{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,11,20]],"date-time":"2025-11-20T06:14:43Z","timestamp":1763619283339,"version":"3.45.0"},"reference-count":96,"publisher":"BMJ","issue":"9","license":[{"start":{"date-parts":[[2025,9,4]],"date-time":"2025-09-04T00:00:00Z","timestamp":1756944000000},"content-version":"unspecified","delay-in-days":3,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"DOI":"10.13039\/100000025","name":"National Institute of Mental Health","doi-asserted-by":"publisher","award":["K08MH133879"],"award-info":[{"award-number":["K08MH133879"]}],"id":[{"id":"10.13039\/100000025","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2025,8,20]]},"published-print":{"date-parts":[[2025,9]]},"abstract":"<jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Identifying anxiety disorders in autistic youth can be challenging due to the unique presentation of anxiety symptoms in autistic youth and the difficulties youth may have reporting on their own anxiety symptoms. These challenges underscore the need for objective and reliable measures. Understanding whether autonomic activity is associated with the presence of anxiety may lead to its use as an objective anxiety assessment tool in individuals who may otherwise struggle to communicate their feelings of anxiety. Most published studies examining autonomic activity and anxiety in autistic individuals lack information regarding racial demographic information, and those that do are predominantly composed of White individuals. These findings highlight the critical need for future research that includes more diverse samples and uses consistent, ecologically valid methods to examine the relation between anxiety and autonomic activity in autistic populations. This study aims to recruit a large sample of racially diverse adolescents to evaluate whether atypical autonomic activity serves as a biomarker of anxiety in autistic and non-autistic youth. This manuscript outlines the recruitment strategies for this study protocol, providing a framework for understanding the interplay between physiological, psychological and contextual factors including self-identified race in anxiety among autistic and non-autistic adolescents.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods and analysis<\/jats:title>\n                    <jats:p>Autistic (n=80) and non-autistic (n=80) adolescents aged 11\u201314\u2009years and their caregivers will be invited to participate in the current study. Autism diagnosis will be confirmed by gold-standard assessments. All participants will complete an in-person visit assessing their child\u2019s cognitive abilities and trait-level anxiety and mental health symptoms, learn how to wear a non-invasive heart rate band that will collect ECG and respiration data, complete a 5-minute in-lab baseline of autonomic activity and enroll in experience sampling. Next, participants will complete three 5-minute baselines of autonomic activity at home, followed by 5\u2009days of wearing the heart rate band for 5\u2009hours per day, overlapping with ecological momentary assessment of their mood. Primary outcome measures include trait-level parent and self-reports of anxiety, real-time self-reports of anxiety captured through ecological momentary assessment, and both baseline and in-the-moment heart rate variability.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Ethics and dissemination<\/jats:title>\n                    <jats:p>The study protocol has been approved by the University of Maryland\u2019s Institutional Review Board. Results will be disseminated through peer-reviewed publications and conferences. Deidentified data from participants who consent to have their data shared with other researchers will be uploaded to the National Data Archive Collection C5316.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjopen-2025-107684","type":"journal-article","created":{"date-parts":[[2025,9,4]],"date-time":"2025-09-04T15:22:08Z","timestamp":1756999328000},"page":"e107684","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Assessing anxiety in adolescents with autism spectrum disorder (ADORA): developing a health equity protocol for non-invasive biomarkers"],"prefix":"10.1136","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8031-0700","authenticated-orcid":false,"given":"Heather A","family":"Yarger","sequence":"first","affiliation":[{"name":"Psychology, University of Maryland College Park, College Park, Maryland, USA"},{"name":"Psychology, James Madison University, Harrisonburg, Virginia, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Elizabeth","family":"Redcay","sequence":"additional","affiliation":[{"name":"Psychology, University of Maryland College Park, College Park, Maryland, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"John","family":"Herrington","sequence":"additional","affiliation":[{"name":"Children\u2019s Hospital of Philadelphia, Philadelphia, Pennsylvania, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Connor M","family":"Kerns","sequence":"additional","affiliation":[{"name":"University of British Columbia, Vancouver, British Columbia, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Stephen B","family":"Thomas","sequence":"additional","affiliation":[{"name":"University of Maryland College Park, College Park, Maryland, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2025,9,4]]},"reference":[{"key":"2025111921300912000_15.9.e107684.1","doi-asserted-by":"publisher","DOI":"10.15585\/mmwr.ss7402a1"},{"key":"2025111921300912000_15.9.e107684.2","doi-asserted-by":"publisher","DOI":"10.1007\/s10567-011-0097-0"},{"key":"2025111921300912000_15.9.e107684.3","doi-asserted-by":"publisher","DOI":"10.1097\/CHI.0b013e318179964f"},{"key":"2025111921300912000_15.9.e107684.4","doi-asserted-by":"crossref","DOI":"10.3389\/fpsyt.2021.744709","article-title":"Prevalence of Autism Spectrum Disorder and Co-morbidities in Children and Adolescents: A Systematic Literature Review","volume":"12","author":"Bougeard","year":"2021","journal-title":"Front Psychiatry"},{"key":"2025111921300912000_15.9.e107684.5","first-page":"352","article-title":"The presentation and classification of anxiety in autism spectrum disorder: Where to from here?","volume":"19","author":"Ollendick","year":"2012","journal-title":"Clinical Psychology: Science and Practice"},{"key":"2025111921300912000_15.9.e107684.6","doi-asserted-by":"crossref","first-page":"164","DOI":"10.1016\/j.rasd.2010.03.006","article-title":"Preliminary evidence suggesting caution in the use of psychiatric self-report measures with adolescents with high-functioning autism spectrum disorders","volume":"5","author":"Mazefsky","year":"2011","journal-title":"Res Autism Spectr Disord"},{"key":"2025111921300912000_15.9.e107684.7","doi-asserted-by":"publisher","DOI":"10.1080\/15374416.2016.1233501"},{"key":"2025111921300912000_15.9.e107684.8","doi-asserted-by":"crossref","first-page":"2026","DOI":"10.1177\/13623613211072593","article-title":"Patterns in reporting and participant inclusion related to race and ethnicity in autism intervention literature: Data from a large-scale systematic review of evidence-based practices","volume":"26","author":"Steinbrenner","year":"2022","journal-title":"Autism"},{"key":"2025111921300912000_15.9.e107684.9","doi-asserted-by":"crossref","first-page":"1091","DOI":"10.1002\/cncr.28575","article-title":"Twenty years post-NIH Revitalization Act: enhancing minority participation in clinical trials (EMPaCT): laying the groundwork for improving minority clinical trial accrual: renewing the case for enhancing minority participation in cancer clinical trials","volume":"120 Suppl 7","author":"Chen","year":"2014","journal-title":"Cancer"},{"key":"2025111921300912000_15.9.e107684.10","doi-asserted-by":"publisher","DOI":"10.1177\/1362361320948313"},{"key":"2025111921300912000_15.9.e107684.11","doi-asserted-by":"publisher","DOI":"10.1177\/0022466916632495"},{"key":"2025111921300912000_15.9.e107684.12","doi-asserted-by":"publisher","DOI":"10.1007\/s10803-014-2041-x"},{"key":"2025111921300912000_15.9.e107684.13","doi-asserted-by":"crossref","unstructured":"Yarger HA , Sarkar M , Harrington E , et al . 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