Parent-Child Agreement on Internalizing Symptoms before and after a Cognitive Behavioural Intervention

Background: Assessment and diagnosis of many mental health disorders relies on multiple informants, one of which is typically child or adolescent self-report (Silverman & Ollendick, 2005). However, many individuals with ASD have difficulties engaging in introspection and demonstrate a lack of awareness and/or difficulties identifying their emotions (Losh & Capps, 2006). Consequently, whether children and youth with ASD provide valid self-reports of their mental health symptoms has been questioned (Mazefsky et al., 2011). Previous research examining parent-child concordance on measures of internalizing symptoms has been mixed (Magiati et al., 2014; Russell & Sofronoff, 2004). Although limited, there is literature to suggest that, in children and adolescents with anxiety but not ASD, parent-child agreement increases following treatment (Los Reyes et al., 2010). In children and adolescents with ASD, despite suggestions that discrepant reporting might relate to a lack of insight into mental health symptoms, no research to date has examined if and how the concordance between parent and child reported internalizing symptoms may be impacted following involvement in an intervention.

Objectives: The present study examined agreement between parent- and child- reported internalizing mental health symptoms after participating in a cognitive-behavioural intervention for children and adolescents with ASD and anxiety.

Methods: Fifty-one children (age 8-13 years, FSIQ ≥ 70) and a parent or caregiver participated in Facing Your Fears (Reaven et al., 2011) – a 14-week cognitive-behavioural intervention to address anxiety in ASD. Before and after participation in the intervention, children and their caregivers independently completed comprehensive (i.e., multi-informant, multi-method) assessments of their child’s internalizing mental health symptoms. Preliminary analyses examined parent-child agreement on the Spence Children’s Anxiety Scale (Spence, 1998) pre- and post-intervention using intraclass correlations (ICC).

Results: Parent-child agreement for total anxiety symptoms at pre-intervention was modest (ICC = .47) but decreased post-intervention (ICC = .36). At the subscale level, agreement for generalized anxiety symptoms was poor at pre-intervention (ICC = .29) and increased to modest at post-intervention (ICC = .48). Similarly, agreement on the separation anxiety subscale was modest at pre-intervention (ICC = .45) and increased slightly post-intervention (ICC = .56). This pattern of decreased overall anxiety symptom agreement despite increases on certain subtests may be related to the issues addressed in the intervention. Secondary analyses will compare agreement on anxiety symptoms with agreement on the Children’s Depression Inventory (Kovacs, 1992) while controlling for ASD severity and cognitive abilities.

Conclusions: Agreement between parent and child reports of internalizing symptoms may differ following participation in a cognitive-behavioural intervention. The intervention may present an opportunity for children and parents to discuss anxiety symptoms which could result in higher levels of agreement between ratings. Conversely, if children better understand their symptoms, they may report higher levels of symptoms while their parents endorse lower levels following participation. Secondary analyses will explore the pattern of reporting before and after participation. Understanding how participation in an anxiety intervention impacts how children and adolescents with ASD self-report internalizing symptoms can help clinicians better conceptualize discrepant parent-child reports and inform the development of self-report measures for ASD.