Abstract
Validated brief screening instruments are needed to improve the detection of anxiety disorders in autism spectrum disorder (ASD). The Screen for Child Anxiety-Related Emotional Disorders (SCARED), a 41-item parent- and self-reported scale measuring anxiety, was compared to the Achenbach System of Empirically Based Assessment (ASEBA) scales. One hundred participants with a clinical diagnosis of high-functioning ASD, aged 8–18 years, and their parents completed the above scales. We hypothesized that the SCARED would be useful in screening for anxiety and its results for total scores of anxiety would converge with ASEBA syndrome scales for anxiety and internalizing disorders. Significant correlations were shown between the SCARED and the Child Behavior Checklist (CBCL) and Youth Self-Report (YSR) across a broad spectrum of scales. The CBCL syndrome scale for anxious/depressed showed the highest correlation and predicted anxiety scores on the SCARED. While many of the YSR scales significantly correlated with child ratings of anxiety, none of the scales predicted the SCARED child scores. Differences in self and parent reports suggest that parents interpret externalizing behaviors as signs of anxiety in ASD, whereas youth may describe internalized symptoms as anxiety. Females were more likely to self-report anxiety than males. Results support the use of the SCARED as a screening tool for anxiety in high-functioning ASD, but it should be supplemented with other tools to increase the specificity of its results.
Highlights
Psychiatric comorbidity represents an important source of increased impairment and dysfunction in autism spectrum disorders (ASD)
Teacher reports were obtained for N = 44 subjects and Youth Self-Report (YSR) were obtained for those subjects aged 11–18 years (N = 72 subjects)
Our study examined the correlations of the Screen for Child Anxiety-Related Emotional Disorders (SCARED)-child and -parent forms in a population of youth with ASD without intellectual disability to the Achenbach System of Empirically Based Assessment (ASEBA) instruments of global psychopathology (CBCL, YSR, and Teacher Report Form (TRF))
Summary
Psychiatric comorbidity represents an important source of increased impairment and dysfunction in autism spectrum disorders (ASD). In a recent study using a structured interview, 72% of children with high-functioning autism had at least one other psychiatric disorder, with the most common diagnoses being specific phobia (44%), obsessive–compulsive disorder (37%), ADHD (30.6%), and major depression (10.1%) [1]. Anxiety disorders are recognized as a leading source of additional impairment in ASD symptoms with estimates of comorbid anxiety symptoms as high as 84% [2]. A meta-analysis showed 39.6% of young people with ASD had at least one comorbid DSM-IV anxiety disorder, with specific phobia the most common [3]. The increased morbidity, dysfunctional behavior, and exacerbation of ASD symptoms caused by anxiety disorders are important to detect because they can provide targets for clinical intervention [5]. Cognitive behavioral therapy has been shown to reduce anxiety symptoms, improve disruptive and repetitive behaviors, and improve social function [6, 7]
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