The diagnoses of autism and anxiety by psychological clinicians may have a critical problem.
BYU students AnnaLisa Ward, Kevin Stephenson and Max Maisel have spotted a potential weakness in the measurement of autistic symptoms. Analyzing a common autism diagnostic test, the Social Responsive Scale (SRS), they found that it may misidentify symptoms of anxiety as indicators of autism. Their findings were presented at a recent research conference at BYU.
The SRS is a survey given to psychiatric patients to differentiate symptoms of autism from symptoms of other disorders. Since people who live with autism often live with anxiety as well, it is sometimes difficult to differentiate between the two. But a diagnosis of anxiety does not necessarily mean a diagnosis of autism. Yet this study found that among people with high symptoms of anxiety, fifty percent of them actually score high enough on the SRSto be diagnosed with autism. Some even scored high enough to be categorized as “severely” autistic – even though they did not have autism. Their anxious symptoms could have been mistakenly accepted as indicators of autism.
“So we see that there is likely a problem with the measure that we are using,” says Kevin Stephenson, a doctoral student in clinical psychology. “When using this test, clinicians may need to take a step back and ask, ‘Is this really autism or is this just anxiety?’ And the data we have provided will most likely lead to improvements on the diagnostic measurements.” The study is being prepared for publication.
What Can WE Do to understand Mental Disorders?
Studies like this can inform a “measure twice, cut once” mentality regarding the diagnosis of autism. The better the diagnostic tool for a mental issue, the higher the likelihood of a correct diagnosis, and the more effective the treatment for the afflicted person. Conversely, if the tool is not as finely tuned as it could be, then diagnoses might be difficult or faulty.
Similarly, each of us need to develop a “measure twice, cut once” attitude in our associations with the mentally disabled. When we learn that someone has autism, anxiety, or depression, do we take the time to know what they experience before we jump to conclusions about how to help or associate with them?
People with autism often do not feel understood by those around them. Yet one in 100 people have autism. So you likely have people in your life who experience it. Do you know them? Are you aware of what they may go through? Perhaps we need a little exposure to what autism is:
Being informed on these kind of mental issues, and how to best associate with people who have them, is essential to removing stigmas and improving the lives of effected individuals and their families. There are resources available in your community and all across the web. For more information on autism, visit AutismSpeaks.org or BYU’s: Autism Connect.
The details of Ward, Stephenson, and Maisel’s study are portrayed in their winning poster below:
Do you know someone with autism or anxiety disorder? How has that effected your understanding?
Anxiety is defined as a feeling of worry, nervousness, or unease, typically about an imminent event or something with an uncertain outcome. Feeling anxious from time-to-time is a normal part of life, but many people feel excessive and persistent anxiety stemming from a variety of different things. Anxiety is a symptom particularly seen in people with autism. “Not all people with autism suffer from anxiety, but it is probably the highest occurring associated psychiatric problem,” said Dr. Mikle South, associate professor of psychology and neuroscience at Brigham Young University.
South was one of several presenters at the second Autism Translational Research Workshop held on BYU campus in January. The purpose of the workshop was to give researchers an opportunity to present their new findings in autism practices and interventions. The findings at this year’s conference were devoted to “things you can do every day to help your patients, students, and children be more successful.” South has conducted extensive research on the frequent correlation of anxiety and autism. Whether you or someone you know has autism, anxiety, or both, there is much to be learned from his research.
Lets Talk About the Brain
The amygdala is an almond-shaped structure in the frontal portion of the temporal lobe. It is the central fear recognition system in the brain. South explained that its job to ask “is this safe or not?” It then sends information to other key brain areas. The frontal cortex helps us dissolve fear. Seeing a scary shadow may cause a quick onslaught of fear, but once you realize that it is just coming from a coat rack, the fear should naturally subside. South explained that if this system is not in balance, as is often seen in people with autism, an immediate threat is not comforted or rationalized and the fear continues.
Sensory Processing Difficulties
Another reason for excessive anxiety may be linked to sensory processing difficulties. South explained that when the brain has to focus on dealing with overwhelming surroundings and is not paying attention to social cues, it can lead to a continuous state of uncertainty. With that comes anxiety. “None of us like not knowing what’s going to happen next, but for some people this is really really problematic,” said South. “So we wonder why people with autism like things the same over and over again – and it might just be that it decreases the level of uncertainty, which might decrease anxiety.”
“One of the causes for anxiety is that we’re not able to figure out our feelings – we’re confused and uncertain – so we are anxious,” said South. He incorporated this thought into some of his research. He wondered: how aware are people with autism of what’s going on inside their bodies? Do they know how they are feeling?
I saw a child [with autism] a couple of weeks ago, a 10 year old boy, and I said, ‘What makes you feel sad?’ He replied, ‘When my brother is mean to me.’ A few minutes later I asked him, ‘What makes you feel mad?’ and he said, ‘I already told you. When my brother is mean to me.’ And so I said to him, ‘well what do you think is the difference between sad and mad?’ And he said, ‘I don’t know, could you tell me?
South was involved in conducting a study that involved both people with and without autism. The participants were asked a variety of questions regarding autism symptoms and their inner emotions. From this study South determined, “There is a really strong correlation that says, the more autism you have, the more anxiety you have.”
Fear of Failure
Though it makes us feel weak and vulnerable, we often learn great lessons from our failures. This understanding can be hard for people with autism to grasp and performance anxiety is common. “A lot of our more verbal kids don’t like to fail. So much so that they don’t try stuff if they don’t know that they’re going to get it exactly right,” South said. “Going to school can be very stressful for kids with autism.”
South and his team actually conducted the first study of its kind that looked at how people with autism learn to feel safe and learn to feel afraid. They included both people with and without autism in their study.
Participants sat in front of a computer. They would periodically see a blue square or a yellow square flash onto the screen. Sometimes a certain colored square would be accompanied by a painless, but startling, puff of air on their neck. South and his team were able to analyze the participant’s brain functions while this was occurring using functional magnetic resonance imaging (fMRI) scans that measured brain activity by detecting changes associated with blood flow.“We have the brain in a strong magnet where we can sort out different tissues in the brain. One thing we can do is watch oxygen flow in their brain sort of indirectly. So we can see what parts of the brain are working at certain times.”
The exercise was meant to produce anxiety and condition the participants to be on their guard. “After a while, when you see the same color of square as the last time you got a puff of air on your neck, you start to think, ‘Oh I might get a puff of air,'” said South.
The puffs would eventually stop coming. This was meant to condition participants to not be afraid anymore. The sequence didn’t work well in people with autism. “They took too long to learn to not be afraid,” South said.
When they analyzed the results of the study, they found that the amygdala was more active in the control group (people without autism) than people in the autism group. Showing amygdala activation is a proper thing to do when there is a threat – the control group should be showing it – but why did they show more activation than the autism group? South believes that this is because people with autism have a hard time understanding when to feel safe and when to feel afraid.
The control group showed ‘afraid then’ and ‘not afraid then’. The people with autism seem to not be differentiating properly. If you are not sure what to do, what do you feel is the safest bet? Be afraid … They may already be afraid, so a puff of air on their neck isn’t really heightening that fear.
Based on his findings, South introduced several interventions that can help ease anxiety for people with autism. These interventions may also be beneficial for people who do not have autism, but have anxiety.