Anxiety disorders are among the most common comorbid conditions in children and adolescents with autism spectrum disorders (ASDs), although assessment presents unique challenges. Many symptoms of anxiety appear to overlap with common presentations of autism. Furthermore, deficits in language and cognitive functioning make it difficult for such children to convey their emotional states accurately. A comprehensive review of the recent literature was conducted to assay the types and rates of use of tools for evaluating anxiety symptoms in children and adolescents with ASDs. We identified strengths and weaknesses in existing scales, identified instruments that (although imperfect) seem to have a good coverage for youngsters with ASDs, recommended strategies for studying anxiety in these youth, and offered suggestions for future scale development.
Autism spectrum disorders (ASDs) are a category of pediatric neurodevelopmental conditions that include autistic disorder (AD), Asperger syndrome (AS), Rett's disorder, childhood disintegrative disorder, and pervasive developmental disorder–not otherwise specified (PDD-NOS; American Psychiatric Association [APA], 2000). AD, AS, and PDD-NOS occur relatively frequently in the population (estimates vary considerably, but the United States Center for Disease Control [2012] has suggested that 1 out of 88 children is diagnosed with an ASD). However, Rett's disorder and childhood disintegrative disorder are quite rare in comparison and usually are not included under the ASD classification unless specifically designated (Fombonne et al., 2004).
One topic that has recently become a common focus of investigation in children with ASDs is comorbid psychopathology and its associated treatments (Bradley et al., 2004, de Bruin et al., 2007, Lainhart, 1999 and Lecavalier, 2006). This is at least partially because ASDs are such heterogeneous categories and consequently have diversity in symptom severity, presentation, and etiology (Piven et al., 1991). Anxiety disorders are quite common in children and adolescents with ASDs, and anxiety has a history of exacerbating the level of impairment experienced by persons with ASDs (e.g., Green and Ben-Sasson, 2010, Leyfer et al., 2006, Moree and Davis, 2010 and White et al., 2009b). Even though the relationship between anxiety and ASD has only recently become a focus of research (Fodstad, Rojahn, & Matson, 2010), there has been a known association between the two conditions since the original account of autism (Kanner, 1943).
In this paper we shall discuss challenges that clinicians and researchers face when evaluating anxiety in children with ASDs. We conducted a review of the recent literature using anxiety-assessment instruments published since 2000 to assess the scope of comorbid anxiety and to determine which measures are being used by researchers. The most common instruments were then examined to determine whether they are appropriate for children with ASD and if they have sound psychometric properties. Recommendations for future researchers and clinicians wishing to explore this area follow.
