Abstract
BackgroundEvidence about relevant outcomes is required in the evaluation of clinical interventions for children with autism spectrum disorders (ASD). However, to date, the variety of outcome measurement tools being used, and lack of knowledge about the measurement properties of some, compromise conclusions regarding the most effective interventions.ObjectivesThis two-stage systematic review aimed to identify the tools used in studies evaluating interventions for anxiety for high-functioning children with ASD in middle childhood, and then to evaluate the tools for their appropriateness and measurement properties.MethodsElectronic databases including Medline, PsychInfo, Embase, and the Cochrane database and registers were searched for anxiety intervention studies for children with ASD in middle childhood. Articles examining the measurement properties of the tools used were then searched for using a methodological filter in PubMed, and the quality of the papers evaluated using the COSMIN checklist.ResultsTen intervention studies were identified in which six tools measuring anxiety and one of overall symptom change were used as primary outcomes. One further tool was included as it is recommended for standard use in UK children's mental health services. Sixty three articles on the properties of the tools were evaluated for the quality of evidence, and the quality of the measurement properties of each tool was summarised.ConclusionsOverall three questionnaires were found robust in their measurement properties, the Spence Children's Anxiety Scale, its revised version – the Revised Children's Anxiety and Depression Scale, and also the Screen for Child Anxiety Related Emotional Disorders. Crucially the articles on measurement properties provided almost no evidence on responsiveness to change, nor on the validity of use of the tools for evaluation of interventions for children with ASD.PROSPERO Registration numberCRD42012002684.
Highlights
The choice of relevant outcomes, and of robust tools to measure those, is a vital stage in the design of evaluation of clinical interventions for children
Overall three questionnaires were found robust in their measurement properties, the Spence Children’s Anxiety Scale, its revised version – the Revised Children’s Anxiety and Depression Scale, and the Screen for Child Anxiety Related Emotional Disorders
We focus on high-functioning autism spectrum disorders (ASD) as the children are likely to be able to participate in verbally-loaded interventions such as cognitive behaviour therapy (CBT), even the prevalence of comorbid psychiatric conditions is similar across IQ and levels of adaptive behaviour [15]
Summary
The choice of relevant outcomes, and of robust tools to measure those, is a vital stage in the design of evaluation of clinical interventions for children. Where tools are reliable and valid, and outcomes important to children and families, the findings can inform parents, clinicians, researchers, service providers and policy makers about which interventions are most effective. To date the outcome measures used for intervention trials for children with autism spectrum disorder (ASD) are too varied to allow sensible decisions about what interventions might be most effective [1;2]. Cross-study syntheses of outcome evidence such as this are much needed in the field of ASD, because individual trials are in the main very small and include broad age groups [4;5]. Evidence about relevant outcomes is required in the evaluation of clinical interventions for children with autism spectrum disorders (ASD). To date, the variety of outcome measurement tools being used, and lack of knowledge about the measurement properties of some, compromise conclusions regarding the most effective interventions
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