The Importance of the Reporter: Parents' State and Trait Anxiety

Background: Anxiety is a common comorbid condition among high-functioning individuals with Autism Spectrum Disorders (ASD; White et al., 2009).  Previous research has been inconclusive about increased affective disorders in parents of children with ASD (Bolton et al., 1998; Lainhart, 1999), although parental anxiety symptoms have been shown to predict comorbid anxiety in adolescents with ASD (Mazefsky, Conner, & Oswald, 2010).  Increased levels of parental anxiety may decrease parents’ ability to accurately report on their child’s behavior and/or affect treatment effectiveness for the child with ASD.

Objectives: The purpose of this study was to investigate the relationship between parent self-reported state and trait anxiety and parent-reported anxiety in their adolescents with ASD.  A related purpose was to explore if parental anxiety was associated with the adolescents’ treatment outcome.

Methods: Data were collected from thirty adolescents (12-17 years old; 7 females) who participated in a randomized controlled trial of a cognitive-behavioral treatment program (White et al., 2010).  All participants had a confirmed ASD diagnosis, based on the ADOS (Lord et al., 2002) and ADI-R (Lord et al., 1994), met diagnostic criteria for at least one anxiety disorder (based on ADIS-C/P; Silverman & Albano, 1996), and were cognitively higher functioning (i.e., IQ > 70).  Prior to the treatment, parents completed the State-Trait Anxiety Inventory (STAI; Spielberger, 1983) as a measure of their own anxiety, in addition to the Child and Adolescent Symptom Inventory-4 ASD Anxiety Scale (CASI-Anx; Sukhodolsky et al., 2008) as a measure of adolescent anxiety.  A second familiar adult reporter (e.g., teacher) also completed the CASI-Anx for each participant.  Treatment response was assessed by an independent evaluator who was blinded to treatment assignment (active treatment or waitling list) using the Clinical Global Impressions-Improvement rating (CGI-I; Guy, 1976) and the Developmentally Disabled Children’s Global Assessment Scale (DD-CGAS; Wagner et al., 2007).

Results: At baseline, parental state-based anxiety (STAI) was positively correlated with parent-reported symptoms of anxiety in the adolescents (CASI-Anx), after controlling for teacher-reported anxiety (CASI-Anx) (r = .462, p < .05).  Of the 15 families randomly assigned to the active treatment condition, adolescents whose parents reported higher baseline STAI-Trait anxiety showed less improvement on the DD-CGAS at the end of treatment (r = -.593; p < .05).  Additionally, a paired-samples t-test revealed that STAI-Trait scores significantly decreased from baseline to endpoint for parents of treatment responders, defined by a “Much Improved” or “Very Much Improved” rating on the CGI-I, t(5) = -2.870, p < .05.

Conclusions: In a clinical sample of high-functioning adolescents with ASD participating in a social skills and anxiety treatment program, parents with higher state-anxiety reported more baseline anxiety in their children, significantly above teacher-reported anxiety.  In addition, the adolescents whose parents had higher baseline trait-anxiety showed less global improvement with treatment.  Findings suggest that parental anxiety is a potentially important consideration in understanding how to assess treatment outcome for adolescents with ASD and anxiety.  Future research studies with larger samples should further explore this relationship between anxiety symptoms and improvement in parents and their children with ASD.