Caregiver Vs. Adolescent Report of Internalizing Symptoms and Relationship to Physiological Arousal Across the PEERS® Intervention

Background: Self- and parent/caregiver-report measures are commonly used to assess symptoms of anxiety and depression among adolescents with ASD. However, agreement in these reports has been found to be low (May et al., 2015). Respiratory Sinus Arrhythmia (RSA) and Heart Period (HP) are used to measure physiological arousal associated with anxiety and depression (Licht et al., 2009). In the present study, RSA and HP were used as a more “objective” reference point for the base level of adolescent anxious and depressive symptoms. No known study to date has examined change in discrepancy of self- and parent/caregiver-report measures over the course of a well-validated social skills intervention.

Objectives:  1) Determine discrepancies between adolescent self- and parent/caregiver-report of anxious and depressive symptoms at pre- and post-intervention. 2) Explore how two measures of physiological arousal, RSA and HP, compared to self- and parent/caregiver-report at both time points. 3) Examine change in discrepancies in report from pre- to post-intervention.

Methods: 139 adolescents with ASD aged 11-16 and their parents/caregivers participated. Descriptive statistics are in Table 1. A randomized controlled trial (RCT: experimental vs. waitlist control) of the PEERS^® intervention (Laugeson & Frankel, 2010) was conducted. Data at pre- and post-PEERS^® included self- and parent/caregiver-report of the Social Anxiety Scale-Adolescent (SAD-NEW, fear and anxiety about unfamiliar peers), Spence Children’s Anxiety Scale (SCAS), Short Mood and Feelings Questionnaire (SMFQ) and Child Behavior Checklist (CBCL)/Youth Self Report (YSR) Anxious/Depressed, Withdrawn/Depressed, Internalizing Problems subscales, as well as RSA and HP from a sub-sample of participants (n_overall=63; n_waitlist=29).

Results: Preliminary results revealed the following effects and correlations. Repeated Measures ANOVAs for Group (EXP vs WL) by Reporter (Parent/caregiver vs. Teen) showed significant main effects for Reporter on the SAS-NEW at Pre, F(1,117)=23.47, p<.001 and Post, F(1,122)=48.22, p<.001; Spence at Pre, F(1,54)=17.51, p<.001; CBCL/YSR Anxious/Depressed at Post, F(1,44)=7.26, p=.01; CBCL/YSR Withdrawn/Depressed subscale at Post, F(1,44)=6.17, p=.02. Correlations between behavioral measures and RSA at both time points revealed a significant relationship between RSA and EXP parent/caregiver reports at Post on the CBCL Internalizing Problems subscale, r(32)=-.585, p=.036, and the Anxious/Depressed subscale, r(32)=-.645, p=.017. No other correlations were significant.

Conclusions: Results demonstrate reporter discrepancies and correlations between RSA and parent/caregiver-reports. Because no significant correlations in RSA and self-report were uncovered, and lower values of RSA are shown to be associated with higher anxiety, parents/caregivers may be more accurate in reporting adolescents’ symptoms post-intervention. This may be a byproduct of the intervention’s focus on behavior that results in parents/caregivers recognizing their adolescent’s social difficulties more accurately. Discrepancies present prior to intervention may be the result of parent/caregivers’ difficulty in recognizing internalizing symptoms (Sourander, Helstelä, & Helenius, 1999). At post-intervention, for the waitlist group, discrepancies on the CBCL/YSR subscales may be due to the parents/caregivers’ perceived expectations of themselves in being part of a research study leading them to assess symptoms differently than at the pre- time point.