98 - Examining Patterns in Communication Profiles and Clinician Recognition of Anxiety in Autism Spectrum Disorder: Insights from a CARS-2 Chart Review

Publication Number: 1090.98

Neel Sharma, Northwell Health, New York, NY, United States; Lillian M. Ravikoff, Northwell Health, Bronx, NY, United States; Alexis Tchaconas, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, New Hyde Park, NY, United States; Caroline Howard, Northwell Health, New York, NY, United States; Joseph Mekhail, Northwell Health, New York, NY, United States; Ruth Milanaik, Northwell Health, Great Neck, NY, United States

Background: Anxiety is one of the most common co-occurring diagnoses in children with autism spectrum disorder (ASD) with an estimated prevalence of 11-84%. This wide range reflects the challenges of measuring anxiety in children with ASD and poses the question of whether additional tools may be needed to identify anxiety in this population. This is especially difficult since many of the symptoms of anxiety (i.e. social withdrawal, limited eye contact) can also be attributed to the ASD diagnosis.

Objective: To investigate the likelihood that a child with ASD and anxiety symptoms received an anxiety disorder diagnosis and a potential correlation with their verbal (V) and nonverbal (NV) communication scores from their CARS-2 evaluation in our clinic.

Design/Methods: A retrospective chart review of children age 2-13 (M = 5.8) diagnosed with ASD who had a CARS-2 evaluation done by a DBP in clinic (n=100, 76 male) (24% White, 21% Asian, 20% Latino, 18% Black) [Figure 1]. CARS-2 items 11 (verbal communication) and Item 12 (nonverbal communication) were collected. Scores range from 1 (typical) to 4 (severely abnormal). Notes taken during the evaluation were analyzed for mention of anxiety symptoms. Patients were grouped into categories: (A) Anxiety Observed in the note and a confirmed Anxiety Disorder diagnosis, (B) Anxiety Observed in the note but no Anxiety diagnosis, and (C) No Anxiety Noted. The mean verbal and nonverbal scores were then calculated for each of the three groups and a Kruskal-Wallis Test was run.

Results: Overall, symptoms of anxiety were noted in 40% of the patients. Group A (n=7) had the most impaired nonverbal communication (M=3.21) but the least impaired verbal skills (M=1.21). Group B (n=33) showed the opposite result, with the most impaired verbal communication (M=3.00) but the least impaired nonverbal skills (M=1.59). Group C (n=60) had moderate scores in both domains (V=2.42; NV=1.87). The Kruskal-Wallis test showed a significant difference in mean scores across the three groups for both verbal (p < 0.01) and nonverbal communication scores (p < 0.01) [Figure 2]. Groups A and B did not differ significantly by age or gender.

Conclusion(s): These results suggest that more nonverbal impairment paired with a more typical verbal score may be a key driver of a formal anxiety diagnosis. In contrast stronger nonverbal paired with more abnormal verbal may lead to observed anxiety being less likely to be given a diagnosis. Our findings highlight the need for more refined assessment tools that can capture anxiety across diverse communication profiles in kids with ASD.

Figure 1. Demographic Data


Figure 2. CARS-2 Verbal Communication Scores by Anxiety Group and CARS-2 Nonverbal Communication Scores by Anxiety Group