Caregiver- and Child-Reported Anxiety Using an Autism-Specific Measure: Measurement Properties and Correlates of the Anxiety Scale for Children with Autism Spectrum Disorder (ASC-ASD) in Verbal Young People with ASD

Identifying and measuring anxiety in young people on the autism spectrum can be challenging. The present study investigated the use of the Anxiety Scale for Children with Autism Spectrum Disorder (ASC-ASD), a self- and caregiver-rated screening tool in a Singaporean sample of ninety-one verbal autistic youths and their caregivers. Internal consistency ranged from satisfactory to desirable (α?=?.74–.92). Convergent validity with medium-large effect size was established using a structured diagnostic interview, the Mini-International Neuropsychiatric Interview for Children and Adolescents (MINI-KID). ASC-ASD scores were positively associated with autistic symptoms and response patterns indicated strong endorsement of autism-specific items. The findings are discussed in relation to existing literature on assessment of anxiety in ASD and in light of the study’s strengths and limitations.

     

Parental perspectives on the importance and likelihood of adult outcomes for children with Autism Spectrum Disorders,Intellectual Disabilities or Multiple Disabilities

AimsThis study examined parental perspectives on the importance and likelihood of future adult outcomes for children with Autism Spectrum Disorders (ASD), Intellectual Disabilities (ID), or Multiple Disabilities (MD) and some of the factors that may affect parental aspirations.MethodsParents of 105 children with ASD, ID, or MD were presented with 21 possible future outcomes and were asked to indicate how important and how likely they considered these outcomes for their children with disabilities when they become adults.ResultsParents rated the overall likelihood of their child attaining various future outcomes significantly lower than the importance they placed on these same outcomes. They mostly valued future outcomes relating to their children's personal satisfaction, safety and security over and above those relating to social participation. Parental ratings of the importance or likelihood of outcomes did not differ across the diagnostic groups. Ratings of importance were independent of the child's age, gender, diagnosis, or severity of functioning, but likelihood ratings were significantly predicted by the children's symptom severity.ConclusionsThe implications of this study's findings for service development, intervention and transitioning planning, and treatment outcome research are discussed in relation to existing literature and the study's strengths and limitations.     

Continuity and Change in,and Child Predictors of,Caregiver Reported Anxiety Symptoms in Young People with Autism Spectrum Disorder: A Follow-Up Study

Little is known about continuity, change and predictors of anxiety in ASD. This follow-up study investigated changes in caregiver-reported anxiety in 54 non-referred youth with ASD after 10–19 months. Earlier child predictors of later anxiety were also examined. Anxiety scores were generally stable. Time 1 ASD repetitive behavior symptoms, but not social/communication symptoms, predicted Time 2 total anxiety scores, over and above child age, gender and adaptive functioning scores, but this predictive relationship was fully mitigated by Time 1 anxiety scores when these were included as a covariate in the regression model. Exploring bi-directionality between autism and anxiety symptomatology, Time 1 anxiety scores did not predict Time 2 ASD symptoms. Preliminary clinical implications and possible future directions are discussed.     

Factors associated with parental stress and satisfaction during the process of diagnosis of children with Autism Spectrum Disorders

Diagnosis of Autism Spectrum Disorders (ASD) is complex and parents worldwide often experience difficulties and frustration during the diagnostic process. This study examined the duration of the diagnostic period, the number of professionals consulted, the relationship with the professional(s) and the perceived helpfulness of information provided in relation to how they impact on parental satisfaction and stress during the diagnostic process. The study also obtained professional perspectives regarding current diagnostic practices to understand aspects of the process which may be helpful in increasing professional confidence in diagnosing ASD. One hundred and two parents of 2-17 years old children and young people with ASD recruited from ASD special schools, intervention centres and hospitals in Singapore completed a survey, which included information on various aspects of the diagnostic process and measures of autism severity, parental stress and satisfaction. Seventeen professionals completed a similar survey. Parents from higher educational and socioeconomic backgrounds were more likely to raise concerns about their child's development at an earlier age. Higher parental stress was associated with more professionals consulted and lower perceived collaboration with professionals. Higher parental satisfaction was associated with higher perceived collaboration with professionals, higher perceived helpfulness of received information, lower severity of child ASD symptoms and lower levels of stress. Findings are discussed in relation to clinical practice guidelines and existing literature on the process and impact of diagnosis on families.     

Stability of the Autism Diagnostic Interview—Revised from Pre-School to Elementary School Age in Children with Autism Spectrum Disorders

This study examined the stability of scores on the ADI-R from pre-school to elementary school age in children with autism spectrum disorders (ASD). Participants were 35 children who, at T1, all had a clinical diagnosis of ASD. On initial assessment (mean age 3.5 years; SD 0.6 years), all met ADI-R algorithm criteria for autism. ADI-R assessments were repeated at follow up (FU; mean age 10.5 years; SD 0.8 years). Changes in ADI-R total, domain and ADI-R algorithm item scores were assessed. Twenty-eight children continued to score above the ADI-R cut-off for autism at FU, although significant decreases in ADI-R domain and item scores were also found. In conclusion while classification of children according to ADI-R criteria generally remained stable between pre-school and elementary school age, many children demonstrated significant improvements in symptom severity.     

Factors Influencing Agreement between Parent and Child Reports of Anxiety Symptoms among Children with High-Functioning Autism Spectrum Disorders

Challenges with identifying and measuring anxiety in children and young people with an Autism Spectrum Disorder (ASD) have prompted studies examining the reliability of and agreement between different informants. In this study, agreement and factors influencing agreement (caregivers’ educational level and stress; child’s age, gender, verbal and performance IQ) between parent and child reports of anxiety symptoms was examined in a sample of 70 children with an ASD (66 boys; 9–16 years; mean age = 11.21, SD = 1.79 years). The participants completed the Spence Children’s Anxiety Scale (SCAS) - Child Version, while their parents completed the SCAS - Parent Version and the Parenting Stress Index. Children rated themselves as having significantly more anxiety symptoms compared to parental ratings of children’s anxiety. Parent and child reports of anxiety were significantly positively correlated for separation, social and generalized anxiety and for total anxiety scores with mostly medium effect sizes, but not for panic attack or obsessive-compulsive subscale scores. Higher parent-child agreement was found for anxiety symptoms associated with clearly observable behaviours. More agreement was associated with higher child verbal IQ and lower levels of parenting stress. Specifically, increased parental stress was associated with more discrepant caregiver-child reports of social anxiety symptoms. Our findings support the need for multi-informant data in order to capture a more comprehensive clinical picture of anxiety symptoms in children with an ASD and to consider the informants’ own stress and anxiety levels when obtaining caregivers’ perspectives.     

Is the Autism Treatment Evaluation Checklist a useful tool for monitoring progress in children with autism spectrum disorders?

Background There are few well validated brief measures that can be used to assess the general progress of young children with autism spectrum disorders (ASD) over time. In the present study, the Autism Treatment Evaluation Checklist (ATEC) was used as part of a comprehensive assessment battery to monitor the progress of 22 school‐aged children with ASD who had previously taken part in intensive home‐ or school‐based intervention programmes in their pre‐school years. Methods Parents completed the ATEC when the children were on average 5.5 years and then again 5–6 years later (mean age 10.4 years). Standardised measures were also used to assess cognitive, language and adaptive behaviour skills and severity of autism symptoms over the same period. Results The ATEC had high internal consistency at both time points. ATEC total and sub‐scale scores remained relatively stable over time and were highly and significantly correlated with cognitive, language and adaptive behaviour skills and severity of autism symptoms at both assessment points. Initial ATEC total scores predicted 64% of the variance in scores at the subsequent follow‐up. However, there was also considerable variation in the patterns of scores shown by individual children over time. Conclusions This study provides some preliminary evidence of the ATEC's potential value for monitoring progress of children with ASD over time. Its advantages and limitations are discussed in the context of the need systematically to monitor the progress of children with ASD over time or in response to intervention.     

A Preliminary Investigation of the Spence Children’s Anxiety Parent Scale as a Screening Tool for Anxiety in Young People with Autism Spectrum Disorders

Despite high rates of clinically elevated anxiety difficulties in children and adolescents with autism spectrum disorders (ASDs), very few studies have systematically examined the usefulness of commonly used caregiver report anxiety screening tools with this population. This study investigated the use of the Spence Children’s Anxiety Scale-Parent version (SCAS-P) as a screening tool for anxiety disorders when compared to a standardized DSM-IV-TR-based clinical interview, the Kiddie-Schedule for Schizophrenia and Affective Disorders-Present and Lifetime version (K-SADS-PL). Thirty-two caregivers of youth with a clinical diagnosis of ASD (mean age 10.3 years) attending a specialist autism school participated in this study. They first completed the SCAS-P, a measure of adaptive functioning and a checklist of other emotional and behavioral difficulties. They were then interviewed with the K-SADS-PL. Internal consistency for the SCAS Total score was .88, but Cronbach’s alphas were <.70 in three of the six SCAS-P subscales. The sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of the SCAS-P against K-SADS diagnosis were .75, .71, .27, and .95, respectively. All values were >.70, except for the PPV. Evidence of convergent validity between the SCAS-P, K-SADS-PL and DBC anxiety subscale was also found. The high false positive rates notwithstanding, the preliminary data of acceptable to excellent sensitivity, specificity and NPV values tentatively suggest that the SCAS-P may be useful for screening non-help seeking young people with ASD for elevated anxiety symptoms. Further replication in larger studies is needed and ways in which the SCAS-P could be further developed and investigated for use with youth with ASD are discussed.     

Patterns of change in children with Autism Spectrum Disorders who received community based comprehensive interventions in their pre-school years: A seven year follow-up study

There are few long-term follow-up studies of children with Autism Spectrum Disorders (ASD) who attended intensive intervention programmes in their pre-school years. Thirty-six children with ASD enrolled in relatively intensive, specialist pre-school programmes (minimum of 15 h intervention per week for 2 years at a mean age of 3.4 years) were assessed after 2 years (mean age 5.5 years) and again after a further 5 years (mean age 10.3 years). Cognitive, language and adaptive behaviour skills and severity of autism symptoms were assessed at intake (Time 1) and subsequent follow-ups (Times 2 and 3). Children made significant increases in raw and age equivalent scores in most areas of development assessed, although mean standard scores remained stable or decreased over time. Time 1 IQ, language and adaptive behaviour skills were predictive of outcome at Time 3. Although there were marked individual differences in the rate and patterns of change over time, many children continued to show increases in test scores over the course of the study. This study highlights that whilst overall group improvements may be evident, the rate and nature of these improvements is highly variable across individual children. Further investigation of the specific child characteristics that affect treatment effectiveness is required.