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Anxiety–Amygdala Associations: Novel Insights From the First Longitudinal Study of Autistic Youth With Distinct Anxiety

      In the current issue of Biological Psychiatry, Andrews et al. (
      • Andrews D.S.
      • Aksman L.
      • Kerns C.M.
      • Lee J.K.
      • Winder-Patel B.M.
      • Harvey D.J.
      • et al.
      Association of amygdala development with different forms of anxiety in autism spectrum disorder.
      ) offer novel and important insights into how the amygdala is associated with anxiety in autism. Despite much theoretical rationale for a role of the amygdala in anxiety in individuals diagnosed with autism spectrum disorder (ASD) (
      • Andrews D.S.
      • Aksman L.
      • Kerns C.M.
      • Lee J.K.
      • Winder-Patel B.M.
      • Harvey D.J.
      • et al.
      Association of amygdala development with different forms of anxiety in autism spectrum disorder.
      ,
      • Yarger H.A.
      • Nordahl C.W.
      • Redcay E.
      Examining associations between amygdala volumes and anxiety symptoms in autism spectrum disorder [published online ahead of print Oct 21].
      ,
      • Herrington J.D.
      • Maddox B.B.
      • Kerns C.M.
      • Rump K.
      • Worley J.A.
      • Bush J.C.
      • et al.
      Amygdala volume differences in autism spectrum disorder are related to anxiety.
      ,
      • Juranek J.
      • Filipek P.A.
      • Berenji G.R.
      • Modahl C.
      • Osann K.
      • Spence M.A.
      Association between amygdala volume and anxiety level: Magnetic resonance imaging (MRI) study in autistic children.
      ,
      • Yarger H.A.
      • Redcay E.
      A conceptual model of risk and protective factors associated with internalizing symptoms in autism spectrum disorder: A scoping review, synthesis, and call for more research.
      ), previous empirical studies have yielded mixed results on the magnitude (or presence), direction, and laterality of the association between anxiety and amygdala volumes. Measurement of anxiety has varied across studies, with differing assessment tools, as well as the use of dimensional versus categorical approaches to evaluating the presence of anxiety. In addition, recent research (
      • Yarger H.A.
      • Nordahl C.W.
      • Redcay E.
      Examining associations between amygdala volumes and anxiety symptoms in autism spectrum disorder [published online ahead of print Oct 21].
      ,
      • Kerns C.M.
      • Winder-Patel B.
      • Iosif A.M.
      • Nordahl C.W.
      • Heath B.
      • Solomon M.
      • et al.
      Clinically significant anxiety in children with autism spectrum disorder and varied intellectual functioning.
      ) has argued that traditional, “DSM” anxiety disorders as operationalized in the DSM-5 (
      • American Psychiatric A.
      Diagnostic and Statistical Manual of Mental Disorders: DSM-5.
      ) (e.g., generalized anxiety disorder, separation anxiety, specific phobia, and social phobia—referred to as “DSM anxiety” in the remainder of the commentary) do not capture all types of anxiety that individuals with ASD experience (
      • Kerns C.M.
      • Winder-Patel B.
      • Iosif A.M.
      • Nordahl C.W.
      • Heath B.
      • Solomon M.
      • et al.
      Clinically significant anxiety in children with autism spectrum disorder and varied intellectual functioning.
      ). Instead, researchers have posited that individuals with ASD experience “distinct anxiety,” which includes anxieties such as idiosyncratic fears (e.g., fears of toilets), social anxiety without the fear of evaluation by others (required criterion for diagnosis of DSM social anxiety), or fear of change. The diverse methods used to assess anxiety and the failure to evaluate the presence of anxiety experienced specifically by those with ASD (i.e., distinct anxiety) may be contributing to these mixed results. Andrews et al. (
      • Andrews D.S.
      • Aksman L.
      • Kerns C.M.
      • Lee J.K.
      • Winder-Patel B.M.
      • Harvey D.J.
      • et al.
      Association of amygdala development with different forms of anxiety in autism spectrum disorder.
      ) address these limitations in the first published study to investigate and report associations between amygdala volumes and DSM anxiety and distinct anxiety in autistic youth and, notably, is the first to look at developmental trajectories in amygdala growth over time with relation to distinct and DSM anxiety in autistic youth.
      SEE CORRESPONDING ARTICLE ON PAGE 977
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