Anxiety and Depression in Children with HFASDs: Symptom Levels and Source Differences

Background: Children with high-functioning ASDs (HFASDs) are reportedly at risk for psychiatric symptoms including depression and anxiety. While some studies have documented significant symptom elevations (e.g., Gadow et al., 2005), others have noted no elevations (e.g., Solomon et al., 2004). Interpretation of findings across studies is confounded by use of different data sources (parent-, teacher-, and/or child-reports). While source differences have been observed, there has been little systematic study of how child-reports align with parent-reports (Weisbrot et al., 2005). Such examination is necessary due to concerns regarding the ability of individuals with HFASDs to express internalized states (Ghaziuddin et al., 2002). Ongoing research is also warranted as studies have been characterized by small and poorly characterized samples, comparisons with normative data, and/or lack of controls for sample characteristics.

Objectives: This study examined: (1) anxiety and depression symptoms in children with HFASDs compared to matched controls using child self-reports and parent-ratings; and (2) source differences (child vs. parent)  within the two condition groups (HFASD vs. control).

Methods: The sample included 40 children ages 7-13 with a HFASD (AD, HFA, or PDD-NOS) and 40 typical-controls matched on age, gender, and ethnicity. Participants in the HFASD group participated in a multiple-gate screening; inclusion criteria included a short-form IQ composite > 70; receptive or expressive language score ≥ 80; and score meeting ASD criteria on the ADI-R. Matched-controls were recruited using flyers.

Symptoms were assessed using the Depression and Anxiety subscales of the Behavior Assessment System for Children 2 – Parent Rating Scales (BASC2-PRS) and Self-Report of Personality (BASC2-SRP).

Results: The two groups did not significantly differ on important demographic variables. A significant between-group multivariate effect was found based on parent reports; follow-up univariate analyses indicated significant between-group differences for both depression (F[1,78] = 34.78, p < .001, d = 1.10) and anxiety (F[1,78] = 13.05, p = .001, d = .75)). No significant multivariate effect was found based on child self-reports. Within-condition source comparisons (parent vs. child) revealed a significant multivariate effect for the HFASD group only, with follow-up univariate analyses indicating significant source-differences for both depression (F[1,78] = 29.07, p < .001, d = 1.04) and anxiety (F[1,78] = 7.01, p = .010, d = .57). Correlations between parent- and child-reports were significant only for depression in the HFASD group (r = .315).

Conclusions: Results indicated significant depression and anxiety symptom elevations for children with HFASDs based on parent ratings. Children with HFASDs reported symptom levels similar to controls. A significant discrepancy was found between parent and child ratings for the HFASD group only, with parent ratings significantly higher for depression and anxiety. A low but significant correlation between parent and child ratings of depression in the HFASD group suggested that the children reported symptoms in a manner that to some degree paralleled parent ratings. Despite this positive association, mean score differences reflected a substantial discrepancy in magnitude of depressive symptoms by rater. Implications will be described.