PhD Presentation

Understanding Anxiety Problems in Autism

Rebecca Roberts-Davis Dr Alex Lau-Zhu Professor Geoff Bird Professor Robin Murphy

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Anxiety in Autism

A recent assessment of various studies showed that approximately 20% of autistic people have a co-occurring anxiety disorder (Lai et al, 2019) It has been established that differences in the quality of autistic peoples’ lives is influenced by mental health symptoms (Oakley et al, 2021) Additionally, autistic adults reported mental health conditions and mental well-being as their number one priority for research (Cage et al, 2024)

Research Gap and Rationale

Quantitative Research - primarily cross-sectional and using neurotypical questionnaire measures Weaker anxiety interventions - is our understanding of cognitive mechanisms sufficient?

Experimental Task

Measurement issues with intolerance of uncertaintytainty Majority of studies use questionnaires which may lack internal validity (Jenkinson et al, 2020) Consider rigid thinking for an autistic person in answering, 'Uncertainty makes me uneasy, anxious, or stressed.'

The Uncertainty in Pictures (UP) Task

Is intolerance of uncertainty valence dependent?

• You are going to see a positive or negative image

• You will either see a description of this image or a random fact

• At three points, you will be asked to show how distressed you are

Longitudinal Study

COVID-19 = Natural experimental setting for high uncertainty Relationships between intolerance of uncertainty and anxiety concurrently and over-time Previous research shows intolerance of uncertainty longitudinally predicting anxiety (Evers et al., 2022; Andrews et al., 2023)

Longitudinal Study

COVID-19 = Natural experimental setting for high uncertainty Relationships between intolerance of uncertainty and anxiety concurrently and over-time Autistic children matched with neurotypical children Constructed index of intolerance of uncertainty & SDQ - Emotional Difficulties Subscale

Cross-Lagged Panel Model

Experimental study

Version 1

Version 2

Measured information seeking Data collected from 86 participants via Prolific and analysed Methodological issue resulted in poor quality sample and low data availability

Simplified task and improved data quality controls Data collected from 100 participants via research database Analysis to be completed

Qualitative Research

Qualitative Research can be used to gain a much more nuanced, in-depth account of how anxiety problems are experienced by an autistic individual Previous qualitative studies have only asked about 'external' causes of anxiety, for example, (Trembath et al, 2012) No work currently has explicitly asked autistic people to agree with or dispute the ideas researchers hold about anxiety

Qualitative Research

Aimed to explore autistic adults endorsement of cognitive mechanisms and their lived experience of anxiety Recruited a diverse sample across age, gender, ethnicity, sexuality and socioeconomic status Analysed these using a combined approach of content analysis and reflexive thematic analysis

Qualitative Research

First study to explore face validity of theorised cognitive mechanisms - very strong endorsement of these Autistic traits interact with anxiety, through psychological and lived experience Lack of suggested new cognitive mechanisms for anxiety in autism

Internal Causes of Anxiety

Intolerance of Uncertainty

Repetitive Negative Thinking

Mental Imagery

Attentional Biases

Follow Up Plans

Simplified version of the UP task Higher data quality controls Large sample

Qualitative Study

Longitudinal Study

Experimental Study

Final draft of publication with supervisor Thesis chapter to be completed: Autumn 2025

Modelling analyses to be finalised Thesis chapter to be completed: Winter 2025

Data from second experiment to be analysed Thesis chapter to be completed: Spring 2025

Qualitative Study

Longitudinal Study

Experimental Study

Rich, detailed data on lived experience Reinforced intolerance of uncertainty as a prominent mechanism Manuscript submitted for publication Submission of first draft of thesis chapter by November 2025

Stronger evidence for causality Uses natural variation in intolerance of uncertainty and anxiety Final stages of modelling Submission of first draft of thesis chapter by December 2025

Controlled manipulation of intolerance of uncertainty and distress Split into two chapters - design and testing of paradigm Completion of data analysis Submission of first drafts by February and March 2026

Qualitative Study

Longitudinal Study

Experimental Study

Rich, detailed data on lived experience Reinforced intolerance of uncertainty as a prominent mechanism Manuscript submitted for publication Submission of first draft of thesis chapter by November 2025

Stronger evidence for causality Uses natural variation in intolerance of uncertainty and anxiety Final stages of modelling Submission of first draft of thesis chapter by December 2025

Controlled manipulation of intolerance of uncertainty and distress Split into two chapters - design and testing of paradigm Completion of data analysis Submission of first draft of thesis chapter by December 2025

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Conceptual Content Analysis

100% of our participants endorsed intolerance of uncertainty and repetitive negative thinking

70% of our participants endorsed attentional biases and intrusive mental imagery

‘what's the worst that could happen?’ Number one, my car won't start in the morning, which means I would be late for work. And that means when I get to the office, there's no parking space, which means I'd have nowhere to park and I don't know the area well enough to find somewhere to park. So I'd have to leave my car somewhere quite far away. Then I go and do my day's work in the office, in a place that's unfamiliar. And then that means it's a long walk back to my car. It's dark, which clearly means I'm going to get mugged, quite probably murdered. And then when I try and start my car, this is obviously after I've been mugged and murdered, it won't start, which means I then can't get to the school to pick my daughter up, which means she's going to be stood at school crying, wondering where her mum is. And that was in my brain a totally logical thought process of what was going to happen

Reflexive Thematic Analysis

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