Can Heart Rhythms Signal Anxiety in Autistic Youths?

It can be hard for any young adolescent to express how they’re feeling—let alone identify those feelings as symptoms of anxiety. Doing so is often even more difficult for autistic youths.

With backing from a $780,000 grant from the National Institute of Mental Health, Heather Yarger, an assistant research professor in the University of Maryland Department of Psychology, is spearheading a new four-year study aimed at giving these young people a voice, particularly those who are Black.

To do so, Yarger will combine heart rate monitoring with text message prompts to investigate whether cues from the involuntary nervous system are indicators of anxiety in autistic adolescents ages 11 to 14. If so, the study’s results may be able to help those with all kinds of communication abilities get the mental health support their parents may not otherwise know they need.

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—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 160 local adolescents for the study—half with autism and half without. Parents will bring their child to UMD for an intake visit that includes standardized assessments of the participant’s intellectual functioning, measures of their anxiety symptoms and a lesson on how to wear a heart rate band.

Although the autistic participants in the study will generally have more extensive communication abilities than the group who could benefit most dramatically, she said she hopes that the study results will be applicable across groups.

Participants will wear the band for eight days, receiving five or six text messages per day over five of those days that ask them about their mood right before the phone beeped—like happy, sad, nervous or stressed—who they interacted with, and whether that interaction was positive or negative.

Through the heart rate band, Yarger will be able to gauge the involuntary nervous system activity of participants as they answer the questions, potentially allowing her to connect dots between reported symptoms of anxiety and the physical manifestations of it.

She may also be able to observe the role that race plays in nonautistic and autistic adolescents’ experiences of anxiety, too: Yarger seeks to ensure that 64% of the study’s participant pool is made up of Black adolescents, mirroring the percentage in UMD’s home base of 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 help Yarger meet her demographic recruitment goals by instilling the equity-centered implementation science framework developed by the Maryland Center for Health Equity, which he directs, and helping her work with the Black barbers and stylists who participate in Thomas’ Health Advocates In-Reach and Research (HAIR) Network.

Elizabeth Redcay, associate professor of psychology, will also assist Yarger in the process of collecting data from autistic adolescents. Psychology 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.