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Continuity and Change in, and Child Predictors of, Caregiver Reported Anxiety Symptoms in Young People with Autism Spectrum Disorder: A Follow-Up Study

  • S.I. : Anxiety in Autism Spectrum Disorders
  • Published:
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Abstract

Little is known about continuity, change and predictors of anxiety in ASD. This follow-up study investigated changes in caregiver-reported anxiety in 54 non-referred youth with ASD after 10–19 months. Earlier child predictors of later anxiety were also examined. Anxiety scores were generally stable. Time 1 ASD repetitive behavior symptoms, but not social/communication symptoms, predicted Time 2 total anxiety scores, over and above child age, gender and adaptive functioning scores, but this predictive relationship was fully mitigated by Time 1 anxiety scores when these were included as a covariate in the regression model. Exploring bi-directionality between autism and anxiety symptomatology, Time 1 anxiety scores did not predict Time 2 ASD symptoms. Preliminary clinical implications and possible future directions are discussed.

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Notes

  1. Special education in Singapore is provided to children with physical disabilities, those with a formal, clinical diagnosis of intellectual disability (IQ and/or adaptive skills standard scores ⩽70), those with a professional diagnosis of ASD and those with sensory impairments. Singapore has a total of 20 special education schools approved by the Ministry of Education. Of these, four cater to children and youths with cerebral palsy or visual/ hearing impairments, and the remaining 16 educate children with intellectual disabilities, ASD and/or multiple disabilities.

  2. Participants were diagnosed before the DSM-5 was published in 2013. Hence, this study included children who had clinical diagnoses of autism, ASD, Asperger Syndrome or Pervasive Developmental Disorder – Not Otherwise Specified (PDD-NOS), using the DSM-IV-TR or ICD-10 criteria. Under current DSM-5 criteria, most of the participants would most likely be described as meeting criteria for an ASD.

  3. These are staffed by qualified multi-disciplinary teams employing evidence-based approaches to diagnosing ASD using DSM-IV or ICD-10 criteria (Academy of Medicine Singapore-Ministry of Health (AMS-MOH) Clinical Practice Guidelines Workgroup on Autism Spectrum Disorders, 2010; Moh & Magiati, 2012).

  4. One item from Magiati et al.’s (2016) DBC repetitive speech/behavior subscale (‘Speaks in whispers, high pitched voice or other unusual tone or rhythm’) was included in the DBC social/communication subdomain in this study, as this item was more closely related to the communication impairments described by the DSM-5 criteria (APA, 2013).

  5. Following Nauta et al. (2004), we also applied the Spearman–Brown formula to correct for differences due to scale length, but there was little difference between the corrected and uncorrected coefficient alphas; hence, only the uncorrected alpha coefficients are reported here.

  6. The ‘fear of physical injury’ subscale was not internally reliable in our sample at both time-points. However, this subscale also has the lowest internal consistency in other samples of typically developing children (Nauta et al. 2004).

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Acknowledgments

We would like to thank all the children and caregivers for their participation and all the special schools for their collaboration. This study was funded by a start-up grant to the fourth author from the Faculty of Arts and Social Sciences, National University of Singapore.

Author Contributions

EJT took the lead in analyzing data, reviewing the literature, and writing the manuscript for publication; DMeC contributed subtantially to data entry, cleaning and analyses; GKJT collected all Time 2 data and contributed to the development of the study’s research questions and initial analyses; IM conceptualized the study, obtained research funding, supervised and oversaw all aspects of the study. All authors contributed substantially to co-writing and revising the manuscript at different stages. All auhors read and approved the final manuscript.

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Authors and Affiliations

  1. Department of Psychology, National University of Singapore, #02-24, Block AS4, 9 Arts Link, 117570, Singapore, Singapore

    Elizabeth J. Teh, Diana Mei-En Chan, Germaine Ke Jia Tan & Iliana Magiati

  2. Autism Resource Centre, Singapore, Singapore

    Diana Mei-En Chan

  3. Response Early Intervention and Assessment in Community (REACH) North Mental Health Team, Institute of Mental Health, Singapore, Singapore

    Germaine Ke Jia Tan

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  1. Elizabeth J. Teh
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  2. Diana Mei-En Chan
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  4. Iliana Magiati
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Correspondence to Iliana Magiati.

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Teh, E.J., Chan, D.ME., Tan, G.K.J. et al. Continuity and Change in, and Child Predictors of, Caregiver Reported Anxiety Symptoms in Young People with Autism Spectrum Disorder: A Follow-Up Study. J Autism Dev Disord 47, 3857–3871 (2017). https://doi.org/10.1007/s10803-017-3136-y

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