Background Anxiety disorders are highly prevalent in children and adolescents with Autism Spectrum Disorder (ASD) and contribute substantially to functional impairment and reduced quality of life (QoL). Objective This paper represents the second part of a two-part narrative overview addressing internalizing symptoms in ASD. Complementing the first paper focused on depression, the present work examines anxiety, emphasizing shared and distinct modifiable risk and protective factors within a unified conceptual framework. Methods A structured narrative overview was conducted, synthesizing evidence from systematic reviews, meta-analyses, and robust clinical studies. Studies were selected based on relevance and scientific rigor, and findings were organized across biological, psychological, and environmental domains. Results Anxiety in ASD is associated with multiple interacting factors, including sensory hypersensitivity, intolerance of uncertainty (IU), social challenges, and neurobiological vulnerability. Protective factors such as cognitive-behavioral therapy (CBT), structured physical activity, and supportive environments may mitigate anxiety symptoms and promote adaptive functioning. Nevertheless, variability in study design and population characteristics limits generalizability. Conclusions Addressing anxiety in ASD requires a comprehensive, multidisciplinary strategy that integrates risk reduction with resilience-building interventions. Together with the first part of this overview, these findings support transdiagnostic and personalized approach to mental health in children and adolescents.
E. Mihai, Ileana Ciobanu, Matei Teodorescu et al.· Frontiers in Psychiatry· 0 citations
Background Autism Spectrum Disorder (ASD) is a complex neurodevelopmental condition frequently associated with internalizing disorders, particularly depression, which significantly impacts functioning and quality of life (QoL) in children and adolescents. Objective This paper represents the first part of a two-part structured narrative overview examining internalizing psychopathology in children and adolescents with ASD. Given the high co-occurrence and shared neurobiological, psychological, and environmental mechanisms linking depression and anxiety, the multidisciplinary research team elected to develop two complementary overviews to allow a more comprehensive and clinically meaningful synthesis of the evidence. The present review specifically aims to identify and synthesize current evidence on modifiable risk and protective factors influencing depression in children and adolescents with ASD. Methods A structured narrative overview was conducted, integrating evidence from systematic reviews, meta-analyses, and robust clinical studies. Studies were selected based on relevance and methodological quality, and findings were synthesized across biological, psychosocial, and lifestyle domains. Results Growing body of evidence indicates that depression in ASD is influenced by a complex interplay of genetic vulnerability, sensory and emotional dysregulation, social stressors, and environmental factors. At the same time, modifiable protective factors—including physical activity, psychosocial interventions, digital health approaches, and family-centered care—show potential in enhancing resilience and emotional well-being. However, the evidence base remains heterogeneous and often limited by methodological constraints. Conclusions A multidisciplinary and prevention-oriented approach that simultaneously addresses risk and strengthens protective pathways may optimize mental health outcomes and improve QoL in children and adolescents with ASD.
E. Mihai, Ileana Ciobanu, Matei Teodorescu et al.· Frontiers in Psychiatry· 0 citations
