study aimed to assess the psychometric properties of the SCAS-P in children with attention-deficit/hyperactivity disorder (ADHD) and autism spectrum disorder (ASD) using Rasch Measurement Theory. Data from the Province of Ontario Neurodevelopmental Disorders Network Registry were used in the analysis. Children (ages 6-13 years old) with a primary diagnosis of ADHD (n=146) or ASD (n=104) were administered the SCAS-P. Rasch Measurement Theory was used to assess measurement properties of the SCAS-P, including unidimensionality and item-level fit, category ordering, item targeting, person separation index and reliability and differential item functioning. The SCAS-P fit well to the Rasch model in both ADHD and ASD, including unidimensionality, satisfactory category ordering and goodness-of-fit. However, item-person measures showed poor precision at lower levels of anxiety. Some items showed differential item functioning, including items within the obsessive-compulsive, panic/agoraphobia and physical injury fears domains, suggesting that the presentation of anxiety may differ between ADHD and ASD. Overall, the results generally support the use of the SCAS-P to screen and monitor anxiety symptoms in children with ADHD and ASD. Future studies would benefit from examination of more severely anxious NDD cohort, including those with clinically diagnosed anxiety.
... We created a quality assessment framework (QAF) to capture information about potential threats to validity (Table 2). Based on previous meta-analyses (Mingins et al., 2020;Richards et al., 2015;Surtees et al., 2018), the QAF was designed to rate each individual study included within the final sample for bias. Studies were scored across four domains as required: sample identification, autism measurement, ID measurement, and self-restraint measurement. ...
Purpose
Self-restraint, purposeful restriction of one’s own bodily movements is observed in individuals with neurodevelopmental conditions. Case studies and cross-sectional investigations have reported that self-restraint co-occurs with self-injurious behaviour; however, small sample sizes limit understanding of prevalence and function. We aimed to synthesise the existing literature and estimate the pooled prevalence of self-restraint in autistic individuals and/or individuals with intellectual disability, and the pooled effect size with self-injury.
Methods
Six databases were systematically searched in accordance with PRISMA guidelines.
Results
A total of 21,567 papers were retrieved, with 15 samples from 13 records included in the analyses. The pooled prevalence estimate of self-restraint in individuals with autism and/or intellectual disability was 39%, 95% CI [26.25, 51.59]. Age and presence of autism significantly increased prevalence rates. Pooled prevalence estimates were consistent across gender, presence of intellectual disability, and type of measurement of self-restraint. Meta-analyses of 31 topographies of self-restraint revealed ‘holds or squeezes objects’ and ‘holding onto others, holding onto others’ clothing’ were the most prevalent behaviours amongst those who self-restrained (both 32%). The least prevalent behaviour was ‘chooses mechanical restraint’ (1%). Pooled prevalence estimates of self-restraint in individuals known to self-injure were 34%, 95% CI [21.36, 46.97], and 13%, 95% CI [5.01, 21.43], in individuals who did not self-injure. Self-restraint and self-injurious behaviour were positively correlated, r = 0.21, 95% CI [0.14, 0.27], K = 13.
Conclusions
Findings highlight that on average, over one third of individuals with autism and/or intellectual disability show self-restraint. Clinical and theoretical implications of findings are discussed.
... To date, there remains little consistency and consensus exist around how anxiety in children with ASD should be measured (White et al., 2009). Importantly, progress has been made towards better anxiety measures with sensitivities towards ASD, although these measures still lack widespread use (Mingins et al., 2021). Examples include an adaption of the parent-rated Children's Yale-Brown Obsessive Compulsive Scale for 5 to 17 year olds, which focuses on behavioural manifestations of anxiety in ASD (Scahill et al., 2019), and a clinician-administered version of the Pediatric Anxiety Rating Scale which was modified based on feedback from a panel of experts, including parents of children with ASD (Maddox et al., 2020). ...
... perceived as more capable and less in need of support to adapt to a neurotypical world (Mingins et al., 2021). However, research has also shown that people with high-functioning ASD may still display poor adaptive behaviours despite not having an intellectual disability (Alvares et al., 2020). ...
Research on the prevalence of anxiety in children and adolescents with autism remains fragmented due to a reliance on help-seeking populations and differences in anxiety assessment. We present the pooled findings from 15 community studies (N = 4459) sourced from the Embase, PubMed, and PsycINFO databases (1970–2023). Equally high rates of anxiety symptoms and disorders were identified via self-report (33%, CI = 25 to 40%) and diagnostic interview (19%, CI = 7 to 40%). Higher IQ and male gender were identified as significant covariates, although these results may reflect sampling biases. The findings highlight the need for routine screening, with multiple informants, and improved sampling methods. Protocol was registered on Open Science Framework (https://osf.io/7mtca/).
... Social motivation has been linked to social skills in autistic children across a range of IQs (Itskovich et al., 2021). However, autistic children with higher IQ show increased anxiety, which may be due, in part, to difficulties measuring anxiety in individuals with ID (Mingins, Tarver, Waite, Jones, & Surtees, 2021). Future studies should test whether effects can be replicated across the spectrum of intellectual ability, where the constructs in this study may be challenging to measure. ...
Background
The Social Motivation Theory proposes that social reward processing differences underlie autism. However, low social motivation has also been linked to higher anxiety. Given the co‐occurrence between autism and anxiety, it is possible that anxiety drives the association between social motivation and autistic characteristics. This study tests the mechanisms underlying the association between social motivation and autistic traits.
Methods
Participants were 165 adolescents (71 male), aged 10–16 years, from the Mapping profiles of cognition, motivation and attention in childhood (C‐MAPS) study, enriched for autistic traits (70 participants with an autism diagnosis, 37 male). Participants completed a battery of online experimental tasks, including a Choose‐a‐Movie social motivation task and social cognition measures (theory of mind; emotion recognition), alongside parent‐reported child anxiety and autistic traits.
Results
Higher social motivation was significantly associated with lower autistic traits (β = −.26, p < .001). Controlling for social cognition did not change the association between social motivation and autistic traits. Controlling for anxiety did significantly reduce the strength of the association (unstandardized coefficient change: p = .003), although social motivation remained associated with autistic traits (β = −.16, p = .004). Post hoc analyses demonstrated differential sex‐effects: The association between social motivation and autistic traits was significant only in the females (β = −.38, p < .001), as was the attenuation by anxiety (unstandardized coefficient change: p < .001).
Conclusions
The association between social motivation and autistic traits could be partially attributed to co‐occurring anxiety. Sex‐specific effects found in females may be due to environmental factors such as increased social demands in adolescent female relationships. Results are consistent with self‐report by autistic individuals who do not identify as having reduced social motivation.
... However, children with cooccurring ID presented with higher levels of specific internalizing problems such as self-injury and unusual fear responses but lower levels of sleep and mood problems. Other studies have reported lower levels of internalizing problems such as depression and anxiety among children with co-occurring ID compared to children without ID (Estes et al., 2007;Hallett et al., 2013;Mayes, Calhoun, Murray, & Zahid, 2011;Salazar et al., 2015) or no differences between groups (Mingins et al., 2021). A significant limitation of the existing evidence is that studies have used a categorical classification either in the form of an ID variable or a dichotomized IQ score, restricting analysis options and statistical power. ...
... Although no significant overall association between IQ scores and parent-reported anxiety was found, when researchers split the sample by IQ score, they found a very small negative association for those above 70 (suggesting anxiety increases as IQ decreases in those with IQs in the 70+ category) and a small positive association in those with an IQ score below 70 (suggesting an increase in anxiety as IQ scores increase for those with an overall IQ score below 70). Mingins et al. (2021) conducted a similar meta-analysis but included data from more autistic children (n = 18,430), across childhood and adolescence, also including studies with autistic participants with ID. In terms of the overall association between IQ scores and anxiety symptoms, Mingins et al. (2021) found a very small correlation (r = 0.08), similar to the Edirisooriya study, though in the Mingins study it was significant probably due to the large sample size. ...
... Mingins et al. (2021) conducted a similar meta-analysis but included data from more autistic children (n = 18,430), across childhood and adolescence, also including studies with autistic participants with ID. In terms of the overall association between IQ scores and anxiety symptoms, Mingins et al. (2021) found a very small correlation (r = 0.08), similar to the Edirisooriya study, though in the Mingins study it was significant probably due to the large sample size. Interestingly, Mingins et al. (2021) found the association increased to 0.18 when restricted to studies that included children with cooccurring ID, but became near zero when studies did not include autistic children with ID. ...
The presence of an intellectual disability (ID) alongside autism is considered to increase the risk for mental health and behavior problems in children and adolescents. Existing evidence is restricted by looking at ID as a categorical classification. The study aimed to examine the association of cognitive and adaptive behavior skills with internalizing and externalizing problems in a large sample of autistic children and adolescents, across a wide range of cognitive skills. Participants were 2759 children and adolescents aged between 4 and 18 years recruited as part of the Simons Simplex Collection (SSC), of whom 709 (approximately 25%) had ID. Multiple regression models examined associations of internalizing and externalizing problems with cognitive and adaptive skills (communication, daily living, and socialization skills). Cognitive skills were not associated with externalizing problems but were associated with more internalizing problems in autistic children without ID (Cog β : 0.126). All adaptive skill domains were inversely associated with externalizing (Communication β : −0.145; Daily‐Living β : −0.132; Socialization β : −0.289) and internalizing problems (Communication β : −0.074; Daily‐Living β : −0.064; Socialization β : −0.213) in those without ID. Daily living ( β : −0.158) and socialization skills ( β : −0.104) were inversely correlated with externalizing problems in autistic children with ID, while only socialization problems ( β : −0.099) were associated with internalizing problems in this group. Socialization skills were systematically associated with internalizing and externalizing problems across all levels of cognitive functioning. Supporting social skills development may benefit all aspects of child mental health, while recognizing that children with higher cognitive skills are more vulnerable to internalizing problems might assist with earlier identification of these problems.
... are higher in autistic individuals without an intellectual disability than in those with a co-occurring intellectual disability (Hollocks et al., 2019;Mingins et al., 2021). ...
Anxiety is one of the most frequently reported co-occurring conditions for autistic children and adolescents. The relationship between anxiety and social outcomes in autistic youth has been the focus of a range of studies, with mixed results. This meta-analysis aimed to identify the strength of the association between anxiety and a frequently researched social outcome (social competence) in autistic young people and whether that association is influenced by individual or research design factors. A previous preregistered systematic review was updated with a search of the same three databases (CINAHL, ERIC, and PsycINFO) as the original review. Through this, 20 studies with sufficient data on a neurotypically-defined measure of social competence and anxiety were identified. Results were synthesised using a mixed effects model. The meta-analysis on 2,321 participants (from 22 samples) highlighted wide heterogeneity in results. The findings show that anxiety has a significant, small negative impact on social competence (d = − 0.48; 95% CI = − 0.71, − 0.26), meaning that as scores on measures of anxiety increase, scores on measures of social competence decrease. This relationship between anxiety and social competence was moderated by age, becoming weaker as age increased. Whilst this is an important finding for supporting mental health and well-being of autistic young people, the large amount of variance left unexplained suggests that multiple factors, including the use of measures designed for neurotypical people and the potential impact of camouflaging on such measures, need to be considered in future designs.
... The rest were equally divided between "Yes" and "To a certain extent". Parents of typically developing children had answered "No"-fifteen (15), "I am not sure"-two (2), and "To a certain extent"-four (4)- Figure 3. Anxiety plays a major role in the functioning of the children with ASD [49,50]. We relate anxiety to the obsessive attachment to routine and stereotypical movements in children with ASD and consider its reduction to be an important aspect of the therapy. ...
... As a result, children with ASD did not display an increase in anxiety levels during the pandemics. Anxiety plays a major role in the functioning of the children with ASD [49,50]. We relate anxiety to the obsessive attachment to routine and stereotypical movements in children with ASD and consider its reduction to be an important aspect of the therapy. ...
... Anxiety plays a major role in the functioning of the children with ASD [49,50]. We relate anxiety to the obsessive attachment to routine and stereotypical movements in children with ASD and consider its reduction to be an important aspect of the therapy. ...
The data available for changes in the behavior and emotional state of children with ASD (autism spectrum disorder) in lockdown situations are controversial and scarce. In our research, we compare results before the first COVID-19 lockdown of 21 children with ASD and 21 typically developing children, four to five years of age with those obtained immediately after. The study attempts to answer the question of whether there are changes in the levels of emotional and behavioral problems in children with ASD after the lockdown and how these new living conditions affect some aspects of their functioning. The instruments used for data analysis are the Childhood Autism Spectrum Test (CAST); Child Behavior Checklist (CBCL); Survey on the consequences of COVID-19 on the life and development of the participants. No significant differences in the emotional and behavioral state of the participants were found, except for attention deficit/hyperactivity problems where ASD children showed lower levels after the lockdown. ASD group parents’ answers to the survey pointed towards more positive consequences of staying at home. Some reported they had more time for learning together, communicating, playing, and assisting the learning process through online therapy. As negatives, the parents of ASD children reported low physical activity, increased time with electronic devices, and time spent with the same people. Caregivers of typically developing children agreed that the lockdown had only negative effects. To conclude, for children with ASD in the study, the lockdown period demonstrated that more time spent with parents in structured everyday activities is an opportunity that can lead to positive results in their behavior.
... Accordingly, the analysis and reporting follow the format observed in other published meta-analytic studies produced within this center. [41][42][43][44][45][46] Memory functioning General memory functioning was described in 17 studies, reporting 22 effect sizes, in a total 2091 participants across the three TBI severity groups. The betweenstudies variance (tau 2 ) in the random effects model was calculated using the DerSimonian-Laird estimator, and there was no evidence of non-normality in the distribution of standardized mean differences within the primary studies. ...
Cognitive outcome for mild TBI with positive brain imaging (complicated MTBI) was compared with that for mild TBI with normal imaging (uncomplicated MTBI) and moderate to severe TBI using meta-analysis. Twenty-three studies utilising objective neurocognitive tests were included in the analysis. At less than 3 months post-injury, complicated MTBI was associated with poorer cognitive outcomes than uncomplicated MTBI but deficits were not comparable to those with moderate-severe TBI. After 3 months post-injury a similar pattern was detected. Beyond 3 months, relative deficits in complicated MTBI to those with uncomplicated MTBI were present in processing speed, memory, executive function and language, though the latter may be due to reduced semantic fluency. The effect size of deficits in these domains was more marked in moderate-severe TBI. The available data supports the use of complicated MTBI as a distinct classification in the prediction of cognitive outcome. The size of cognitive deficit in complicated MTBI was small and unlikely to cause significant disability. However, complicated MTBI is a broad category encompassing individuals who may differ markedly in the nature and extent of intracranial imaging abnormality and further studies are warranted. Limitations of the available studies include small, selected samples, variations in TBI severity classification, absence of validity ('effort') testing, differing imaging methodology and lack of long-term follow up.
... In addition, individuals with ASD may display atypical manifestations of anxiety which are not captured by current standardized anxiety measures. Children with ASD with higher IQs may also exhibit increased anxiety (Mingins et al., 2021). This may lead to differences in anxiety being reported in ASD participants. ...
Lay abstract:
Autism spectrum disorder (ASD) is clinically characterized by social communication difficulties as well as restricted and repetitive patterns of behavior. In addition, children with ASD are more likely to experience anxiety compared with their peers who do not have ASD. Recent studies suggest that atypical amygdala structure, a brain region involved in emotions, may be related to anxiety in children with ASD. However, the amygdala is a complex structure composed of heterogeneous subnuclei, and few studies to date have focused on how amygdala subnuclei relate to in anxiety in this population. The current sample consisted of 95 children with ASD and 139 non-autistic children, who underwent magnetic resonance imaging (MRI) and assessments for anxiety. The amygdala volumes were automatically segmented. Results indicated that children with ASD had elevated anxiety scores relative to peers without ASD. Larger basal volumes predicted greater anxiety in children with ASD, and this association was not seen in non-autistic children. Findings converge with previous literature suggesting ASD children suffer from higher levels of anxiety than non-autistic children, which may have important implications in treatment and interventions. Our results suggest that volumetric estimation of amygdala's subregions in MRI may reveal specific anxiety-related associations in children with ASD.
... The relationships between IQ and symptoms of psychiatric comorbidity have been mixed. There is some evidence to indicate that higher IQ is associated with greater symptoms of anxiety [17] and depression [13], although this may in part be driven by difficulty measuring internalizing disorders in individuals with intellectual disability; both in terms of caregivers recognising and individual's themselves communicating relevant symptoms. Conversely, others report that lower IQ in autistic children predicts increased symptoms of hyperactivity [7], separation anxiety in adolescence [18], and poorer mental health outcomes in adulthood [19]. ...
... These null findings are in line with previous work which has found few established risk factors predict psychiatric diagnosis in autistic youth [2]. At wave 1 of this study, higher intellectual ability was significantly associated with risk for any anxiety disorder [20], which is generally supported in the literature [17]. However, a limitation is that intellectual ability was measured in childhood and, therefore, did not account for any change in FSIQ between childhood and adolescence. ...
Autistic people experience high rates of co-occurring psychiatric diagnoses. Current prevalence estimates vary considerably due to an over-reliance on clinical cohorts and the longitudinal stability of diagnoses from childhood into adolescence is poorly understood. This study aims to provide prevalence rates of co-occurring DSM-5 psychiatric diagnosis for autistic adolescence and investigate, for the first time, the stability of diagnoses from childhood. Using a longitudinal stratified sample of autistic youth ( N = 77; 13–17 years; 60% male), selected from a larger community-derived sample of those with pre-existing autism diagnoses ( N = 277) weighted prevalence estimates of emotional (anxiety, depression), behavioural (oppositional and conduct disorders) and ADHD diagnoses were calculated based on semi-structured psychiatric interview. Prediction of adolescent psychiatric diagnosis based on childhood diagnostic status, sex, childhood IQ (both assessed at age 4–10 years) was tested. Emotional and behavioural disorders in adolescence were particularly prevalent, and significantly predicted by childhood disorder status. Attention-deficit/hyperactivity-disorder (ADHD) was prevalent but not predicted by childhood ADHD diagnosis. Neither sex nor childhood IQ predicted diagnostic outcomes. Autistic youth have high levels of co-occurring psychiatric conditions, which are broadly persistent across childhood and adolescence. Emotional disorders are particularly prevalent and remain persistent from childhood to adolescence. Greater diagnostic variability was found for ADHD with more adolescents moving across diagnostic thresholds.
