Assessment of Anxiety in Children and Adolescents with Autism Spectrum Disorders

Background: Anxiety disorders are some of the most common comorbid conditions in children and adolescents with autism spectrum disorders (ASDs), although assessing such disorders presents unique challenges. Most notably, many symptoms of anxiety overlap with common presentations of autism. Furthermore, deficits in language and cognitive functioning make it difficult for such children to convey their feelings accurately. Although anxiety disorders are only found in 5% of the general population, current research indicates that the prevalence of anxiety in children ASDs could be between 11% and 84%, clearly a larger problem than for typically developing children.

Objectives: The project objective was to investigate how frequently types of anxiety were evaluated in children and adolescents with ASDs and to determine by what means those assessments were completed. The most popular tools were then investigated in-depth to determine whether they are appropriate to use with children and adolescents with ASDs. Recommendations on ways that measures of anxiety in this sample can be improved were provided.

Methods: A review of recent literature since 2000 was conducted using PsycInfo, Medline, and Google Scholar with various combinations of the terms “anxiety,” “anxious,” “children,” “adolescents,” “comorbidity,” “autism,” “asperger,” or “pervasive.” Then, a manual search was done using an online journal database by looking through all abstracts from the most popular journals in the intellectual and developmental disability field. Assessments that were used in more than 5% of the anxiety literature that was found were then critiqued more thoroughly.

Results: The search produced 60 articles that used a total of 36 different measures for assessing symptoms of anxiety. Only 10 instruments were used more in more than 5% of this literature. These instruments, in descending order of frequency,  were the  Anxiety Disorders Interview Schedule for Children (ADIS; used in six studies), the Multidimentional Anxiety Scale for Children (MASC; found in six articles), the Behavioral Assessment System for Children (BASC; found in five of the articles), the Child Behavior Checklist (CBCL; used in five studies), the Spence Children’s Anxiety Scale (SCAS; used in five studies), the Autism Spectrum Disorders – Comorbid for Children (ASD-CC; used in four studies), the Social Anxiety Scale for Children – Revised (SASC-R; found in four of the articles), the Baby and Infant Scale for Children with Autism Traits (BISCUIT; used in four studies), the Autism Comorbidity Interview – Present and Lifetime (ACI-PL; found in three articles), and the Child Symptom Inventory (CSI; also used in three articles).         

Conclusions: There is a reasonably large group of researchers who are investigating and publishing (at least 60 articles since 2000) on anxiety in children and adolescents with ASDs. However, the majority of the literature (82%) used assessments that were not designed for children with ASDs. Those measures that were designed for children and adolescent with ASD do not have adequate continuity across development. The field will benefit from modification of existing measures to accommodate particular ASD challenges, or from entirely new measures being created that can address the known issues for young people with ASDs.