Letter to the Editor: Bridging or blurring? Reflections on measurement overlap, cultural adaptation, and robustness in autism–anxiety network analysis

Dear Editor, We read with great interest the article by Zaidman-Zait et al. (2025) exploring the links between autism traits and anxiety symptoms in children and adolescents across four countries. This important contribution advances the field by applying network analysis to a large, pooled dataset and identifying clinically meaningful bridge nodes. We would like to highlight three issues that we believe warrant further consideration to strengthen the interpretation and generalizability of the findings. First, the bridge identified between preference for sameness (AUT7) and anxiety nodes such as general worry (Anx1) may partly reflect conceptual overlap. Prior work has shown that intolerance of uncertainty is both an autism trait and a core anxiety mechanism (Rodgers, Herrema, Honey, & Freeston, 2018; Wigham, Rodgers, South, McConachie, & Freeston, 2015). Parent reports of ‘rigid routines’ or ‘resistance to change’ can easily be interpreted as ‘worry’, raising the possibility that this bridge reflects measurement redundancy rather than a distinct cross-domain mechanism. Item-level analyses or multi-trait multi-method approaches would help clarify this distinction. Second, the multinational nature of the dataset is a notable strength, but it introduces challenges of translation and cultural adaptation. For example, ‘fear of speaking in class’ may strongly indicate social anxiety in Western classrooms but may be perceived as normative reticence in East Asian contexts. Similarly, ‘preference for sameness’ may be culturally valued as discipline rather than pathologized. Without tests of measurement invariance or evidence of back-translation procedures, there is a risk that observed correlations reflect cultural interpretations rather than true symptom dynamics. This issue is critical: if not addressed, the entire pattern of associations could be confounded by translation bias (Stevanovic et al., 2017). Third, the identification of bridge nodes appears sensitive to analytic choices. The network was estimated with γ fixed at 0.5 and bridge nodes defined at the 80th percentile. While reasonable, these decisions introduce subjectivity; different γ or thresholds could yield different bridge structures. Sensitivity analyses across parameter values or the use of bootstrapped confidence intervals would increase confidence that the reported bridges are robust rather than artifacts of a single configuration. In sum, the study makes a valuable contribution by mapping anxiety and autism traits at the symptom level, but attention to construct overlap, translation and cultural equivalence, and parameter robustness would further strengthen confidence in the reported bridges. We offer these points in the hope of supporting continued progress in refining network models for pediatric populations. Cai Ai Lai: Conceptualization, writing of the comment letter; Yanfang Huang: Review, editing of the comment letter; Guangliang Luo: Overall responsibility for the comment letter. All authors have read and agreed to the published version of the comment letter. The authors have declared that they have no competing or potential conflicts of interest. This comment letter was supported by the Research Project of Shenzhen Hospital (Futian) of Guangzhou University of Chinese Medicine (Grant No. GZYSY2024013). The views expressed in this comment letter are those of the authors and do not necessarily reflect the views of their affiliated institution. This letter to the editor does not involve any original data collection or human subjects and therefore does not require ethical approval. The views expressed in this letter are those of the authors and do not necessarily reflect the views of their affiliated institution. Data sharing not applicable to this article as no datasets were generated or analyzed during the current study.