Assessing anxiety in ASD: the development of the Anxiety Scale for Children – ASD (ASC-ASD)

Background Individuals with autism spectrum disorder (ASD) often experience anxiety. There is a lack of suitable anxiety measures for people with ASD. A valid measure of anxiety for neurotypical children is the Revised Child... [ view full abstract ]

Background
Individuals with autism spectrum disorder (ASD) often experience anxiety. There is a lack of suitable anxiety measures for people with ASD. A valid measure of anxiety for neurotypical children is the Revised Child Anxiety and Depression Scale (RCADS). We aimed to adapt the RCADS to include items related to anxiety in ASD, including uncertainty, sensory issues and phobias and to investigate the factor structure of the adapted measure.

Methodology
177 children with ASD (8-16 years) and their parents participated. Children completed the adapted child version of the RCADS and the Screen for Anxiety and Related Emotional Disorders (SCARED). Parents completed the parent version of the adapted measure, and a range of other measures, to assess reliability and validity.

Results
Following factor analysis a 24 item anxiety measure was created (Anxiety Scale for Children- ASD (ASC-ASD), child and parent version) with four subscales, Performance Anxiety, Anxious Arousal, Separation Anxiety, and Uncertainty. Internal consistency of the ASC-ASD subscales and total scores was excellent. One month test-retest reliability was excellent. Validity was demonstrated with significant correlations between the ASC-ASD and other measures.

Conclusions
The results provide evidence for the need to adapt anxiety measures for young people with ASD and support emerging evidence for the importance of uncertainty in the presentation of anxiety in ASD. The ASC-ASD is one of the first reliable and valid ASD specific anxiety measures which captures aspects of anxiety relevant to ASD that are absent in other measures; replication and extension is required in novel samples.