Identifying Anxiety in Autistic Adolescents

PSYC Researcher’s New Study Seeks to Address the Challenge and Increase Representation

It can be difficult for any 11- to 14-year-old to express how they’re feeling—let alone identify those feelings as symptoms of anxiety. Doing so is often even more difficult for autistic adolescents.

Heather Yarger, an assistant research professor in the Department of Psychology (PSYC), is dedicating her efforts to support this overlooked demographic through a new, four-year study she's spearheading. With the backing of a $780,000 Mentored Research Scientist Development Award (K08) from the National Institute of Mental Health, Yarger will use a combination of heart rate monitors and text message prompts to investigate whether distinct physical cues of the autonomic nervous system can serve as indicators for anxiety in autistic adolescents.

The results of a meta-analysis she recently published in the Review Journal of Autism and Developmental Disorders, suggest that anxiety in autistic adolescents is associated with low levels of respiratory sinus arrhythmia (RSA)—a specific kind of heart rate variability.

“If I could demonstrate that this heart rate variability is a biomarker of anxiety, it could potentially be a way to assess for anxiety in non-speaking autistic individuals,” she said. “That's the ultimate goal, to be able to find a way to objectively assess the presence of anxiety in individuals who could not otherwise communicate that.”

Yarger plans to recruit 80 autistic adolescents and 80 nonautistic adolescents who live within driving range of the University of Maryland. The parents of the autistic adolescents will meet with Yarger virtually to confirm that their child meets the research criteria for an autism spectrum disorder diagnosis. All parents will bring their child in for a 2-2.5 hour research visit that includes standardized assessments of the participant’s intellectual functioning, measures of their anxiety symptoms, and a lesson on how to wear the heart rate band.

Participants will then wear a heart rate band for eight days. During five of those days, they will be sent 5-6 text messages that ask them questions about their mood right before the phone beeped (e.g., happy, sad, nervous, stressed), who they interacted with, and whether that interaction was positive or negative. 

Through the heart rate band, Yarger will be able to see the autonomic activities of each participant as they are filling out the survey, potentially allowing her to connect dots between reported symptoms of anxiety and attendant physical manifestations.

She may be able to observe the role that race plays in nonautistic and autistic adolescents’ experiences of anxiety, too: Yarger is aiming to ensure that 64% of the study’s participant pool is made up of Black adolescents, a number that represents demographic breakdown of the county UMD calls home, Prince George’s County, Md.

“Unfortunately, I hear many Black individuals say that they don't see their child represented in autism research, or even studies that are trying to understand what anxiety or autism looks like. I hope this study will start to change that,” said Yarger.

School of Public Health Professor Stephen B. Thomas will serve as the primary mentor for the study. He will train Yarger in the equity-centered implementation science framework developed by the Maryland Center for Health Equity, and help Yarger work with Black barbers and stylists within the Health Advocates In-Reach and Research (HAIR) Network to co-create participant recruitment and retention protocols.

"We will initiate an extensive educational campaign focusing on autism—providing insights into its nature and dispelling common misconceptions—through our cutting-edge Zoom townhalls, which have been ongoing since the onset of the pandemic," explained Thomas. "This approach establishes a new pathway for engaging with the community by meeting individuals where they are and providing them with culturally relevant educational resources. It also encourages community members to come forward and share their experiences, ultimately laying the groundwork for a culturally tailored engagement strategy."

Thomas and Yarger also plan to transform the personal narratives of study participants and their parents into educational resources formatted as graphic novels, a "qualitative story deck" method gleaned from Thomas's experiences within the HAIR Network. 

Thomas says the graphic novels will serve a dual purpose: Not only facilitating engagement with the material, but providing a platform to depict the lived experiences of Black individuals on the autism spectrum—voices often absent from conventional resource materials. 

Elizabeth Redcay, PSYC associate professor, will assist Yarger in the process of collecting data from autistic adolescents. PSYC Professor Ed Lemay will provide Yarger with guidance on how to best analyze that data. 

“The study could help those in the autism community in several ways," said Yarger. "In addition to more accurate racial representation in research, it could also provide an objective tool for identifying anxiety in non-speaking autistic individuals, or for identifying situations where someone may not be able to communicate that they’re experiencing anxiety or distress.

“Down the line, we could turn that into an intervention with cognitive behavioral therapy, where someone could say to themselves ‘Oh, my heart rate's starting to increase. Now let's try some of these emotion regulation strategies,’” she said. 

To learn more about the “Assessing Anxiety in Adolescents with Autism Spectrum Disorder: The Role of Autonomic Activity as a Biomarker” (ADORA) study, email adora@umd.edu. Interested parents can also fill out this form.

Main photo of Heather Yarger is by Nathaniel Underland.

Published on Thu, Apr 18, 2024 - 4:00PM