Understanding Anxious Thoughts

The study

Anxiety is common in children with ASD, but it is difficult to get a clear picture of how common it is and which types of anxiety are more common than others (e.g. social phobia, OCD etc.). One reason for this is that anxiety can be difficult to measure in children with ASD because some of the symptoms of anxiety overlap with some of the features of ASD. For example, repetitive behaviours in ASD can be difficult to tease apart from anxious compulsive behaviours in OCD.

The anxiety questionnaires that are being used with children with ASD were designed to be used with typically developing children, so they do not take account of the specific challenges of measuring anxiety in children with ASD. One of the most commonly used mainstream anxiety measures is the Spence Children's Anxiety Scale (SCAS) though little is understood about how well it measures anxiety in children with ASD. The overall aim of this research was to consider whether a mainstream measure of anxiety such as the SCAS can be used with children with ASD.

What we did

Twelve parents of children with a diagnosis of ASD and seven parents of typically developing children with anxiety problems took part in the study. These parents completed the SCAS and were then interviewed about their responses on this questionnaire. Specifically, parents were asked to give examples of times when their child has been anxious, and then describe what their child's anxiety was like in that situation (e.g. what they did; what thoughts went through their mind; what happened in their body).

What we found

We found that some questions on the SCAS were capturing features of ASD rather than symptoms of anxiety. For example, a SCAS questionnaire item designed to measure obsessional thoughts in OCD (My child gets bothered by bad or silly thoughts or pictures in his/her head), was found to measure recurrent and pleasurable thoughts about the child's area of special interest (e.g. thoughts about trains or computer games) in children with ASD. We also found that some questions on the SCAS were capturing symptoms of anxiety closely tied to the features of ASD. For example, a SCAS questionnaire item designed to measure symptoms of panic disorder with agoraphobia (My child is afraid of being in crowded places) was found to measure anxiety associated with their heightened sensory sensitivity (an associated feature of ASD) in crowded/noisy places. In typically developing anxious children, by contrast, this questionnaire item was found to measure anxiety associated with being able to escape in the event of a panic attack (a recognised symptom of panic disorder with agoraphobia).

On the basis of these findings, we have made some recommendations for adaptations to the SCAS (and questionnaires like it) to make it a more accurate measure of anxiety in children with ASD.

For further information about the study, contact Dr Jacqui Rodgers (jacqui.rodgers@ncl.ac.uk) or Professor Helen McConachie (helen.mcconachie@ncl.ac.uk).