Impact of anxiety disorders on quality of life of adolescents with autism spectrum disorder without intellectual disability

Introduction. - The prevalence of anxiety disorders has been recently estimated at 42 % in a population of adolescents with autism spectrum disorder without intellectual disability. This rate is more than two times higher than in adolescents without developmental disorders (around 20 %). Besides, according to recent studies, the quality of life of adolescents with ASD without mental retardation seems to be lower than adolescents with typical development. We guess that anxiety disorders may be responsible for a low quality of life in adolescents with ASD. Objectives. - The aim of this study was to describe the relationship between quality of life and anxiety disorders. The first objective was to determine if anxiety disorders are a risk factor for having a low quality of life in adolescents with ASD. The second objective was to confirm this link with another comparison using a control group of adolescents with an anxiety disorder but without ASD. Our hypothesis was that anxiety disorder is a risk factor to decrease the quality of life of adolescents with ASD. Methods. - This research was a transversal descriptive and comparative study. Sixty-six adolescents aged between 11 and 18 years old were included: 46 with ASD without mental retardation and 20 controls (with anxiety disorders without ASD). Among the ASD group, 20 patients were identified as having an anxiety disorder according to international classifications of mental diseases, and 26 adolescents had no psychiatric comorbidity. Quality of Life (QoL) was reported in five domains with the KIDSCREEN-27, for each patient in the three different groups. Diagnosis of anxiety disorders was assessed using the Kiddie-SADS-PL. The level of anxiety was measured with a self-report questionnaire (RC-MAS). We compared the anxiety rates and the QoL levels between the two groups of adolescents with ASD, one with anxiety disorders, the other without anxiety disorder. Comparisons were also made with QoL data from the general population. Results. - Quality of life in the two different groups of adolescents with ASD without mental retardation (with and without anxiety disorders) was significantly lower than in adolescents in the general population. Those rates were, significantly lower in the group with ASD and anxiety disorders than in the group with ASD without anxiety disorders for the domain of "physical well-being" only. There was no significant difference between the groups regarding the four other domains of the Kidscreen-27. Moreover, there was no difference between adolescents with ASD and adolescents without ASD regarding the perceived level of anxiety. Conclusion. - This study shows that anxiety disorders could be a risk factor for impairment of the "physical well-being" dimension of QoL in adolescents with ASD without intellectual disability. Results highlight the interest of a self-evaluation of anxiety level in a population of adolescents with ASD. Findings about self-report of QoL might be temper probably due to the insight difficulties that meet patients with ASD reported in literature review. Further research need to be done with larger samples of patients using self-evaluation coupled with hetero-evaluation such as parents' reports and clinicians' reports. (C) 2016