Refining our Understanding of Anxiety in Autistic Youth: Examining the Role of Behavioral Inflexibility.
The Behavioral Inflexibility Scale predicts anxiety in youth better than age, IQ, or diagnosis, so screen for rigidity first.
01Research in Context
What this study did
Harrop et al. (2024) asked parents to fill out the new Behavioral Inflexibility Scale (BIS). The scale captures everyday rigidity like trouble with new foods or schedule changes.
They also gave standard anxiety questionnaires to autistic and neurotypical youth. Then they checked which scores best predicted anxiety.
What they found
BIS scores beat age, IQ, and even autism diagnosis at forecasting anxiety levels. More rigidity meant more worry in both groups.
The link stayed strong across the whole age range studied.
How this fits with other research
A Boyd et al. (2024) tracked the same kids for a year and watched BIS scores move as children matured. Their data give confidence that the scale is sensitive to real change, not just a one-time snapshot.
Baker et al. (2025) looked at older autistic teens and young adults. They found emotion-regulation skills, not inflexibility, drove anxiety in that age band. The two studies together suggest the prime target shifts from rigidity in childhood to emotion skills after puberty.
Richards et al. (2017) and Spackman et al. (2025) echo the rigidity-anxiety link using youth self-report and mixed-diagnosis samples. The pattern holds no matter who answers the questions or what labels the youth carry.
Why it matters
Add the free BIS to your intake packet today. A high score flags anxiety risk faster than sifting through developmental history. If rigidity is high, weave flexibility drills into treatment and watch anxiety as the outcome. For teens, layer in emotion-regulation work as well. One quick measure now guides two clear intervention paths.
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02At a glance
03Original abstract
Prior research has demonstrated that cognitive inflexibility is associated with anxiety in autistic individuals. Everyday patterns of behavioral inflexibility (e.g. observable inflexible behavior in the context of the need to change or adapt and that is manifested in real-world everyday settings) is common in autism and can be distinguished from performance on discrete cognitive tasks that tap flexible attention, learning, or decision-making. The purpose of this study was to extend this prior work on inflexibility in autism but with measures specifically developed with input from stakeholders (caregivers and clinicians) for autistic youth designed to measure everyday behavioral inflexibility (BI). We characterized anxiety in a large sample of autistic (N = 145) and non-autistic youth (N = 91), ages 3 to 17 years, using the Parent Rated Anxiety Scale for Autism Spectrum Disorder (PRAS-ASD). Further, we sought to understand how BI, measured via the Behavioral Inflexibility Scale (BIS), predicted anxiety compared to other variables known to increase anxiety in youth (chronological age, IQ, autism diagnosis, assigned sex at birth). Autistic youth had higher parent-related anxiety and BI compared to non-autistic youth. BI was the strongest predictor of anxiety scores, irrespective of diagnosis. Overall, our findings highlight the importance of BI to the understanding of anxiety in autistic youth.
Journal of autism and developmental disorders, 2024 · doi:10.1146/annurev.clinpsy.3.022806.091358