Managing ASD and Anxiety: Understanding Co-Morbidity - Essay Sample

Introduction

Most children with Autism Spectrum Disorder (ASD) also show the symptoms of co-morbid conditions such as anxiety and Attention Deficit Hyperactivity Disorder (ADHD). The comorbid conditions may be present from an early age only to show the symptoms at adolescence or advanced stages of life. ASD often appears in comorbidity with anxiety, and the condition affects a patient's response to ASD therapy among other modes of intervention. ASD and anxiety have overlapping cognitive factors of response control and functioning that dictate the comorbidity of their symptoms.

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Background/Rationale

Children with ASD are more likely to show anxiety disorders compared to adolescents with the same condition. The prevalence of co-morbidity of ASD and anxiety decreases with increase in age (White, Oswald, Ollendick & Scahill, 2009). The most prevalent anxiety disorders among children with ASD are Obsessive Compulsive Disorder (OCD), social phobia, specific phobias, separation anxiety disorder, agoraphobia, generalized anxiety disorder, and panic anxiety disorder. Specific phobias are the most common affecting 30-44% of children with ASD. OCD affects 17-37% while panic disorder affects the least fraction at 1-2% (Duvekot, van der Ende, Verhulst & GreavesLord, 2018). The overlapping characteristics of ASD and anxiety make it difficult to conduct differential diagnosis and assessment of the disorders. Some of the common characteristics include repetitive behaviors, avoidance of social interactions and difficulties in communication. Additionally, patients with co-morbidity of ASD and anxiety emphasis to live in rituals and lead their lives through strict adherence to a routine.

The most common co-morbid condition to ASD is OCD. At least 84% of ASD patients show comorbid conditions and 17% of the comorbid conditions shown are specifically OCD (Lietz, Kos, Dix, Trevitt, Uljarevic & O'Grady, 2018). The interactions of the two disorders yield complex symptoms that are different from those of either disorder. The complex symptoms further complicate diagnosis and render standard interventions such as Cognitive Behavioral Therapy (CBT) inefficient. Patients of ASD and OCD desire familiarity and thus are less obliged to change their daily routines. They show repetitive behaviors and great desire to control conditions and events in their lives. However, patients with OCD show thoughts that are more irrational and may engage in conflicting behaviors such as positive and negative (White et al., 2009).

Other disorders such as ADHD have significant amounts of research on their nature. There exist numerous studies on the cognitive factors in ADHD's occurrence and treatment intervention. The comorbidity of ASD and anxiety needs to be addressed with higher critical data obtained from new research. ADHD is more explored due to their effect on impulsive behaviors and activity in children. People with ADHD are easily distracted, and face difficulties paying attention while people with ASD may pay attention but are unable to match it with social skills and other aspects of learning in the social context (Gordon-Lipkin, Marvin, Law & Lipkin, 2018).

Autism is surrounded by controversy in deciding whether it is a development disorder or a cognitive phenotype that makes its victim communicate and perceive the world differently. A significant cognitive aspect seen in people with ASD is the theory of mind. The theory of mind dictates the mental processes involved in assessing another person's perspective and choosing to follow it or not (Lietz et al., 2018). People with ASD have a lower theory of mind compared to other people, and they have difficulties understanding other people's perspectives. People with ASD recognize social situations less and take more time in understanding the processes or activities in a particular situation. Weak theory of mind is seen in ASD children who do not respond normally to punishment or praise (White et al., 2009). For example, children with ASD show negative behaviors towards interventions that persuade them to change their perspectives on subjects, grades and other aspects of life. Such cognitive factors lead them to misconceptions that the society or family hates them or considers them of a lower cognitive ability.

The cognitive effects of anxiety are reflected through fear and negative thoughts. People with anxiety show rational and irrational fear that affects their decision-making. They are mostly biased towards the future and make decisions at present after critical evaluation of the future. However, due to fear, the cognitive processes of an anxious mind are aligned towards eliminating the fear through settling on familiarity and risk elimination. Children and adults with anxiety face negative thoughts that keep them down and erode their need for exploration. Negative thoughts are not entirely negative as they can help one to plan actions with a view of probable consequences (Duvekot et al., 2018). Negative thoughts dhow unfavorable ways forward. People with anxiety are thus bound to seek positive enforcers and external affirmations to their thoughts and plans.

ASD implicates the central coherence theory. Uta Frith developed the theory in 1989, and it defines central coherence as the ability of a person to examine details and decode meaning (Delli, Varveris & Geronta, 2017). Under the theory, people with ASD face difficulties identifying and relating to the broader meaning in a situation. Such people excel more in picking out the extreme details from a mass of information. The central coherence theory holds that people with ASD are more focused on details instead of the broader picture from a situation. The mindblindness theory proposed by Simon Baron in 2002 implicates people with ASD as effect systemizers (Delli et al., 2017). The theory considers two types of brain based on perception and attitude towards reality. The two are empathetic and systemizing. Empathetic brains are those that invest in understanding the feelings and emotions of another people while systemizing brains focus on systems. People with ASD focus on systems and invest more in understanding the behavior of a system instead of the single entities that make the system. Systemizers believe that they can control a system through predicting and controlling its variables. Empathetic brains are more common in female while systematic brains are common in males. Patients with ASD are offered addressed as people with extreme male brains according to the mindblindness theory.

Anxiety implicates the cognitive theory and the psychodynamic theory. The cognitive theory describes anxiety as a condition where victims overestimate the possibility of danger (Gordon-Lipkin et al., 2018). The cognitive theory thus holds that people with anxiety find the worst possible scenario from an event and avoid the circumstances where they cannot handle the prospected worst-case scenario. Examples of anxiety in real life include the fear of swimming, heights, and crowds among others. The psychodynamic theory defines anxiety as a condition that emanates from a conflict between an individual's ego and id. Treatment goals under the psychodynamic goal involve understanding the ego and id of the patient and working through cognitive therapy to amend the conflict.

The two disorders overlap in the prevalence of their symptoms. The brain activity and resultant perception are determined by the preexisting conceptions such as fear and worry. The two disorders might show the same symptoms but with different magnitudes of the effects. The research will look into the areas of response control and functioning as critical areas in understanding cognitive aspects of comorbidity of ASD and anxiety symptoms.

Literature Review

Children with OCD and ASD show a similar neurocognitive pattern of functioning. Executive functioning is profoundly affected by the two disorders. Executive functioning is the central component of the information reception and processing system in the brain (Zandt, Prior & Kyrios, 2009). It is the system responsible for monitoring activity, directing attention and uniting information with actions. Contemporary researches continue to differ on whether executive functioning has an impact on repetitive behaviors. Zandt et al. (2009), investigated to identify and compare the role of executive functioning in the two disorders and ascertain whether there exists a relationship between repetitive behavior and executive functioning in patients of OCD and ASD. The research employed the use of 54 respondents aged between 7 and 26 years. 19 of the respondents had ASD while 17 had OCD and 18 formed the control sample. Individuals with Asperger syndrome, autistic disorder and pervasive development disorder (PDD-NOS) were all classified as the ASD sample since the conditions have similar symptoms and disparities in intelligence level cause the differences.

The research found out that children with OCD and ASD had minimal differences in executive functioning compared to the control sample. The three samples were analyzed based on intelligence level and age. However, some ground differences stood out. For instance, children with ASD show more impairment in tasks that called for critical thinking and multiple responses. The children with ASD faced more difficulties in verbal communication and generation of new concepts. Children with OCD only showed impairment in inhibition when compared to the control group. Interviews with parents reported that children with ASD had more developmental difficulties compared to those with OCD and the control sample. However, the findings obtained are not conclusive, and future research should use different clinical populations to affirm or refute the results. The cognitive factors of generative ability and mental flexibility affect the comorbidity of ASD and anxiety symptoms. Extensive repetitive behavior in people with ASD causes extensive impairment in executive functions (Zandt et al., 2009).

People with OCD and ASD show shared abnormalities in neurocognitive dysfunctions. The dysfunctions may appear as a shared characteristic or a specific component of the two disorders (Delorme, Gousse, Roy, Trandafir, Mathieu, Mouren-Simeoni, & Leboyer, 2007). ASD and OCD can be examined further through tests that involve planning and the type of executive dysfunction observed in the two disorders is reliant on the specific clinical features shared. Repetitive behaviors are a common such feature, and the diagnosis criterion should include the history and analysis of the prevalence of the condition in family members such as parents. Children who have extensive symptoms of ASD and OCD often have their parents with the same underlying disorders. Behavioral measures are significantly limited in examining psychiatric phenotypes due to their complexity and specificity (Delorme et al., 2007).

Anxiety patients appear detached from reality and do not trust their own decisions. Children with OCD show more detachment compared to other anxiety disorders and more alignment with the symptoms of ASD. The DSM-IV algorithm forbids physicians from diagnosing a personality disorder if the patient's condition can be described as an autistic disorder (Bejerot, 2007). Odd personalities and behaviors such as paranoia, avoidance of social interactions, schizoidal antics, and schizotypal behavior serve as reliable indicators for ASD in OCD patients. The appearance of the symptoms in children who are already diagnosed with OCD often indicates comorbidity with a similar disorder ASD. Sameness in the behavior of children within the same age bracket aid in the diag...