In-Depth Understanding of Anxiety Experienced By Children and Adolescents with ASD, and Impact on the Family

Background: Among adolescents and school-aged children with ASD, anxiety-related concerns are among the most common presenting problems (White et al., 2009). Research has shown that anxiety may increase their poor social skills and have a substantial negative impact on a person’s ability to engage in activities in the home, at school or in general community activities (White, Schry & Maddox, 2012). Both increased rates of aggression and high social understanding are also associated with increased anxiety. However, the underlying nature of anxiety symptoms in ASD is still unclear. A key obstacle for this area of research is that current measures of anxiety may not always be appropriate for assessing individuals with ASD. 

Objectives: This exploratory study was designed to better characterize the co-occurring symptoms of anxiety in individuals with autism as described by their mothers. The rich descriptions gathered from a parent interview were used to determine how well the reported features of anxiety on a standard pencil-and-paper questionnaire are representative of anxiety or characteristics of ASD. 

Methods: Mothers of children ages 12-16 diagnosed with ASD completed the Spence Children’s Anxiety Scale-Parent Survey Version (SCAS, Spence, 1998) and the Social Responsiveness Scale (SRS; Constantino, 2004). Following the completion of the surveys, each mother was interviewed using the Spence Children’s Anxiety Scale–Parent Interview developed by Dr. Jacqui Rodgers and Ruth Jamieson of Newcastle University. Mothers answered questions about 1) statements on the SCAS-P most relevant to their child; and 2) any other anxiety-producing situations not captured by the SCAS. Interview questions specifically addressed the child’s anxious thoughts, emotions, physical symptoms, as well as the context in which the anxious response was developed. Mothers were asked to describe the impact their child’s anxiety has on the family.

Results: 35 mothers (20 with ASD children; 15 with non-autism anxious children) completed the study. Mothers of ASD children endorsed more statements on the Obsessive-Compulsive Disorder, Separation Anxiety and Social Anxiety subscales of the SCAS. Statements such as “My child can’t seem to get bad or silly thoughts out of his head” and “My child feels afraid that he will make a fool of himself in front of people” were endorsed by a significant portion of ASD mothers. Mothers of ASD children tended to attribute the development of the anxiety to school situations and often reported that they felt their child’s thoughts and worries were reasonable given the situation their children faced at school. All mothers described significant levels of family interference due to anxiety. 

Conclusions: Initial qualitative analysis of the data reveals that the anxious features reported by mothers of children with ASD are significant and impact both the child and the family. This suggests that assessing for anxiety in children on the spectrum should be an integral part of treatment. Furthermore, many of the socially anxious symptoms were attributed to either the start of school or experiences at school. This suggests that early intervention for school preparation may be beneficial for children with ASD.