A Case for Including Adolescent Self Report of Sensory and Anxiety Symptoms in ASD: Evidence from Questionnaire and Autonomic Data

Background: Dysregulated sensory processing and anxiety are both highly prevalent clinical concerns for individuals with autism spectrum disorder (ASD). While it is clear that both sensory dysfunction and anxiety are present in individuals with ASD, accurately and fully measuring these symptoms is challenging, given that they are largely experienced internally. Furthermore, while past research has suggested that individuals with ASD have difficulty reporting on their internal states, parent report is also subject to limitations, such as reporter effects (e.g., bias, memory) and reliance on the ability to index internal emotions and sensory states based solely on observable behaviors.

Objectives: The current study used a multi-method approach to evaluate differences between child- and parent-report of sensory processing and anxiety symptoms in high-functioning adolescents with ASD and typically developing (TD) controls. To determine the relative validity of self- versus parent-report for identifying symptoms, we compared these questionnaires to objective, physiological measurements of the sympathetic and parasympathetic nervous systems during a laboratory sensory challenge.

Methods: Participants included 22 adolescents with ASD (mean age=14.5, range=12-17 yrs) and 18 TD controls (mean age=15.1, range=12-17 yrs). Diagnoses were confirmed using the ADOS and ADI-R in the ASD group and ruled out using the ADOS and SRS in the TD group. Groups were matched on age, gender, and Wechsler Verbal Comprehension Index. Each participant and their parent completed the Brain Body Center Sensory Scales and the Screen for Childhood Anxiety Related Disorders (SCARED). Electrocardiography, respiratory sinus arrhythmia, and electrodermal activity were collected at rest (baseline) and during a laboratory task presented in continuous, 75 dB gated broadband noise (sensory challenge).

Results: Group x Reporter ANOVAs were conducted for both sensory symptoms and trait anxiety. For both domains, the ASD group showed significantly higher symptoms than TD peers (sensory, F=41.27, p<.001; anxiety, F=30.15, p<.001). For both domains, there was also a significant effect of reporter. Children from both groups reported higher levels of sensory dysfunction than reported by parents, F=16.65, p<.001. An identical pattern emerged for the anxiety data, with children from both groups reporting higher levels of trait anxiety than their parents reported, F=18.27, p<.001. To better understand these reporter differences, we examined the relationship between questionnaire measures and autonomic arousal. Interestingly, in the ASD group, child-report of sensory (r=.55, p=.05) and anxiety (r=.49, p<.05) symptoms correlated with autonomic arousal levels, whereas parent-reports of these symptoms were not related to autonomic reactivity.

Conclusions: These results make a substantial contribution by demonstrating that high-functioning adolescents with ASD are able to accurately report on their internal experiences with sensory and anxiety symptoms, and that their report may reveal a greater degree of symptoms than reported by parents. The validity of child-reports in ASD was substantiated by demonstrating concordance between self-report of symptoms and autonomic arousal levels collected in the lab. Together, these results suggest that research and clinical evaluations of high-functioning adolescents with ASD should include the perspective of the individuals themselves as they are likely able to contribute a different and important perspective.