Autism Spectrum Disorders, Anxiety, and Religion: The Role of Personality Traits

Round 1

Reviewer 1 Report

Comments and Suggestions for Authors

1.     1.-  I find the article very interesting, nevertheless

2.     2.- I would thank if the authors could clarify from the beginning

a.       The sample’s amount of people (103 according to the data at the end of the article)

b.       How many people are control group and how many are ASD or anxiety disorder people

c.       If all the questionnaires (164 items/13 scales if I understood well) were answered all together or in different moments. Because the way of answering could be another limit of the study if the pressure to answer could have increased the anxiety (or the passivity) of the respondents

Author Response

Thank you for your feedback. We have now added the information about the sample in the abstract and method section. Furthermore we have added a sentence about the way of measuring in the limitations section.

Author Response File: Author Response.pdf

Reviewer 2 Report

Comments and Suggestions for Authors

In  file  below

Comments for author File: Comments.pdf

Author Response

Apologies if it was not clear enough that the current study primarily focuses on God representations. The QGR is described in detail as a measurement tool in the methods section, and the anxiety-related items we used, for example, come from this questionnaire. For clarity, we have now explicitly mentioned more often in the results that we are analyzing the QGR.

We understand the concern about the shift from the theoretical focus to the practical implications for therapists and chaplains. While the primary aim of the study was to investigate the role of personality traits in God representations, we believe that understanding the relationship between religiousness, autistic traits, and personality can provide valuable insights for practitioners working with individuals with ASD. This dual focus on both theory and clinical practice aims to bridge the gap between research and real-world applications, offering therapists and chaplains a better understanding of how to approach the religious and spiritual needs of their patients. We have clarified this balance in the revised manuscript.

Indeed research on ASD and religiousness shows conflicting results. We have no rewritten this paragraph and hope that it is more clear that study results vary a lot.

We have now clarified that practitioners ensured the voluntary nature of participation in the study and made it clear that participation, or lack thereof, would in no way influence treatment or the therapeutic relationship. The practitioners themselves had no personal interest in the study.

Author Response File: Author Response.pdf

Reviewer 3 Report

Comments and Suggestions for Authors

The current study is very pertinent because of the association between ASD, personality traits and representations of God, and could indeed be very useful for professionals working with spirituality and health interventions. 

Some recommendations that are not very clear to me when reading the text are 1) How is it concluded that orthodox Calvinists in this context of ASD are more likely to suffer from the guilt-driven type of anxiety? I think that understanding this method and the approaches taken can be very useful in perceiving other denominational affiliations. It's worth explaining this process better. and how they work to analyse the information qualitatively; 2) The complexity of the problem contrasts with the conclusion drawn. For example, the statement "the nature of anxiety may be more related to religion (guilt) or to psychology (uncertainty)" could lead to the misconception that religion is related to guilt, or even that religion is not related to uncertainty. I understand what this means in the context of the article, but phrased in this way, it may serve to reinforce stereotypes. The conclusion aims to present the results in a clear and concise way, but I think it could be reworded here to avoid buzzwords and thus ensure the accuracy of the analysis; 3) the reasons for the sample limitations and the rationale for the selection of variables in this study could be explained a little more, as well as pointing to its continuation.

Otherwise, I think the article is an excellent contribution.

Author Response

1) Thank you for this interesting question. The paragraph on this topic in the introduction is a summary of findings from previous research (after unblinding, the reviewer can refer to the references here). In that study, it was found that strict Calvinists scored higher on a certain guilt-driven form of anxiety, which may very well relate to their doctrines. The current study aimed to further investigate two anxiety scales on its value, but did not analyze the relation with denominations again. However, we have now included the recommendation to specifically explore this further in the future.

2) This is a valid point, thank you for proposing the nuance. We have adapted the text in the conclusion section.

3) We have now added two sentences about the study population in the limitation section and more extendedly explained the choice for our variables in the method section.

Round 2

Reviewer 2 Report

Comments and Suggestions for Authors

See Review file.

Comments for author File: Comments.pdf

Author Response

Reviewer round 2

 

Comment 1: Review February 2025 “Before the start, the METC of VUmc had decided that the study was not WMO complicit.” This is unclear, and raises questions. Complicit?

Response 1: Apologies for this unclear formulation, referring to the Dutch context. We have now adapted the sentence and hope that this is more clear this way.

“Before the start of the study, the Medical Ethics Review Committee (METC) of VUmc determined that the study did not fall under the scope of the Dutch Medical Research Involving Human Subjects Act (WMO). This meant that formal approval from the METC was not required.”

Comment 2: The authors devote much space to discussing “spirituality”, which I criticized in my first review, but then choose not to measure it. Why? This had been asked in my first review.

Response 2: Thank you for this point, we now better understand that you suggested to exclude spirituality. At the same time, we think that religion and spirituality are interconnected. Religion and spirituality have many interpretations and definitions and are sometimes used interchangeably. In different studies, considerable variation in the definitions and meanings is applied to both religion, religious, religiousness, religiosity, spiritual and spirituality. In our definition religion can be seen as the social, institutional and cultural context of spirituality (Pargament, 2007). ‘Religiosity’, or more common today ‘religiousness’, can be understood as how the individual relates to religion (Reynolds, 2017). Though worldwide, more than eight in ten people identify with a religious group (Pew, 2012), in Western countries such as the Netherlands, this number is substantially lower (Pew, 2018). Traditional religious denominations are still present, but have become a minority during the last few decades (Van Beek, 2016). In the Netherlands, religion and religiousness in this way have diminished over the last decennia, but spirituality has not (Dros, 2010). Many people in Dutch society – which is sometimes referred to as a ‘post-Christian society’ – have their roots in Christianity and may still feel spiritual. One of the definitions of spirituality is ‘a dynamic and intrinsic aspect of humanity through which persons seek ultimate meaning, purpose, and transcendence, and experience relationship to self, family, others, community, society, nature, and the significant or sacred’ (Puchalski, Vitillo, Hull, & Reller, 2014). People who do not define religious, may still have their own God representations.

We have tried to make our definitions and interpretations more clear and hope this will meet your expectations.

“In the current study, religion and religiousness are seen as the social, institutional and cultural context of spirituality (Pargament, 2007).”

“Both religious and nonreligious patients, as well as those who identify as spiritual, have ways in which they relate to God or the divine.”

Author Response File: Author Response.docx