Comorbid Anxiety Disorders in Young Children with ASD: Parent and Teacher Report

Background:

Children with ASD often experience high levels of anxiety. Indeed, a meta-analysis conducted by van Steensel et al. (2011) revealed that 40% of children had at least one comorbid anxiety disorder. Symptoms of anxiety include fear of separation from parents, resistance to change, crying easily, tenseness, shyness, and irritability (Brereton et al., 2006). However, most previous studies have not focused on young children with ASD who are transitioning to early schooling, when a comorbid anxiety disorder compounds the academic and other risk factors these children experience as they transition to school (Perry & Weinstein, 1988).

Objectives:

This study looks at the prevalence and presentation of comorbid anxiety in young children with ASD who are transitioning to school. Specifically: (1) What is the prevalence of anxiety problems in children ages 4 to 7 years? (2) How does anxiety manifest in preschool (ages 4-5) and in the early school grades (ages 6-7) as reported by parents and teachers? (3) Are there differences between parent and teacher reports of anxiety symptoms?

Methods:

Participants in this study included 180 children ages 4 to 7 years old (147 boys, 33 girls) and their parents and teachers, who were participating in the longitudinal, IES-funded Smooth Sailing study. Behavioral information was collected from parents and teachers using the Child Behavior Checklist – Parent Report and the Teacher Report Form, respectively (CBCL and C-TRF; Achenbach & Rescorla, 2001). This study examined narrow band scores in children who scored in the clinically significant range on the CBCL/TRF.

Results:

Parents reported that 31% of preschool children and 50% of school-aged children were experiencing clinically elevated anxiety. Teachers reported much lower rates, identifying clinically elevated anxiety in less than 5% of preschool children and 30% of school-aged children. Parent and teacher reports of anxiety were uncorrelated for both preschool children (r = -.11, p = .40) and school-aged children (r = .15; p = .20). Parents of preschool children with clinically elevated anxiety problems reported that their children frequently exhibit dependence, reluctance to sleep alone, and fears. These behaviors were marginally more frequent, per parent-report, than worrying or separation anxiety . Parents of school-aged children with clinically elevated anxiety problems reported that fears and nervousness were frequent behaviors. These behaviors were significantly more frequent, per parent-report, than worrying (. Similarly, teachers of school-aged children also reported nervousness as a frequent behavior. However, they rated fears as occurring much less frequently than parent report of fears.

Conclusions:

Findings were congruent with the literature that reported a discrepancy between parent and teacher report of behavior (Stratis & Lecavalier, 2015), although here we identified specific internalizing behaviors on which reporters differed. Overall, teachers reported less frequent behaviors indicative of anxiety. Lack of recognition by teachers of important internalizing behaviors, such as anxiety, can delay access to intervention. Implications of the specific behaviors reported by parents and teachers during preschool and the early school years will be discussed.