Measures of Symptom Severity in Preschoolers with Autism Spectrum Disorder: The Role of Maternal Anxiety

Background: Approximately 38% of first-degree relatives of children with Autism Spectrum Disorder (ASD) are diagnosed with an anxiety disorder (Smalley, et al., 1995). Mothers of very young children recently diagnosed with ASD report significantly increased psychological distress as measured by mean scores on anxiety and depression scales, even when compared to mothers of children with other developmental disabilities (DD; Estes, et al., 2009). Additionally, previous research suggests that parents who have been diagnosed with an Axis I Disorder (e.g., mood or anxiety disorders) may over report the severity of ASD symptoms in their children (Winterrowd, et al., 2008).

Objectives: This research examined the relationship between maternal anxiety and parent-report and objective measures of ASD symptom severity. Specifically, it was hypothesized that parent-reported symptoms of ASD would not be significantly correlated with clinical symptom severity. Additionally, maternal anxiety and clinical assessment of ASD severity was not expected to be significantly correlated; however a positive and significant relationship between maternal anxiety and parent-reported symptom severity was expected.

Methods: The sample consisted of 198 preschool-aged children with ASD (82% male) who were followed throughout the school year as part of a completed multi-site study comparing comprehensive treatment models (Boyd, et al., 2013). Children were between the ages of 3 and 5 years during enrollment (M = 48 mo. Range = 34-62 mo.), and were evaluated at three time points (pre-test, post-test, and follow-up). Only data collected at pre-test were utilized in the current study. The Autism Diagnostic Observation Schedule (ADOS; Lord et al., 1999) was used to measure clinical assessments of symptom severity. ADOS severity scores were then compared to parent-reports of symptom severity, as measured by the Social Responsiveness Scale (SRS; Constantino, 2003). The relationship of each measure to self-reported maternal anxiety scores on the Endler Multidimensional Anxiety Scales – Trait (EMAS-T) was also assessed (Endler, et al., 1991).

Results: Pearson rs were calculated to determine the correlation between maternity anxiety scores on the EMAS-T, and symptom severity scores on the ADOS and SRS. No significant relationship was found between clinical symptom severity and parent-reported symptom severity (r(182) = .072, p = .331). Further, standardized clinical symptom severity and maternal anxiety were not significantly related (r(180) = .050, p = .509). However, a strong relationship between parent-reported symptom severity and maternal anxiety level was detected (r(182) = .269, p = .001). Results provide support for our hypotheses and indicate that parent-reported symptom severity scores are not significantly related to objective measures of symptom severity; however, a significant relationship does exist between maternal anxiety and parent-reported symptom severity.

Conclusions: Results indicate that parents and clinicians may not agree on ASD symptom severity and suggest the possibility that maternal anxiety may be an influential factor. The potential implications of a relationship between maternal anxiety and parent perception of symptom severity are discussed. Future studies may investigate the impact of maternal anxiety on diagnostic decisions and/or parent-child relationships, with the ultimate goal of improving quality of life for family members impacted by ASD diagnosis.