The Differential Diagnosis of Anxiety Disorders in Cognitively-Able Youth With Autism

Abstract

Anxiety disorders are common in children and adolescents with autism spectrum disorder (ASD), yet difficult to disentangle from features of ASD itself. Challenges to assessment include symptom overlap, the varied manifestation of some anxiety symptoms, and the limitations of self-report. Nonetheless, a growing body of research suggests that it is both possible and important to reliably differentiate anxiety and ASD pathology. Anxiety disorders are associated with a number of additive difficulties in youth with ASD. Emerging evidence also suggests that these difficulties—when identified—can be effectively treated in cognitively-able youth with cognitive-behavioral methods. The present article will provide a clinical framework for diagnosing anxiety disorders in cognitively-able youth on the autism spectrum, with a particular emphasis on differentiating anxiety and ASD symptoms. We will review recent research on the presentation, measurement, and predictors of anxiety in ASD, provide an overview of the pros and cons of available measures and illustrate approaches for differential diagnosis via vignettes of actual clinical assessments.