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Sparks A, Gilbert Evans S, Javadi M, Lasalandra B, Martens E, Venkatesh R, Vaccarino IT, Vaccarino AL. Assessment of anxiety in children with neurodevelopment disorders: Rasch analysis of the Spence Children's Anxiety Scale. Front Psychiatry 2024; 15:1240357. [PMID: 38742131 PMCID: PMC11089232 DOI: 10.3389/fpsyt.2024.1240357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Accepted: 04/10/2024] [Indexed: 05/16/2024] Open
Abstract
Anxiety is common in neurodevelopmental disorders (NDD). The parent version of the Spence Children's Anxiety Scale (SCAS-P) is a widely used measure to assess anxiety across a broad range of childhood populations. However, assessment of the measurement properties of the SCAS-P in NDDs have been limited. The present study aimed to assess the psychometric properties of the SCAS-P in children with attention-deficit/hyperactivity disorder (ADHD) and autism spectrum disorder (ASD) using Rasch Measurement Theory. Data from the Province of Ontario Neurodevelopmental Disorders Network Registry were used in the analysis. Children (ages 6-13 years old) with a primary diagnosis of ADHD (n=146) or ASD (n=104) were administered the SCAS-P. Rasch Measurement Theory was used to assess measurement properties of the SCAS-P, including unidimensionality and item-level fit, category ordering, item targeting, person separation index and reliability and differential item functioning. The SCAS-P fit well to the Rasch model in both ADHD and ASD, including unidimensionality, satisfactory category ordering and goodness-of-fit. However, item-person measures showed poor precision at lower levels of anxiety. Some items showed differential item functioning, including items within the obsessive-compulsive, panic/agoraphobia and physical injury fears domains, suggesting that the presentation of anxiety may differ between ADHD and ASD. Overall, the results generally support the use of the SCAS-P to screen and monitor anxiety symptoms in children with ADHD and ASD. Future studies would benefit from examination of more severely anxious NDD cohort, including those with clinically diagnosed anxiety.
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Nekar DM, Kang HY, Lee JW, Oh SY, Yu JH. Effects of Cooperative, Competitive, and Solitary Exergames on Cognition and Anxiety Levels in Children with Developmental Disabilities. Games Health J 2023; 12:405-413. [PMID: 37279027 DOI: 10.1089/g4h.2023.0050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023] Open
Abstract
Objective: Exergames are playing an important role in person-centered therapy, health care services, and in the rehabilitation field. This study aimed to compare the effects of cooperative, competitive, and solitary exergames on cognition and anxiety levels in children with developmental disabilities (DD). Materials and Methods: This study was a randomized controlled trial pretest-posttest including 36 children with DD who were allocated to the cooperative exergame group (CGG), competitive exergame group (CmGG), and solitary exergame group (SGG). The exergame program was performed two times a week for 8 weeks and the outcome measurements were conducted before and after the program. A paired sample t-test and one-way analysis of variance (ANOVA) were used to analyze the changes within and between the groups. Results: The result indicated a significant improvement in memory, attention, and visual perception in all groups; the CGG and CmGG showed a high increase in attention compared with the SGG. However, only the CGG presented a significant improvement in the language subscale. In terms of anxiety, only the CGG presented substantial improvements in all anxiety subscales. The CmGG showed improvement in social phobia and the SGG in physical injury fears, social phobia, and general anxiety fears. Conclusion: The findings suggest that cooperative and competitive exergames may be used to effectively improve cognitive functions; cooperative exergames can be applied as the most effective method to reduce anxiety compared with the other game types for children with DD.
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Affiliation(s)
- Daekook M Nekar
- Department of Physical Therapy, Sun Moon University, Asan, Republic of Korea
| | - Hye-Yun Kang
- Department of Physical Therapy, Sun Moon University, Asan, Republic of Korea
| | - Jae-Won Lee
- Department of Physical Therapy, Sun Moon University, Asan, Republic of Korea
| | - Sung-Yeon Oh
- Department of Physical Therapy, Sun Moon University, Asan, Republic of Korea
| | - Jae-Ho Yu
- Department of Physical Therapy, Sun Moon University, Asan, Republic of Korea
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Burnley A, St Clair M, Bedford R, Wren Y, Dack C. Understanding the prevalence and manifestation of anxiety and other socio-emotional and behavioural difficulties in children with Developmental Language Disorder. J Neurodev Disord 2023; 15:17. [PMID: 37322422 PMCID: PMC10268478 DOI: 10.1186/s11689-023-09486-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Accepted: 05/30/2023] [Indexed: 06/17/2023] Open
Abstract
BACKGROUND It is well-documented that children with Developmental Language Disorder (DLD) have a higher likelihood of experiencing anxiety, as well as other socio-emotional and behavioural (SEB) difficulties. Despite this, there is little consensus as to how these difficulties manifest. This study aims to understand the prevalence of broader SEB difficulties and anxiety, informing intervention development by understanding the relationships between them. METHODS A mixed-methods, case-control study was conducted. First, an online survey was completed by 107 parents of either children with DLD ("DLD sample"; n = 57) or typically developing children ("typical sample"; n = 50), aged 6-12 years old. Binary SEB statements informed by previous qualitative work (e.g. "my child requires routine/sameness"; "my child has frequent tantrums") provided an insight into the prevalence of SEB difficulties in both DLD and typical samples. Validated measures of anxiety, emotion regulation, intolerance of uncertainty, insistence on sameness, family stress and coping mechanisms were also collected. Correlation and mediation analyses were run using these validated measures to understand the manifestation of anxiety in children with DLD in more detail. Qualitative interviews were then carried out with a select panel of survey respondents (n = 4). RESULTS The DLD sample scored significantly higher on all binary SEB statements than the typical sample: experiencing anxiety (80.7%, p < .05), requiring routine and sameness (75.4%, p < .001) and emotional dysregulation (75.4%; p < .001) were the most common difficulties reported for children with DLD. Using the validated scales, family stress and coping mechanisms were found to only correlate with the manifestation of anxiety in the typical group, not the DLD group. "Intolerance of uncertainty" and "insistence on sameness" were found to fully mediate the relationship between DLD diagnosis and symptoms of anxiety. Parent's interviews provided contextual support for the analysis, as well as highlighting sensory sensitivities as a focus for future research. CONCLUSIONS Parents of children with DLD appear to cope well with their children's complex SEB needs. Intervention focussing on intolerance of uncertainty may help the management of difficulties with anxiety. Behaviours such as insistence on sameness should be investigated further, as potential indicators for anxiety amongst children with DLD.
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Affiliation(s)
- Annabel Burnley
- Department of Psychology, University of Bath, Bath, Somerset County UK
| | - Michelle St Clair
- Department of Psychology, University of Bath, Bath, Somerset County UK
| | - Rachael Bedford
- Department of Psychology, University of Bath, Bath, Somerset County UK
| | - Yvonne Wren
- Bristol Dental School, University of Bristol, Bristol, Bristol County UK
| | - Charlotte Dack
- Department of Psychology, University of Bath, Bath, Somerset County UK
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4
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Spackman E, Lerh JW, Rodgers J, Hollocks MJ, South M, McConachie H, Ozsivadjian A, Vaughan Van Hecke A, Libove R, Hardan AY, Leekam SR, Simonoff E, Frazier TW, Alvares GA, Schwartzman JM, Magiati I, Uljarević M. Understanding the heterogeneity of anxiety in autistic youth: A person-centered approach. Autism Res 2022; 15:1742-1754. [PMID: 35642170 DOI: 10.1002/aur.2744] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Accepted: 04/18/2022] [Indexed: 11/10/2022]
Abstract
The present study aimed to examine anxiety profiles among children and adolescents on the autism spectrum. It further aimed to characterize the association between the identified anxiety profiles and key clinical and developmental variables. The Spence Children's Anxiety Scale-Parent Version (SCAS-P) data from a large international pooled sample of 870 caregivers of autistic children and adolescents (Mage = 11.6 years, SDage = 2.77; 107 females) was used. Latent profile analysis identified a three-anxiety profile solution exhibiting high entropy (0.80) and high latent profile probabilities, with good classification accuracy. Identified profiles fell along the severity spectrum and were named as the mild (n = 498), moderate (n = 272) and severe (n = 100) anxiety profiles. There were no statistically significant differences between the three anxiety profiles in terms of sex distribution. Participants in the mild profile were significantly younger than those in the severe profile, had significantly fewer social communication difficulties than youth in the moderate anxiety profile group and had significantly fewer restricted and repetitive behaviors and lower cognitive functioning scores compared to participants in moderate and severe anxiety profiles. This is the first study to move beyond identifying associations and group-level differences to exploring and identifying characteristics of anxiety-based subgroups at an individual level that differ on key clinical and developmental variables. The subgroups identified in this study are a preliminary, yet important, first step towards informing future assessment and individualized interventions aiming to support young people on the autism spectrum to reduce and manage anxiety. LAY SUMMARY: This study tried to understand if there are subgroups of autistic young people who may have similar anxiety profiles. We found that we could meaningfully group young people into three groups based on how severe the anxiety symptoms their caregivers reported were: a group with low levels of anxiety, those with moderate anxiety, and those with more severe anxiety. We also found that the young people in the mild group were younger, had fewer autism traits and lower levels of intellectual functioning than young people in the other two groups.
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Affiliation(s)
- Emily Spackman
- Melbourne School of Psychological Sciences, University of Melbourne, Melbourne, Victoria, Australia
| | - Jian Wei Lerh
- Department of Psychology, National University of Singapore, Singapore, Singapore
| | - Jacqui Rodgers
- Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
| | - Matthew J Hollocks
- Department of Child & Adolescent Psychiatry, King's College London, London, UK.,Central and North West London NHS Foundation Trust, London, UK
| | - Mikle South
- Emory University School of Medicine, Emory University, Atlanta, Georgia, USA
| | - Helen McConachie
- Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
| | - Ann Ozsivadjian
- Evelina London Children's Hospital, Guys and St Thomas' NHS Foundation Trust, London, UK
| | | | - Robin Libove
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford University, Stanford, California, USA
| | - Antonio Y Hardan
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford University, Stanford, California, USA
| | - Susan R Leekam
- Wales Autism Research Centre, School of Psychology, Cardiff University, Cardiff, UK
| | - Emily Simonoff
- Department of Child & Adolescent Psychiatry, King's College London, London, UK
| | - Thomas W Frazier
- Department of Psychology, John Carroll University, University Heights, Ohio, USA
| | - Gail A Alvares
- School of Psychological Science, University of Western Australia, Perth, Western Australia, Australia
| | - Jessica M Schwartzman
- Vanderbilt Child and Adolescent Psychiatry, Vanderbilt University, Nashville, Tennessee, USA
| | - Iliana Magiati
- School of Psychological Science, University of Western Australia, Perth, Western Australia, Australia
| | - Mirko Uljarević
- Melbourne School of Psychological Sciences, University of Melbourne, Melbourne, Victoria, Australia
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5
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Stewart TM, Martin K, Fazi M, Oldridge J, Piper A, Rhodes SM. A systematic review of the rates of depression in autistic children and adolescents without intellectual disability. Psychol Psychother 2022; 95:313-344. [PMID: 34605156 DOI: 10.1111/papt.12366] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Accepted: 08/12/2021] [Indexed: 11/29/2022]
Abstract
OBJECTIVES Increasing evidence suggests that major depressive disorder (MDD) is highly prevalent in autism spectrum disorder (ASD). The current study is a systematic review of rates of depression in autistic children and adolescents, without intellectual disability. DESIGN Adhering to PRISMA guidelines, a total of 14,557 studies were identified through five databases (MEDLINE, EMBASE, Cinahl, ERIC, PsycINFO, and Web of Science). METHODS Articles were screened for inclusion and exclusion criteria and 10% double coded at each stage. Nineteen studies met criteria and were retained in the review. RESULT The reported rates of depression in autistic children and adolescents varied from 0% to 83.3%. We discuss these findings in relation to method of report (self/informant, interview/questionnaire), recruitment status (clinical/community recruited), and age (pre-pubertal/adolescent). CONCLUSION Rates of depression vary considerably across studies and do not show a particular pattern in relation to methodology, or age. Our research joins a crucial call to action from the research community for future research to improve the identification of depression in autism, which in turn will aid our understanding of the potentially different characterization and manifestation of depression in autism, to ultimately improve assessment and treatment of depression in autistic children and adolescents. PRACTITIONER POINTS Rates of depression in autistic children and adolescents vary and do not show a particular pattern in relation to methodology or age. Our research joins the call to action from the research community for future research to improve the identification of depression in autistic children and adolescents, which in turn will aid understanding of depression in autism, and ultimately improve assessment and treatment of depression in autistic children and young people. The development of new measures of depression, specifically designed with, and for, children and adolescents with autism, is warranted.
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Affiliation(s)
- Tracy M Stewart
- Moray House School of Education and Sport, University of Edinburgh, UK
| | | | | | - Jessica Oldridge
- Child Life and Health, Clinical Brain Sciences, University of Edinburgh, UK
| | - Allan Piper
- Child and Adolescent Mental Health, NHS Lothian, Edinburgh, UK
| | - Sinead M Rhodes
- Child Life and Health, Clinical Brain Sciences, University of Edinburgh, UK
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6
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Huston JC, Thom RP, Ravichandran CT, Mullett JE, Moran C, Waxler JL, Pober BR, McDougle CJ. Repetitive Thoughts and Repetitive Behaviors in Williams Syndrome. J Autism Dev Disord 2021; 52:852-862. [PMID: 33837487 DOI: 10.1007/s10803-021-04979-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/10/2021] [Indexed: 10/21/2022]
Abstract
The purpose of the study was to characterize repetitive phenomena in Williams syndrome (WS). The parents of 60 subjects with WS completed the Yale-Brown Obsessive Compulsive Scale (Y-BOCS) or Children's Y-BOCS, the Yale Global Tic Severity Scale, the Stereotyped Behavior Scale, and the Spence Children's Anxiety Scale-Parent Version. Nineteen males and 41 females participated in the study. Six subjects (10%) had obsessions only, six (10%) had compulsions only, and eleven (18%) had at least one obsession and at least one compulsion. None of the subjects had tics. Fifty subjects (83.3%) endorsed at least one stereotypy. Increased anxiety was associated with increased severity of obsessions, but not severity of compulsions or stereotypies.
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Affiliation(s)
- John C Huston
- Department of Internal Medicine, Yale Medical School, 333 Cedar St, New Haven, CT, 06510, USA.,Lurie Center for Autism, 1 Maguire Road, Lexington, MA, 02421, USA
| | - Robyn P Thom
- Lurie Center for Autism, 1 Maguire Road, Lexington, MA, 02421, USA.,Massachusetts General Hospital, 55 Fruit St, Boston, MA, 02114, USA.,Department of Psychiatry, Harvard Medical School, 25 Shattuck St, Boston, MA, 02115, USA
| | - Caitlin T Ravichandran
- Lurie Center for Autism, 1 Maguire Road, Lexington, MA, 02421, USA.,Massachusetts General Hospital, 55 Fruit St, Boston, MA, 02114, USA.,Department of Psychiatry, Harvard Medical School, 25 Shattuck St, Boston, MA, 02115, USA.,McLean Hospital, 115 Mill Street, Belmont, MA, 02478, USA
| | - Jennifer E Mullett
- Lurie Center for Autism, 1 Maguire Road, Lexington, MA, 02421, USA.,Massachusetts General Hospital, 55 Fruit St, Boston, MA, 02114, USA
| | - Carly Moran
- Lurie Center for Autism, 1 Maguire Road, Lexington, MA, 02421, USA
| | - Jessica L Waxler
- Massachusetts General Hospital, 55 Fruit St, Boston, MA, 02114, USA
| | - Barbara R Pober
- Massachusetts General Hospital, 55 Fruit St, Boston, MA, 02114, USA.,Department of Pediatrics, Harvard Medical School, 25 Shattuck St, Boston, MA, 02115, USA
| | - Christopher J McDougle
- Lurie Center for Autism, 1 Maguire Road, Lexington, MA, 02421, USA. .,Massachusetts General Hospital, 55 Fruit St, Boston, MA, 02114, USA. .,Department of Psychiatry, Harvard Medical School, 25 Shattuck St, Boston, MA, 02115, USA.
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Ezell J, Hogan A, Will EA, Smith K, Roberts J. Cardiac Startle Response and Clinical Outcomes in Preschool Children With Fragile X Syndrome and Autism Spectrum Disorder. Front Psychiatry 2021; 12:729127. [PMID: 35046845 PMCID: PMC8761627 DOI: 10.3389/fpsyt.2021.729127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Accepted: 11/09/2021] [Indexed: 11/13/2022] Open
Abstract
Objective: Poor physiological regulation in response to threat is linked to multiple negative developmental outcomes including anxiety, which is highly prevalent and impairing in young children with neurodevelopmental disabilities like fragile X syndrome (FXS) and autism spectrum disorder (ASD). The present study contrasted cardiac startle response in pre-school-aged children with FXS, with and without ASD, to children with non-syndromic ASD (nsASD) and neurotypical controls (NT). The relationship of cardiac startle to non-verbal mental age (NVMA), ASD severity, and parent-reported anxiety was also examined. Method: Four age-matched groups of pre-school children participated including those with FXS without ASD (FXS-Only, n = 21), FXS with ASD (FXS+ASD, n = 17), nsASD (n = 42), and NT children (n = 27). Participants viewed a silent movie during which a single 200 ms 98-decibel white noise burst occurred. Cardiac activity was analyzed for pre-stimulus respiratory sinus arrhythmia (RSA) and the inter-beat intervals (IBI) at the auditory stimulus and 10 s post-stimulus. The Spence Pre-school Anxiety Scale, Autism Diagnostic Observation Schedule-2nd Edition, and Mullen Scales of Early Learning were examined in relation to startle response. Results: The nsASD group demonstrated heightened cardiac activity at the auditory stimulus and 10 s post-stimulus compared to the NT controls. Neither of the FXS groups showed differences from any other group. Higher pre-stimulus RSA was associated with reduced cardiac response across groups, while the relationship between cognitive ability and ASD severity to cardiac response varied between groups. Parent-reported anxiety was not associated with cardiac response for any group. Conclusion: These findings demonstrate group distinctions in cardiac responses to auditory startle. Although FXS and ASD share behavioral characteristics, the nsASD group showed a heightened cardiac startle response compared to the NT group that was not present in the FXS groups with or without ASD. Non-verbal mental age was associated with greater stimulus or post-stimulus reactivity for all groups except the FXS+ASD group, which showed no association between startle response and any clinical outcomes. Increased understanding of the relationship between physiological regulation and clinical outcomes will assist in identifying the timing and targets for effective interventions for individuals with neurodevelopmental disabilities.
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Affiliation(s)
- Jordan Ezell
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC, United States
| | - Abigail Hogan
- Department of Psychology, University of South Carolina, Columbia, SC, United States
| | - Elizabeth A Will
- Department of Psychology, University of South Carolina, Columbia, SC, United States
| | - Kayla Smith
- Department of Psychology, University of South Carolina, Columbia, SC, United States
| | - Jane Roberts
- Department of Psychology, University of South Carolina, Columbia, SC, United States
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Den houting J, Adams D, Roberts J, Keen D. An exploration of autism‐specific and non‐autism‐specific measures of anxiety symptomatology in school‐aged autistic children. CLIN PSYCHOL-UK 2020. [DOI: 10.1111/cp.12174] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Affiliation(s)
- Jacquiline Den houting
- Autism Centre of Excellence, School of Educational and Professional Studies, Griffith University, Brisbane, Queensland, Australia,
- Cooperative Research Centre for Living with Autism (Autism CRC), Brisbane, Queensland, Australia,
| | - Dawn Adams
- Autism Centre of Excellence, School of Educational and Professional Studies, Griffith University, Brisbane, Queensland, Australia,
- Cooperative Research Centre for Living with Autism (Autism CRC), Brisbane, Queensland, Australia,
| | - Jacqueline Roberts
- Autism Centre of Excellence, School of Educational and Professional Studies, Griffith University, Brisbane, Queensland, Australia,
- Cooperative Research Centre for Living with Autism (Autism CRC), Brisbane, Queensland, Australia,
| | - Deb Keen
- Autism Centre of Excellence, School of Educational and Professional Studies, Griffith University, Brisbane, Queensland, Australia,
- Cooperative Research Centre for Living with Autism (Autism CRC), Brisbane, Queensland, Australia,
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Carruthers S, Kent R, Hollocks MJ, Simonoff E. Brief Report: Testing the Psychometric Properties of the Spence Children's Anxiety Scale (SCAS) and the Screen for Child Anxiety Related Emotional Disorders (SCARED) in Autism Spectrum Disorder. J Autism Dev Disord 2020; 50:2625-2632. [PMID: 30334126 PMCID: PMC7308247 DOI: 10.1007/s10803-018-3774-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Anxiety is a prevalent and impairing co-morbidity among individuals with autism spectrum disorder (ASD), yet assessment measures, including screening tools, are seldom validated with autism samples. We explored the psychometric properties of the child and parent reports of the Spence Children’s Anxiety Scale (SCAS) and the Screen for Anxiety Related Disorder-71 (SCARED-71) with 49 males with ASD (10–16 years, 63% co-occurring anxiety). Both measures had excellent internal consistency and fair-good parent–child agreement. The SCAS has a higher proportion of items evaluating observable behaviors. Predictive power of the measures did not differ. Higher cut-points in the parent reports (SCARED only) and lower cut-points in the child reports may enhance prediction in this sample. Choice of measure and cut-points should be considered alongside intended purpose.
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Affiliation(s)
- Sophie Carruthers
- Institute of Psychology, Psychiatry, and Neuroscience, Department of Child & Adolescent Psychiatry, King's College London, 16 De Crespigny Park, Denmark Hill, London, SE5 8AF, UK. .,Institute of Psychology, Psychiatry and Neuroscience, Department of Psychology, King's College London, 16 De Crespigny Park, Denmark Hill, London, SE5 8AF, UK.
| | - Rachel Kent
- Institute of Psychology, Psychiatry, and Neuroscience, Department of Child & Adolescent Psychiatry, King's College London, 16 De Crespigny Park, Denmark Hill, London, SE5 8AF, UK
| | - Matthew J Hollocks
- Department of Clinical Psychology, Norwich Medical School, University of East Anglia, Norwich, NR4 7TJ, UK
| | - Emily Simonoff
- Institute of Psychology, Psychiatry, and Neuroscience, Department of Child & Adolescent Psychiatry, King's College London, 16 De Crespigny Park, Denmark Hill, London, SE5 8AF, UK
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10
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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. J Autism Dev Disord 2020; 51:2646-2662. [PMID: 33025362 DOI: 10.1007/s10803-020-04739-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
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.
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11
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Muratori F, Santocchi E, Calderoni S. Psychiatric assessment. HANDBOOK OF CLINICAL NEUROLOGY 2020; 174:217-238. [PMID: 32977880 DOI: 10.1016/b978-0-444-64148-9.00016-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Studies have consistently reported an increased prevalence of psychiatric comorbidity (PC) in individuals with neurodevelopmental disorders (NDDs) compared with typically developing controls, with high rates of anxiety disorders in autism spectrum disorders and challenging behaviors in children and adolescent with intellectual disability. Psychiatric assessment in this population should include multiple sources of information, derived from multiple contexts and using multiple methods, with accurate detection of contributing and trigger factors. It is important to focus on detecting change from the child's baseline functioning and to use, when possible, ad hoc instruments for assessing PC in the NDD population. Modifications in the setting and assessment procedures should be scheduled based on the child's age, developmental level, and sensory sensitivities. Simultaneously, validated screening instruments, which dimensionally assess the symptomatology of several NDDs and psychiatric disorders, are warranted to not only assist in the identification of PCs in NDDs but also discriminate among different NDDs. Changes from DSM-IV-TR to DSM-5 have had an impact on the diagnosis of several disorders in children and adolescents and, subsequently, on the current diagnostic tools, requiring appropriate and prompt modifications of the available instruments.
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Affiliation(s)
- Filippo Muratori
- Department of Developmental Neuroscience, IRCCS Fondazione Stella Maris, Pisa, Italy; Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Elisa Santocchi
- Department of Developmental Neuroscience, IRCCS Fondazione Stella Maris, Pisa, Italy; Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Sara Calderoni
- Department of Developmental Neuroscience, IRCCS Fondazione Stella Maris, Pisa, Italy; Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
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12
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Lau BY, Leong R, Uljarevic M, Lerh JW, Rodgers J, Hollocks MJ, South M, McConachie H, Ozsivadjian A, Van Hecke A, Libove R, Hardan A, Leekam S, Simonoff E, Magiati I. Anxiety in young people with autism spectrum disorder: Common and autism-related anxiety experiences and their associations with individual characteristics. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2019; 24:1111-1126. [PMID: 31852214 DOI: 10.1177/1362361319886246] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Anxiety is common in autism spectrum disorder. Many anxiety symptoms in autism spectrum disorder are consistent with Diagnostic and Statistical Manual of Mental Disorders (5th ed.) anxiety disorders (termed "common" anxieties), but others may be qualitatively different, likely relating to autism spectrum disorder traits (herein termed "autism-related" anxieties). To date, few studies have examined both "common" and "autism-related" anxiety experiences in autism spectrum disorder. We explored caregiver-reported Spence Children's Anxiety Scale-Parent version data from a multi-site (United Kingdom, Singapore, and United States) pooled database of 870 6- to 18-year-old participants with autism spectrum disorder, of whom 287 provided at least one written response to the optional open-ended Spence Children's Anxiety Scale-Parent item 39 ("Is there anything else your child is afraid of?"). Responses were thematically coded to explore (a) common and autism-related anxiety presentations and (b) their relationship with young people's characteristics. Nearly half of the responses were autism-related anxieties (mostly sensory, uncommon, or idiosyncratic specific phobias and worries about change and unpredictability). The other half described additional common anxieties not covered in the original measure (mostly social, weather and environmental disasters, and animals). Caregivers of participants who were more severely affected by autism spectrum disorder symptoms reported more autism-related, as compared to common, additional anxieties. Implications for the assessment and understanding of anxiety in autism are discussed.
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Affiliation(s)
| | - Ruth Leong
- National University of Singapore, Singapore
| | | | | | | | - Matthew J Hollocks
- King's College London, UK.,Central and North West London NHS Foundation Trust, UK
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13
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Stadnick NA, Brookman-Frazee L, Mandell DS, Kuelbs CL, Coleman KJ, Sahms T, Aarons GA. A mixed methods study to adapt and implement integrated mental healthcare for children with autism spectrum disorder. Pilot Feasibility Stud 2019; 5:51. [PMID: 30976456 PMCID: PMC6438023 DOI: 10.1186/s40814-019-0434-5] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2018] [Accepted: 03/15/2019] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND There is a critical need for effective implementation of integrated healthcare systems for children with autism spectrum disorder (ASD). Children with ASD have many service needs, including the need to access effective mental healthcare, given high rates of co-occurring psychiatric conditions. Pediatric primary care is an ongoing point of healthcare that is well positioned to identify mental health concerns and facilitate linkage to mental health services for children with ASD. However, identifying mental health problems in children with ASD by primary care providers is complex, subject to being overlooked and may significantly vary based on primary care organizational characteristics. Efforts targeting integrated primary-mental healthcare implementation require a tailored approach for children with ASD. METHODS This mixed methods, community-partnered study will apply the Exploration, Preparation, Implementation, Sustainment (EPIS) framework (Aarons et al., 2011; Moullin et al., in press) to adapt and implement an integrated care model, "Access to Tailored Autism INtegrated Care" (ATTAIN), in pediatric practices within three diverse healthcare settings for children ages 4-18 years. Key inner context factors from the Exploration, Preparation, and Implementation phases of the EPIS framework will guide three objectives of this study: (1) to identify targets to improve mental health screening and linkage to mental health services in primary care for children with ASD, (2) to adapt integrated care procedures to facilitate identification of mental health problems and linkage to evidence-based care for children with ASD, and (3) to examine feasibility, acceptability, and uptake of the adapted integrated mental healthcare model through a pilot study in pediatric primary care. DISCUSSION Improving integrated mental healthcare for children with ASD could have a significant public health impact on mental healthcare access, child clinical outcomes, and reduction in healthcare costs. Results from this mixed methods study will inform selection of implementation strategies to conduct larger-scale implementation of tailored integrated mental healthcare for children with ASD that will ultimately help to address the high unmet mental health needs for these children.
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Affiliation(s)
- Nicole A. Stadnick
- Department of Psychiatry, University of California, San Diego, La Jolla USA
- Child and Adolescent Services Research Center, San Diego, USA
| | - Lauren Brookman-Frazee
- Department of Psychiatry, University of California, San Diego, La Jolla USA
- Child and Adolescent Services Research Center, San Diego, USA
- Rady Children’s Hospital, San Diego, USA
| | - David S. Mandell
- Department of Psychiatry, Center for Mental Health, University of Pennsylvania, Philadelphia, USA
| | - Cynthia L. Kuelbs
- Department of Pediatrics, University of California, San Diego, La Jolla USA
- Rady Children’s Hospital, San Diego, USA
| | - Karen J. Coleman
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, USA
| | - Timothy Sahms
- Department of Pediatrics, University of California, San Diego, La Jolla USA
- San Ysidro Health Center, San Ysidro, USA
| | - Gregory A. Aarons
- Department of Psychiatry, University of California, San Diego, La Jolla USA
- Child and Adolescent Services Research Center, San Diego, USA
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14
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Neil L, White H, Warren K, Pellicano E. Anxiety and Interpretation of Ambiguity in Autistic Children, Typical Children and Their Mothers. J Autism Dev Disord 2019; 49:1035-1047. [PMID: 30406913 PMCID: PMC6394784 DOI: 10.1007/s10803-018-3781-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Anxiety is highly prevalent in autistic children. Yet interpretation biases implicated in anxiety in non-autistic individuals have received little research attention in this group. Twenty-two autistic children and 25 typical children completed an ambiguous scenarios interview and questionnaire-based measures of anxiety. A subsample of mothers completed parent-report and adult relevant versions of the interview and anxiety questionnaires. Autistic children self-reported similar interpretations of ambiguous scenarios, and similar levels of anxiety, to their typical peers. In contrast, mothers of autistic children reported greater levels of anxiety, and more negative interpretations of ambiguous scenarios in both their children and themselves, relative to mothers of typical children. These data highlight the importance of including autistic children's self-reports when measuring and treating anxiety.
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Affiliation(s)
- Louise Neil
- Centre for Research in Autism and Education (CRAE), UCL Institute of Education, University College London, London, UK.
- Department of Clinical, Educational, and Health Psychology, University College London, 26 Bedford Way, London, WC1H 0AP, UK.
| | - Hannah White
- Centre for Research in Autism and Education (CRAE), UCL Institute of Education, University College London, London, UK
| | - Katy Warren
- Centre for Research in Autism and Education (CRAE), UCL Institute of Education, University College London, London, UK
| | - Elizabeth Pellicano
- Centre for Research in Autism and Education (CRAE), UCL Institute of Education, University College London, London, UK
- Department of Educational Studies, Macquarie University, Sydney, Australia
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15
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Hollocks MJ, Lerh JW, Magiati I, Meiser-Stedman R, Brugha TS. Anxiety and depression in adults with autism spectrum disorder: a systematic review and meta-analysis. Psychol Med 2019; 49:559-572. [PMID: 30178724 DOI: 10.1017/s0033291718002283] [Citation(s) in RCA: 378] [Impact Index Per Article: 75.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Adults with autism spectrum disorder (ASD) are thought to be at disproportionate risk of developing mental health comorbidities, with anxiety and depression being considered most prominent amongst these. Yet, no systematic review has been carried out to date to examine rates of both anxiety and depression focusing specifically on adults with ASD. This systematic review and meta-analysis examined the rates of anxiety and depression in adults with ASD and the impact of factors such as assessment methods and presence of comorbid intellectual disability (ID) diagnosis on estimated prevalence rates. Electronic database searches for studies published between January 2000 and September 2017 identified a total of 35 studies, including 30 studies measuring anxiety (n = 26 070; mean age = 30.9, s.d. = 6.2 years) and 29 studies measuring depression (n = 26 117; mean age = 31.1, s.d. = 6.8 years). The pooled estimation of current and lifetime prevalence for adults with ASD were 27% and 42% for any anxiety disorder, and 23% and 37% for depressive disorder. Further analyses revealed that the use of questionnaire measures and the presence of ID may significantly influence estimates of prevalence. The current literature suffers from a high degree of heterogeneity in study method and an overreliance on clinical samples. These results highlight the importance of community-based studies and the identification and inclusion of well-characterized samples to reduce heterogeneity and bias in estimates of prevalence for comorbidity in adults with ASD and other populations with complex psychiatric presentations.
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Affiliation(s)
| | - Jian Wei Lerh
- Department of Psychology,National University of Singapore,Singapore
| | - Iliana Magiati
- Department of Psychology,National University of Singapore,Singapore
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16
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Carter Leno V, Chandler S, White P, Yorke I, Charman T, Pickles A, Simonoff E. Alterations in electrophysiological indices of perceptual processing and discrimination are associated with co-occurring emotional and behavioural problems in adolescents with autism spectrum disorder. Mol Autism 2018; 9:50. [PMID: 30323914 PMCID: PMC6173917 DOI: 10.1186/s13229-018-0236-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2018] [Accepted: 09/24/2018] [Indexed: 11/12/2022] Open
Abstract
Background Many young people with autism spectrum disorder (ASD) experience emotional and behavioural problems. However, the causes of these co-occurring difficulties are not well understood. Perceptual processing atypicalities are also often reported in individuals with ASD, but how these relate to co-occurring emotional and behavioural problems remains unclear, and few studies have used objective measurement of perceptual processing. Methods Event-related potentials (ERPs) were recorded in response to both standard and deviant stimuli (which varied in pitch) in an auditory oddball paradigm in adolescents (mean age of 13.56 years, SD = 1.12, range = 11.40–15.70) with ASD (n = 43) with a wide range of IQ (mean IQ of 84.14, SD = 24.24, range 27–129). Response to deviant as compared to standard stimuli (as indexed by the mismatch negativity (MMN)) and response to repeated presentations of standard stimuli (habituation) were measured. Multivariate regression tested the association between neural indices of perceptual processing and co-occurring emotional and behavioural problems. Results Greater sensitivity to changes in pitch in incoming auditory information (discrimination), as indexed by increased MMN amplitude, was associated with higher levels of parent-rated behaviour problems. MMN amplitude also showed a trend positive correlation with parent-rated sensory hyper-sensitivity. Conversely, greater habituation at the later N2 component was associated with higher levels of emotional problems. Upon more detailed analyses, this appeared to be driven by a selectively greater ERP response to the first (but not the second or third) standard stimuli that followed deviant stimuli. A similar pattern of association was found with other measures of anxiety. All results remained in covariation analyses controlling for age, sex and IQ, although the association between MMN amplitude and behaviour problems became non-significant when controlling for ASD severity. Conclusions Findings suggest that alterations in mechanisms of perceptual processing and discrimination may be important for understanding co-occurring emotional and behavioural problems in young people with ASD. Electronic supplementary material The online version of this article (10.1186/s13229-018-0236-2) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Virginia Carter Leno
- 1Institute of Psychiatry, Psychology & Neuroscience, King's College London, 16 De Crespigny Park, London, SE5 8AF UK
| | - Susie Chandler
- 1Institute of Psychiatry, Psychology & Neuroscience, King's College London, 16 De Crespigny Park, London, SE5 8AF UK
| | - Pippa White
- 1Institute of Psychiatry, Psychology & Neuroscience, King's College London, 16 De Crespigny Park, London, SE5 8AF UK
| | - Isabel Yorke
- 1Institute of Psychiatry, Psychology & Neuroscience, King's College London, 16 De Crespigny Park, London, SE5 8AF UK
| | - Tony Charman
- 1Institute of Psychiatry, Psychology & Neuroscience, King's College London, 16 De Crespigny Park, London, SE5 8AF UK.,2South London and Maudsley NHS Foundation Trust (SLaM), London, UK
| | - Andrew Pickles
- 1Institute of Psychiatry, Psychology & Neuroscience, King's College London, 16 De Crespigny Park, London, SE5 8AF UK
| | - Emily Simonoff
- 1Institute of Psychiatry, Psychology & Neuroscience, King's College London, 16 De Crespigny Park, London, SE5 8AF UK.,2South London and Maudsley NHS Foundation Trust (SLaM), London, UK
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17
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Spence SH. Assessing anxiety disorders in children and adolescents. Child Adolesc Ment Health 2018; 23:266-282. [PMID: 32677290 DOI: 10.1111/camh.12251] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/28/2017] [Indexed: 12/19/2022]
Abstract
BACKGROUND Given the relatively high prevalence of anxiety problems among young people and their adverse consequences if left untreated, it is important that clinicians and researchers have access to reliable and valid assessment tools to facilitate early detection, case formulation, treatment design and evaluation of outcomes. METHOD This paper presents the findings of a pragmatic review of the literature regarding the assessment of anxiety in young people in multiple contexts, including mental health services, school-based screening and research trials. RESULTS Commonly used diagnostic interviews, questionnaire measures and alternative assessment methods are described, along with psychometric properties and practical issues. The review indicates the complexities of assessing anxiety problems given the high level of comorbidity between anxiety disorders and with depression. It also highlights the different approaches required for assessment across different age groups, the need for multiple informants and issues relating to the lack of agreement between reporters. There is a strong evidence-base for several diagnostic instruments and anxiety scales, although the accuracy of youth and parent report scales in forming clinical diagnoses is not sufficiently strong to justify their use in isolation for diagnostic purposes. CONCLUSIONS The assessment of youth anxiety should ideally include a multiinformant, multimethod approach, with measures tailored to the age of the child, and the purpose of the evaluation. There is now a sufficiently strong research base to enable clinicians and researchers to ensure that they select evidence-based instruments.
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Affiliation(s)
- Susan H Spence
- Australian Institute for Suicide Research and Prevention and School of Applied Psychology, Griffith University, Mt Gravatt, Australia
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18
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Jitlina K, Zumbo B, Mirenda P, Ford L, Bennett T, Georgiades S, Waddell C, Smith IM, Volden J, Duku E, Zwaigenbaum L, Szatmari P, Vaillancourt T, Elsabbagh M. Psychometric Properties of the Spence Children's Anxiety Scale: Parent Report in Children with Autism Spectrum Disorder. J Autism Dev Disord 2018; 47:3847-3856. [PMID: 28409361 DOI: 10.1007/s10803-017-3110-8] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Although anxiety is frequently reported in children with autism spectrum disorder (ASD), existing anxiety scales are often psychometrically inappropriate for this population. This study examined the internal structure, reliability, convergent and discriminant validity of the Spence Children's Anxiety Scale-Parent Report (SCAS-P; Spence 1999) in 238 school-aged children with ASD. While confirmatory factor analysis did not support the original six-correlated-factor structure, structural support as well as acceptable internal consistency and convergent validity was found for Generalized Anxiety, Separation Anxiety, Panic, and Agoraphobia subscales. Use of the SCAS-P in its original form for assessment in children with ASD was not supported. However, four subscales showed viability, and may benefit re-analyses of existing SCAS-P data and future scale adaptations for research and clinical purposes.
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Affiliation(s)
- Katia Jitlina
- University of British Columbia, Vancouver, BC, Canada.
| | - Bruno Zumbo
- University of British Columbia, Vancouver, BC, Canada
| | - Pat Mirenda
- University of British Columbia, Vancouver, BC, Canada
| | - Laurie Ford
- University of British Columbia, Vancouver, BC, Canada
| | | | | | | | - Isabel M Smith
- Dalhousie University/IWK Health Centre, Halifax, NS, Canada
| | | | - Eric Duku
- McMaster University, Hamilton, ON, Canada
| | | | - Peter Szatmari
- Centre for Addiction and Mental Health, Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
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19
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Ozsivadjian A, Hollocks MJ, Southcott J, Absoud M, Holmes E. Anxious Imagery in Children With and Without Autism Spectrum Disorder: An Investigation into Occurrence, Content, Features and Implications for Therapy. J Autism Dev Disord 2017; 47:3822-3832. [PMID: 27328680 PMCID: PMC5676832 DOI: 10.1007/s10803-016-2840-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Mental imagery has been implicated in anxiety disorders in adults, but has not been investigated in child and adolescent populations. Anxiety is highly prevalent in autism spectrum disorder (ASD), and as people with ASD are often thought of as 'visual thinkers', the potential role of distressing imagery in children with ASD merits exploration. Participants aged 8-16 years were grouped as follows: ASD/high anxiety, ASD/low anxiety, non-ASD/high anxiety and non-ASD/low anxiety. Imagery and associated features were assessed using an interview. Group differences were found in number and frequency of images experienced. There were few differences between the groups in the characteristics of the spontaneous images, which included emotional valence, vividness, controllability and realism. Implications for treatment are discussed.
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Affiliation(s)
- Ann Ozsivadjian
- Children's Complex Neurodevelopmental Disability Service, Children's Neurosciences Centre Newcomen at St Thomas', South Wing, St Thomas' Hospital, Guy's and St Thomas' NHS Foundation Trust, Westminster Bridge Road, London, SE1 7EH, UK.
| | - Matthew J Hollocks
- Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK
| | - Jess Southcott
- Children's Complex Neurodevelopmental Disability Service, Children's Neurosciences Centre Newcomen at St Thomas', South Wing, St Thomas' Hospital, Guy's and St Thomas' NHS Foundation Trust, Westminster Bridge Road, London, SE1 7EH, UK
| | - Michael Absoud
- Children's Complex Neurodevelopmental Disability Service, Children's Neurosciences Centre Newcomen at St Thomas', South Wing, St Thomas' Hospital, Guy's and St Thomas' NHS Foundation Trust, Westminster Bridge Road, London, SE1 7EH, UK
| | - Emily Holmes
- MRC Cognition and Brain Sciences Unit, Cambridge, UK
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20
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Crawford H, Waite J, Oliver C. Diverse Profiles of Anxiety Related Disorders in Fragile X, Cornelia de Lange and Rubinstein-Taybi Syndromes. J Autism Dev Disord 2017; 47:3728-3740. [PMID: 28144878 PMCID: PMC5676833 DOI: 10.1007/s10803-016-3015-y] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
Anxiety disorders are heightened in specific genetic syndromes in comparison to intellectual disability of heterogeneous aetiology. In this study, we described and contrasted anxiety symptomatology in fragile X (FXS), Cornelia de Lange (CdLS) and Rubinstein-Taybi syndromes (RTS), and compared the symptomatology to normative data for typically-developing children and children diagnosed with an anxiety disorder. Scores did not differ between children diagnosed with an anxiety disorder and (a) participants with FXS on social phobia, panic/agoraphobia, physical injury fears, and obsessive-compulsive subscales (b) participants with CdLS on separation anxiety, generalized anxiety, panic/agoraphobia, physical injury fears and obsessive-compulsive subscales, and (c) participants with RTS on panic/agoraphobia and obsessive-compulsive subscales. The results highlight divergent profiles of anxiety symptomatology between these groups.
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Affiliation(s)
- Hayley Crawford
- Centre for Research in Psychology, Behaviour and Achievement, Coventry University, James Starley Building (JSG12), Priory Street, Coventry, CV1 5FB, UK.
- Cerebra Centre for Neurodevelopmental Disorders, School of Psychology, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK.
| | - Jane Waite
- Cerebra Centre for Neurodevelopmental Disorders, School of Psychology, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK
| | - Chris Oliver
- Cerebra Centre for Neurodevelopmental Disorders, School of Psychology, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK
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21
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Glod M, Creswell C, Waite P, Jamieson R, McConachie H, Don South M, Rodgers J. Comparisons of the Factor Structure and Measurement Invariance of the Spence Children's Anxiety Scale-Parent Version in Children with Autism Spectrum Disorder and Typically Developing Anxious Children. J Autism Dev Disord 2017; 47:3834-3846. [PMID: 28393292 PMCID: PMC5676838 DOI: 10.1007/s10803-017-3118-0] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
The Spence Children's Anxiety Scale-Parent version (SCAS-P) is often used to assess anxiety in children with autism spectrum disorder (ASD), however, little is known about the validity of the tool in this population. The aim of this study was to determine whether the SCAS-P has the same factorial validity in a sample of young people with ASD (n = 285), compared to a sample of typically developing young people with anxiety disorders (n = 224). Poor model fit with all of the six hypothesised models precluded invariance testing. Exploratory factor analysis indicated that different anxiety phenomenology characterises the two samples. The findings suggest that cross-group comparisons between ASD and anxious samples based on the SCAS-P scores may not always be appropriate.
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Affiliation(s)
- Magdalena Glod
- Institute of Neuroscience, Newcastle University, Level 3, Sir James Spence Institute, Royal Victoria Infirmary, Queen Victoria Road, Newcastle upon Tyne, NE1 4LP, UK
| | - Cathy Creswell
- Anxiety and Depression in Young People (AnDY) Research Clinic, School of Psychology and Clinical Language Sciences, University of Reading, Earley Gate, Reading, RG6 6AL, UK
| | - Polly Waite
- Anxiety and Depression in Young People (AnDY) Research Clinic, School of Psychology and Clinical Language Sciences, University of Reading, Earley Gate, Reading, RG6 6AL, UK
| | - Ruth Jamieson
- School of Psychology, Newcastle University, 4th Floor, Ridley Building 1, Queen Victoria Road, Newcastle upon Tyne, NE1 7RU, UK
- Greater Glasgow and Clyde NHS, Glasgow, Scotland, UK
| | - Helen McConachie
- Institute of Health and Society, Newcastle University, Level 3, Sir James Spence Institute, Royal Victoria Infirmary, Queen Victoria Road, Newcastle upon Tyne, NE1 4LP, UK
| | - Mikle Don South
- Department of Psychology, Brigham Young University, 245 TLRB, Provo, UT, 84602, USA
| | - Jacqui Rodgers
- Institute of Neuroscience, Newcastle University, Level 3, Sir James Spence Institute, Royal Victoria Infirmary, Queen Victoria Road, Newcastle upon Tyne, NE1 4LP, UK.
- School of Psychology, Newcastle University, 4th Floor, Ridley Building 1, Queen Victoria Road, Newcastle upon Tyne, NE1 7RU, UK.
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22
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Magiati I, Lerh JW, Hollocks MJ, Uljarevic M, Rodgers J, McConachie H, Ozsivadjian A, South M, Van Hecke A, Hardan A, Libove R, Leekam S, Simonoff E. The measurement properties of the spence children's anxiety scale-parent version in a large international pooled sample of young people with autism spectrum disorder. Autism Res 2017; 10:1629-1652. [DOI: 10.1002/aur.1809] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2016] [Revised: 02/03/2017] [Accepted: 04/07/2017] [Indexed: 12/27/2022]
Affiliation(s)
- Iliana Magiati
- Department of Psychology; National University of Singapore, 9 Arts Link; Singapore 117570
| | - Jian Wei Lerh
- Department of Psychology; National University of Singapore, 9 Arts Link; Singapore 117570
| | - Matthew J. Hollocks
- Department of Child and Adolescent Psychiatry; Institute of Psychiatry, Psychology & Neuroscience, King's College London, DeCrespigny Park, Denmark Hill; London SE5 8AF UK
- Department of Clinical Psychology; Faculty of Medicine and Health Sciences, Norwich Medical School, University of East Anglia; Norwich UK
| | - Mirko Uljarevic
- Olga Tennison Autism Research Centre; School of Psychological Science, La Trobe University; Victoria 3086 Australia
- Cooperative Research Centre for Living with Autism (Autism CRC), Long Pocket; Brisbane Queensland Australia
| | - Jacqui Rodgers
- Clinical Psychology; Ridley Building, Institute of Neuroscience, Newcastle University; Newcastle NE1 7RU UK
| | - Helen McConachie
- Institute of Health and Society, Newcastle University, Sir James Spence Institute, Royal Victoria Infirmary, Queen Victoria Road; Newcastle upon Tyne NE1 4LP UK
| | - Ann Ozsivadjian
- Evelina London Children's Hospital, St Thomas' Hospital; London UK
| | - Mikle South
- Department of Psychology; College of Family, Home and Social Sciences, Brigham Young University; Provo Utah
| | - Amy Van Hecke
- Department of Psychology; College of Arts and Sciences, Marquette University, Cramer Hall; Milwaukee Wisconsin 53201-1881
| | - Antonio Hardan
- Department of Psychiatry and Behavioral Sciences; Stanford University School of Medicine, Stanford University; Stanford California 94305
| | - Robin Libove
- Department of Psychiatry and Behavioral Sciences; Stanford University School of Medicine, Stanford University; Stanford California 94305
| | - Susan Leekam
- Wales Autism Research Centre; School of Psychology, Cardiff University; Cardiff CF10 3AT UK
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23
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Teh EJ, Chan DME, Tan GKJ, Magiati I. Continuity and Change in, and Child Predictors of, Caregiver Reported Anxiety Symptoms in Young People with Autism Spectrum Disorder: A Follow-Up Study. J Autism Dev Disord 2017; 47:3857-3871. [DOI: 10.1007/s10803-017-3136-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/26/2023]
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24
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Neil L, Olsson NC, Pellicano E. The Relationship Between Intolerance of Uncertainty, Sensory Sensitivities, and Anxiety in Autistic and Typically Developing Children. J Autism Dev Disord 2017; 46:1962-1973. [PMID: 26864157 PMCID: PMC4860201 DOI: 10.1007/s10803-016-2721-9] [Citation(s) in RCA: 93] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Guided by a recent theory that proposes fundamental differences in how autistic individuals deal with uncertainty, we investigated the extent to which the cognitive construct ‘intolerance of uncertainty’ and anxiety were related to parental reports of sensory sensitivities in 64 autistic and 85 typically developing children aged 6–14 years. Intolerance of uncertainty and anxiety explained approximately half the variance in autistic children’s sensory sensitivities, but only around a fifth of the variance in typical children’s sensory sensitivities. In children with autism only, intolerance of uncertainty remained a significant predictor of children’s sensory sensitivities once the effects of anxiety were adjusted for. Our results suggest intolerance of uncertainty is a relevant construct to sensory sensitivities in children with and without autism.
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Affiliation(s)
- Louise Neil
- Centre for Research in Autism and Education (CRAE), UCL Institute of Education, University College London, 55-59 Gordon Square, London, WC1H 0NU, UK.
| | - Nora Choque Olsson
- Center of Neurodevelopmental Disorders, Karolinska Institutet (KIND), Stockholm, Sweden
| | - Elizabeth Pellicano
- Centre for Research in Autism and Education (CRAE), UCL Institute of Education, University College London, 55-59 Gordon Square, London, WC1H 0NU, UK.,School of Psychology, University of Western Australia, Perth, Australia
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25
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Kerns CM, Rump K, Worley J, Kratz H, McVey A, Herrington J, Miller J. The Differential Diagnosis of Anxiety Disorders in Cognitively-Able Youth With Autism. COGNITIVE AND BEHAVIORAL PRACTICE 2016. [DOI: 10.1016/j.cbpra.2015.11.004] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
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26
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Stadnick N, Chlebowski C, Baker-Ericzén M, Dyson M, Garland A, Brookman-Frazee L. Psychiatric comorbidity in autism spectrum disorder: Correspondence between mental health clinician report and structured parent interview. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2016; 21:841-851. [PMID: 27407039 DOI: 10.1177/1362361316654083] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Publicly funded mental health services are critical in caring for children with autism spectrum disorder. Accurate identification of psychiatric comorbidity is necessary for effective mental health treatment. Little is known about psychiatric diagnosis for this population in routine mental health care. This study (1) examined correspondence between psychiatric diagnoses reported by mental health clinicians and those derived from a structured diagnostic interview and (2) identified predictors of agreement between clinician-reported and diagnostic interview-derived diagnoses in a sample of 197 children aged 4-14 years with autism spectrum disorder receiving mental health services. Data were drawn from a randomized effectiveness trial conducted in publicly funded mental health services. Non-autism spectrum disorder diagnoses were assessed using an adapted version of the Mini-International Neuropsychiatric Interview, parent version. Cohen's kappa was calculated to examine agreement between Mini-International Neuropsychiatric Interview, parent version and clinician-reported diagnoses of comorbid conditions. Children met criteria for an average of 2.83 (standard deviation = 1.92) Mini-International Neuropsychiatric Interview, parent version diagnoses. Agreement was poor across all diagnostic categories (κ values: 0.06-0.18). Logistic regression identified child gender and clinical characteristics as significant predictors of agreement for specific diagnoses. Results underscore the need for training mental health clinicians in targeted assessment of specific psychiatric disorders and prioritizing treatment development and testing for specific diagnoses to improve care for children with autism spectrum disorder served in publicly funded mental health settings.
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Affiliation(s)
- Nicole Stadnick
- 1 University of California, San Diego, USA.,2 Child and Adolescent Services Research Center, San Diego, USA
| | - Colby Chlebowski
- 1 University of California, San Diego, USA.,2 Child and Adolescent Services Research Center, San Diego, USA.,3 Autism Discovery Institute at Rady Children's Hospital, San Diego, USA
| | - Mary Baker-Ericzén
- 1 University of California, San Diego, USA.,2 Child and Adolescent Services Research Center, San Diego, USA.,3 Autism Discovery Institute at Rady Children's Hospital, San Diego, USA.,4 Rady Children's Hospital, San Diego, USA
| | - Margaret Dyson
- 1 University of California, San Diego, USA.,2 Child and Adolescent Services Research Center, San Diego, USA.,4 Rady Children's Hospital, San Diego, USA
| | - Ann Garland
- 2 Child and Adolescent Services Research Center, San Diego, USA.,5 University of San Diego, USA
| | - Lauren Brookman-Frazee
- 1 University of California, San Diego, USA.,2 Child and Adolescent Services Research Center, San Diego, USA.,3 Autism Discovery Institute at Rady Children's Hospital, San Diego, USA
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27
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A Comparison Between Caregiver-Reported Anxiety and Other Emotional and Behavioral Difficulties in Children and Adolescents with Autism Spectrum Disorders Attending Specialist or Mainstream Schools. J Autism Dev Disord 2016; 49:2653-2663. [PMID: 27160302 DOI: 10.1007/s10803-016-2792-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Increasing numbers of students with Autism Spectrum Disorder (ASD) are attending mainstream schools. Nonetheless, concerns about their emotional well-being and mental health in these settings have also been raised. This study sought to compare caregiver-reported anxiety and other emotional and behavioural problems in youth with ASD attending mainstream or specialist schools. Caregivers of 27 youth with ASD in mainstream schools (age 10.91 ± 3.44 years) and 69 youth with ASD in special schools (age 10.93 ± 2.81 years) matched for gender, age, adaptive functioning and autism symptom severity scores participated. Caregivers completed the Spence Children's Anxiety Scale-Parent, a measure of adaptive functioning, and a checklist of other emotional and behavioral difficulties. Students with ASD attending mainstream schools experienced higher levels of social anxiety symptoms compared to their specialist school counterparts. No other statistically significant differences were found in other aspects of emotional and behavioural functioning examined, but some differences emerged in item-level analyses. Uncertainties in navigating more complex social environments and increased social relating difficulties in mainstream schools are discussed as probable environmental triggers for increased social phobia related symptomatology, although other explanations for this small effect size difference are also considered. Limitations of the present study and recommendations for future research focusing on exploring environmental socio-ecological factors influencing anxiety and mental health in young people with ASD are also discussed.
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28
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Rodgers J, Wigham S, McConachie H, Freeston M, Honey E, Parr JR. Development of the anxiety scale for children with autism spectrum disorder (ASC-ASD). Autism Res 2016; 9:1205-1215. [PMID: 26887910 DOI: 10.1002/aur.1603] [Citation(s) in RCA: 129] [Impact Index Per Article: 16.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2015] [Revised: 11/23/2015] [Accepted: 12/26/2015] [Indexed: 12/28/2022]
Abstract
Many children with autism spectrum disorder (ASD) experience high levels of anxiety. A widely used measure for typically developing children is the Revised Child Anxiety and Depression Scale (RCADS). However, such anxiety measures may require adaptation to accommodate characteristics of those with ASD. An adapted version of the RCADS was created based on empirical evidence of anxiety phenomenology in ASD, which included additional items related to sensory anxiety, intolerance of uncertainty, and phobias. Content validity was refined during focus groups with parents. Polychoric factor analysis was undertaken on data from 170 children with ASD, aged 8-16, and their parents. This process resulted in the creation of a new 24 item scale (self and parent report) each with four subscales: Performance Anxiety, Uncertainty, Anxious Arousal, and Separation Anxiety, with evidence of good reliability and validity. The freely available Anxiety Scale for Children - ASD, Parent and Child versions (ASC-ASD) has promising psychometric properties including good internal consistency, validity, and 1 month test-retest reliability. Autism Res 2016, 9: 1205-1215. © 2016 International Society for Autism Research, Wiley Periodicals, Inc.
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Affiliation(s)
| | - Sarah Wigham
- Institute of Neuroscience, Newcastle University, UK
| | | | - Mark Freeston
- School of Psychology, Newcastle University, UK.,Northumberland, Tyne and Wear NHS Trust
| | - Emma Honey
- School of Psychology, Newcastle University, UK.,Northumberland, Tyne and Wear NHS Trust
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29
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Abstract
PURPOSE OF REVIEW Anxiety is one of the most common co-occurring psychiatric conditions in youth with autism spectrum disorders (ASDs). This article reviews recent evidence as well as earlier relevant studies regarding the characteristics, assessment, and treatment of anxiety in youth with ASD. RECENT FINDINGS It is well established that the prevalence of anxiety in youth with an ASD is significantly greater than the prevalence of anxiety in the general population. Recent studies have highlighted the importance of informant, method, and instrument when measuring anxiety in this population. Despite the high prevalence, findings to date have been unable to identify any consistent risk factors for anxiety. New psychological treatments, including modified cognitive behavioral therapy for youth with high functioning ASD and co-occurring anxiety, are emerging. Pharmacological data, however, are scant. Existing studies show that youth with ASD are at increased risk for behavioral activation when taking SSRIs. SUMMARY Clinicians working with youth with ASD are encouraged to routinely screen for anxiety. Until further data are available, clinical judgment is needed when prescribing treatments, particularly selective serotonin reuptake inhibitors, which require close monitoring of side-effects. Research on risk factors, pathophysiology, and treatment of this condition is needed.
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30
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Grossman RB, Steinhart E, Mitchell T, McIlvane W. "Look who's talking!" Gaze Patterns for Implicit and Explicit Audio-Visual Speech Synchrony Detection in Children With High-Functioning Autism. Autism Res 2015; 8:307-16. [PMID: 25620208 DOI: 10.1002/aur.1447] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2013] [Accepted: 11/25/2014] [Indexed: 11/11/2022]
Abstract
Conversation requires integration of information from faces and voices to fully understand the speaker's message. To detect auditory-visual asynchrony of speech, listeners must integrate visual movements of the face, particularly the mouth, with auditory speech information. Individuals with autism spectrum disorder may be less successful at such multisensory integration, despite their demonstrated preference for looking at the mouth region of a speaker. We showed participants (individuals with and without high-functioning autism (HFA) aged 8-19) a split-screen video of two identical individuals speaking side by side. Only one of the speakers was in synchrony with the corresponding audio track and synchrony switched between the two speakers every few seconds. Participants were asked to watch the video without further instructions (implicit condition) or to specifically watch the in-synch speaker (explicit condition). We recorded which part of the screen and face their eyes targeted. Both groups looked at the in-synch video significantly more with explicit instructions. However, participants with HFA looked at the in-synch video less than typically developing (TD) peers and did not increase their gaze time as much as TD participants in the explicit task. Importantly, the HFA group looked significantly less at the mouth than their TD peers, and significantly more at non-face regions of the image. There were no between-group differences for eye-directed gaze. Overall, individuals with HFA spend less time looking at the crucially important mouth region of the face during auditory-visual speech integration, which is maladaptive gaze behavior for this type of task.
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Affiliation(s)
- Ruth B Grossman
- Emerson College, Department of Communication Sciences and Disorders, 120 Boylston Street, Boston, Massachusetts.,University of Massachusetts Medical School Shriver Center, 200 Trapelo Rd, Waltham, Massachusetts
| | - Erin Steinhart
- University of Massachusetts Medical School Shriver Center, 200 Trapelo Rd, Waltham, Massachusetts
| | - Teresa Mitchell
- University of Massachusetts Medical School Shriver Center, 200 Trapelo Rd, Waltham, Massachusetts
| | - William McIlvane
- University of Massachusetts Medical School Shriver Center, 200 Trapelo Rd, Waltham, Massachusetts
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