1. Measuring anxiety in young children with ASD: How effective is the Spence Children’s Anxiety Scale?
Sophie Landa, Dr. Jacqui Rodgers, Dr. Emma Honey & Dr. Vicki Grahame (Newcastle University, Northumberland, Tyne and Wear NHS Foundation Trust)
Introduction
Approximately 40% of children with ASD have high anxiety (van Steensel et al., 2011).
Anxiety may develop differently in children with ASD to typically developing children, and symptoms may also look different (e.g. repetitive behaviours may be mistaken for OCD, Kerns et al., 2014). Therefore scales developed with typically developing children may not be effective for children with ASD. However, measures of anxiety in children with ASD focus on children aged 8 years or older (e.g. the ASC-ASD, Rodgers et al. 2016).
This study explores how anxiety in young children with ASD can be measured, by evaluating the Spence Children’s Anxiety Scale – Parent Rated (SCAS-P).
Methods
A two-phase mixed-methods approach was taken to explore how the SCAS-P functions for young children with ASD:
Phase One: Statistical analysis of an archival dataset (contributed by an international consortium of researchers). 129 children with ASD aged 3-8 were included; 14 were female and 44 had a learning disability. Descriptive statistics and exploratory factor analyses were conducted, and t-tests to assess effects of age, gender and learning disability.
Phase Two: Thematic analysis of focus groups of parents of children with ASD. Nine parents in the North East attended one of two groups where the results of Phase One were discussed, as well as the roles of intolerance of uncertainty and sensory processing in their children’s anxiety.
Phase One Results
T-tests showed that overall level of anxiety as measured by the SCAS-P was not affected by age (t(77.3)=-0.41, p=.68), gender (t(127)=-0.32, p=.75) or learning disability (t(121)=0.08, p=.93).
Infrequently reported items
Four items were responded to as “never” by over 75% of parents.
All of these related to symptoms of panic.
e.g. “My child complains of suddenly becoming dizzy or faint when there is no reason for this.”
These items were eliminated from factor analysis.
Scree plot
The structure of the SCAS-P
A single factor solution explained 30.5% of variance.
A two-factor solution (implicated by the scree plot) explained 39.5% of variance.
No factor solution corresponded with the six-factor solution (i.e. anxiety subtypes such as social anxiety) in the original SCAS-P.
Phase Two Results
Parents indicated that several items had problematic phrasing: many young children with ASD cannot “complain” about symptoms due to language delay – so the symptoms may be present, but the SCAS-P isn’t asking the right question! Other questions were confusing or ambiguous for parents.
The SCAS-P does not ask about aspects of anxiety that parents felt were important: intolerance of uncertainty and sensory anxiety were significant.
Parents also noted the impact of visible and invisible disability on anxiety (e.g. children worrying that they will not be able to communicate a need for support, or conversely that their well-developed communication means that their anxiety will not be recognised).
Discussion
The SCAS-P uses ambiguous, unclear or irrelevant language that makes it difficult for parents to answer questions, which can lead to frustration and refusal to respond.
It is hard to draw firm conclusions about factor structure of anxiety (e.g. if anxiety is undifferentiated) until we are confident that we are asking parents the right questions.
There are several ASD-specific aspects of anxiety (e.g. sensory issues) not covered by a measure designed for typically developing children.
Generating and trialling a new pool of items is therefore implicated as the next step to developing a more effective and reliable measure of anxiety in young children with ASD, and parents will be key informants in this process.
References
Kerns et al. (2014). Traditional and Atypical Presentations of Anxiety in Youth with Autism Spectrum Disorder. Journal of Autism and Developmental Disorders, 1-11.
Rodgers et al. (2016). Development of the anxiety scale for children with autism spectrum disorder (ASC-ASD). Autism Research. van Steensel et al. (2011). Anxiety disorders in children and adolescents with autistic spectrum disorders: A meta-analysis. Clinical Child and Family Psychology Review, 14(3),