Assessing Anxiety and Measuring Treatment Outcomes: Challenges and Creative Solutions for Implementing the Facing Your Fears Program in a Tertiary Care Setting

Background: Children with autism spectrum disorders (ASD) experience greater levels of anxiety than typically developing children, making accurate assessment and diagnosis especially important in this population. Moreover, early assessment promotes early intervention, which is well-known to improve outcomes. However, considerable challenges exist with current measures of anxiety in terms of their clinical utility for children with ASD and in terms of their applicability in real-world clinical settings. Available measures of anxiety have been designed for typically developing children and rely heavily on language and abstract concepts (e.g., emotions and cognitions). Since language impairment and difficulties with abstract thinking are core features of autism, there are important questions about the applicability of traditional measures of anxiety for children with ASD. Likewise, gold-standard anxiety assessment protocols (e.g., Anxiety Disorders Interview Schedule; Silverman & Albano, 1996) were developed for use in research settings with typically developing children, and considerable challenges exist when clinicians attempt to apply traditional assessment measures with this special population in real-world clinical settings.

Objectives: The primary objective of this presentation is to discuss challenges and possible solutions for assessing anxiety and treatment outcomes in the context of evidence-based intervention for anxiety in children with ASD in real-world clinical settings. Strengths and weaknesses of existing measures of anxiety commonly used with this population will be reviewed, along with their applicability in clinical settings. Factors that complicate assessment of anxiety in the context of ASD, particularly in a tertiary care setting, will be reviewed. Finally, creative solutions and alternative methods of real-world measurement of anxiety in ASD will be discussed, including presentation of two newly-developed visual measures of anxiety designed specifically for children with ASD.

Methods: A well-characterized sample of 13 children with ASD and anxiety, ages 8-12, participated in the study. Two visual measures of anxiety were designed for children with ASD participating in the Facing Your Fears program. The first measure, About My Worry, uses visual scales to assess children’s perceptions of the frequency and intensity of anxiety symptoms. The second measure, How My Body Feels, uses diagrams in conjunction with a visual scale to assess severity of physiological symptoms of anxiety. Traditional measures of children’s anxiety (e.g., Anxiety Disorders Interview Schedule, Spence Children’s Anxiety Scale– parent and child versions) were also administered. Data were collected within a repeated-measures, pre-post treatment design in a tertiary care setting.

Results: Preliminary findings will be presented with respect to the validity of these visual measures for assessing anxiety in children with ASD, including descriptive and correlational data gathered in a tertiary-care setting.

Conclusions: Measurement issues present a significant barrier to implementation of evidence-based assessment and treatments for children with co-morbid mental health issues and ASD receiving services in real-world clinical settings. There is a need for creative solutions to overcoming these barriers as we develop a better understanding of how to best assess anxiety and treatment outcomes for children with ASD.