The neurobiological presentation of anxiety in autism spectrum disorder: A systematic review.
Neurobiological signs of anxiety in autism are too scattered to guide treatment—lean on behavior data instead.
01Research in Context
What this study did
The team hunted for brain and body signs of anxiety in autism. They pulled every paper that used EEG, heart rate, skin conductance, or brain scans. They looked at kids, teens, and adults with autism. In the end, they had a pile of studies that did not line up.
No clear pattern emerged. Some kids showed high arousal. Others looked calm. The same measure gave opposite results across labs.
What they found
The review found chaos, not clarity. One lab said anxious autistic kids have fast heart rates. Another lab found no change. Brain-wave studies were just as split.
Skin-conductance papers swung both ways. MRI studies pointed to different brain areas each time. The authors could not stitch the data into one story.
How this fits with other research
Laugeson et al. (2014) showed CBT can cut anxiety in high-functioning autistic youth. Yet Symons (2019) cannot tell us why it works, because the biology is messy.
Lecavalier et al. (2014) warned that only four anxiety measures are ready for autism trials. This may explain the messy biology—different labs used different yardsticks.
South et al. (2017) found autistic kids had lower skin-conductance spikes during social threat. That single study sits inside the broader noise that Symons (2019) maps.
Lecavalier et al. (2006) reviewed older neurochemical work and also saw mixed signals. Symons (2019) updates that story by adding newer tools like fMRI, but the confusion remains.
Why it matters
Do not wait for a clean brain marker before treating anxiety. Use solid behavior tools like CBT and watch the client, not the lab chart. Pick one of the four trial-ready anxiety scales Lecavalier et al. (2014) flagged, then track change session by session.
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02At a glance
03Original abstract
Anxiety is common among people with autism and is associated with unique and additive challenges. Anxiety is thought to have neurobiological components, and measures of arousal in typical development have long been studied. Recently, neurobiological measures of anxiety in autism have begun to receive empirical evaluation, but results have not yet been examined together. This systematic review, therefore, summarizes the state of the research of the neurobiology of anxiety in autism. Studies published between 1999 and June 2017 were reviewed. Results across measures of arousal point to inconsistencies in results and a lack of synthesis in the literature. Considerations regarding these inconsistencies are discussed, recommendations for future studies are offered, and clinical implications for this work are presented. Autism Res 2019, 12: 346-369 © 2019 International Society for Autism Research, Wiley Periodicals, Inc. LAY SUMMARY: Anxiety is common among people with autism. Because anxiety has been linked with a variety of differences in physiological (bodily) and neurophysiological (brain) functioning in people without autism, research has begun to examine these processes in autism as well. This literature, however, has not yet been examined as a whole. Therefore, this paper begins to address that gap to provide the field with a better understanding of how anxiety affects people with autism and discusses implications for future research and clinical practice.
Autism research : official journal of the International Society for Autism Research, 2019 · doi:10.1002/aur.2063