Disentangling the autism-anxiety overlap: fMRI of reward processing in a community-based longitudinal study.
Reward-circuit fMRI can flag adolescents with ASD traits at heightened risk for developing anxiety two years later.
01Research in Context
What this study did
Mikita et al. (2016) scanned 49 teens while they played a simple money game. Half had high autism traits, half were typical peers. All were 14 years old and lived in the same county.
The team tracked brain activity in reward circuits. They also measured anxiety symptoms. Two years later, they checked anxiety levels again.
What they found
High-autism teens showed weaker reward-circuit activation. Anxiety alone also dampened the signal. When both traits were present, the drop was even bigger.
The right dorsal cingulate stood out. Stronger activity there at age 14 predicted new anxiety by age 16, but only in the high-autism group.
How this fits with other research
Jackson et al. (2025) saw the same pattern in Down syndrome. Poor shifting and working memory predicted later anxiety. Mikita’s team shows the same forward link, but the marker is fMRI reward activity instead of EF tasks.
Schultz (2008) called for large autism imaging studies that predict real-life outcomes. Mikita delivers that roadmap with a county-wide sample and two-year follow-up.
Fusaroli et al. (2022) found small, reliable voice differences in autistic kids. Mikita’s brain data add another layer: reward circuits may explain why some of these kids later feel anxious.
Why it matters
You now have a brain-based early-warning sign. If a teen with ASD traits shows high right dorsal-cingulate activation during a reward task, plan anxiety screens and coping-skills training before symptoms bloom. Pair the scan info with your usual questionnaires for sharper risk detection.
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02At a glance
03Original abstract
Up to 40% of youth with autism spectrum disorder (ASD) also suffer from anxiety, and this comorbidity is linked with significant functional impairment. However, the mechanisms of this overlap are poorly understood. We investigated the interplay between ASD traits and anxiety during reward processing, known to be affected in ASD, in a community sample of 1472 adolescents (mean age=14.4 years) who performed a modified monetary incentive delay task as part of the Imagen project. Blood-oxygen-level dependent (BOLD) responses to reward anticipation and feedback were compared using a 2x2 analysis of variance test (ASD traits: low/high; anxiety symptoms: low/high), controlling for plausible covariates. In addition, we used a longitudinal design to assess whether neural responses during reward processing predicted anxiety at 2-year follow-up. High ASD traits were associated with reduced BOLD responses in dorsal prefrontal regions during reward anticipation and negative feedback. Participants with high anxiety symptoms showed increased lateral prefrontal responses during anticipation, but decreased responses following feedback. Interaction effects revealed that youth with combined ASD traits and anxiety, relative to other youth, showed high right insula activation when anticipating reward, and low right-sided caudate, putamen, medial and lateral prefrontal activations during negative feedback (all clusters PFWE<0.05). BOLD activation patterns in the right dorsal cingulate and right medial frontal gyrus predicted new-onset anxiety in participants with high but not low ASD traits. Our results reveal both quantitatively enhanced and qualitatively distinct neural correlates underlying the comorbidity between ASD traits and anxiety. Specific neural responses during reward processing may represent a risk factor for developing anxiety in ASD youth.
Translational Psychiatry, 2016 · doi:10.1038/tp.2016.107