Skip to main content
Log in

A Preliminary Investigation of the Spence Children’s Anxiety Parent Scale as a Screening Tool for Anxiety in Young People with Autism Spectrum Disorders

  • Original Paper
  • Published:
Journal of Autism and Developmental Disorders Aims and scope Submit manuscript

An Erratum to this article was published on 26 March 2014

Abstract

Despite high rates of clinically elevated anxiety difficulties in children and adolescents with autism spectrum disorders (ASDs), very few studies have systematically examined the usefulness of commonly used caregiver report anxiety screening tools with this population. This study investigated the use of the Spence Children’s Anxiety Scale-Parent version (SCAS-P) as a screening tool for anxiety disorders when compared to a standardized DSM-IV-TR-based clinical interview, the Kiddie-Schedule for Schizophrenia and Affective Disorders-Present and Lifetime version (K-SADS-PL). Thirty-two caregivers of youth with a clinical diagnosis of ASD (mean age 10.3 years) attending a specialist autism school participated in this study. They first completed the SCAS-P, a measure of adaptive functioning and a checklist of other emotional and behavioral difficulties. They were then interviewed with the K-SADS-PL. Internal consistency for the SCAS Total score was .88, but Cronbach’s alphas were <.70 in three of the six SCAS-P subscales. The sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of the SCAS-P against K-SADS diagnosis were .75, .71, .27, and .95, respectively. All values were >.70, except for the PPV. Evidence of convergent validity between the SCAS-P, K-SADS-PL and DBC anxiety subscale was also found. The high false positive rates notwithstanding, the preliminary data of acceptable to excellent sensitivity, specificity and NPV values tentatively suggest that the SCAS-P may be useful for screening non-help seeking young people with ASD for elevated anxiety symptoms. Further replication in larger studies is needed and ways in which the SCAS-P could be further developed and investigated for use with youth with ASD are discussed.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Similar content being viewed by others

References

  • Achenbach, T. M. (1991). Integrative guide for the 1991 CBCL/4-18, YSR and TRF profiles. Burlington: Department of Psychiatry, University of Vermont.

    Google Scholar 

  • American Psychiatric Association. (2013). Diagnostic and statistical manual of mental health Disorders: DSM-5 (5th ed.). Washington, DC: American Psychiatric Association.

    Google Scholar 

  • Aschenbrand, S. G., Angelosante, A. G., & Kendall, P. C. (2005). Discriminant validity and clinical utility of the CBCL with anxiety-disordered youth. Journal of Clinical Child and Adolescent Psychology, 34(4), 735–746.

    Article  PubMed  Google Scholar 

  • Bellini, S. (2004). Social skill deficits and anxiety in high functioning adolescents with autism spectrum disorders. Focus on Autism and Other Developmental Disabilities, 19, 78–86.

    Article  Google Scholar 

  • Ben-Sasson, A., Cermak, S. A., Orsmond, G. I., Tager-Flusberg, H., Kadlec, M. B., & Carter, A. S. (2008). Sensory clusters of toddlers with autism spectrum disorders: Differences in affective symptoms. Journal of Child Psychology and Psychiatry, 49, 817–825.

    Article  PubMed  Google Scholar 

  • Birmaher, B., Khetarpal, S., Brent, D., Cully, M., Balach, L., Kaufman, J., et al. (1997). The screen for child anxiety related emotional disorders (SCARED): Scale construction and psychometric characteristics. Journal of the American Academy of Child and Adolescent Psychiatry, 36(4), 545–553.

    Article  PubMed  Google Scholar 

  • Birmaher, B., Brent, D., Chiapetta, L., Bridge, J., Monga, S., & Baugher, M. (1999). Psychometric properties of the screen for child anxiety related emotional disorders (SCARED): A replication study. Journal of the American Academy of Child and Adolescent Psychiatry, 38(10), 1230–1236.

    Google Scholar 

  • Bodden, D. H. M., Bogels, S. M., & Muris, P. (2009). The diagnostic utility of the screen for child anxiety related emotional disorders-71 (SCARED-71). Behaviour Research and Therapy, 47, 418–425.

    Article  PubMed  Google Scholar 

  • Brereton, A. V., Bruce, J. T., Mackinnon, A. J., & Einfield, S. L. (2002). Screening young people for autism with the developmental behavior checklist. Journal of the American Academy of Child and Adolescent Psychiatry, 41(11), 1–13.

    Article  Google Scholar 

  • Bruininks, R. H., Woodcock, R. W., Weatherman, R. F., & Hill, B. K. (1996). Scales of independent behavior–revised: Manual. Boston, MA: Riverside Publishing Company.

    Google Scholar 

  • Chalfant, A. M., Rapee, R., & Carroll, L. (2007). Treating anxiety disorders in children with high functioning autism spectrum disorders: A controlled trial. Journal of Autism and Developmental Disorders, 37, 1842–1857.

    Article  PubMed  Google Scholar 

  • Charman, T., & Baird, G. (2002). Practitioner review: Diagnosis of autism spectrum disorder in 2- and 3-year-old children. Journal of Child Psychology and Psychiatry, 43(3), 289–305.

    Article  PubMed  Google Scholar 

  • Chorpita, B. F., Moffitt, C. E., & Gray, J. (2005). Psychometric properties of the Revised Child Anxiety and Depression Scale in a clinical sample. Behaviour Research and Therapy, 43, 309–322.

    Google Scholar 

  • Cohen, J. (1992). A power primer. Psychological Bulletin, 112(1), 155–159.

    Article  PubMed  Google Scholar 

  • Cosi, S., Canals, J., Hernàndez-Martinez, C., & Vigil-Colet, A. (2010). Parent-child agreement in SCARED and its relationship to anxiety symptoms. Journal of Anxiety Disorders, 24, 129–133.

    Article  PubMed  Google Scholar 

  • Einfeld, S. L., & Tonge, B. J. (2002). Manual for the developmental behaviour checklist: Primary carer version (DBC-P) and teacher version (DBC-T) (2nd ed.). Clayton, Melbourne: Monash University Centre for Developmental Psychiatry and Psychology.

  • Einfeld, S. L., Tonge, B. J., & Florio, T. (1997). Behavioral and emotional disturbance in individuals with Williams syndrome. American Journal on Mental Retardation, 102(1), 45–53.

    Article  PubMed  Google Scholar 

  • Farrugia, S., & Hudson, J. (2006). Anxiety in adolescents with Asperger syndrome: Negative thoughts, behavioral problems, and life interference. Focus on Autism and Other Developmental Disabilities, 21, 25–35.

    Article  Google Scholar 

  • Fitzgerald, M. (2007). Suicide and Asperger’s syndrome. The Journal of Crisis Intervention and Suicide Prevention, 28(1), 1–3.

    Article  Google Scholar 

  • Gadow & Sprafkin. (2002). Child symptom inventory 4: Screening and norms manual. Stony brook. New York: Checkmate Plus.

    Google Scholar 

  • Gillott, A., Furniss, F., & Walter, A. (2001). Anxiety in high-functioning children with autism. Autism, 5, 277–286.

    Article  PubMed  Google Scholar 

  • Green, S. A., & Ben-Sasson, A. (2010). Anxiety disorders and sensory over-responsivity in children with autism spectrum disorders: Is there a causal relationship? Journal of Autism and Developmental Disorders, 40, 1495–1504.

    Article  PubMed Central  PubMed  Google Scholar 

  • Greenaway, R., & Howlin, P. (2010). Dysfunctional attitudes and perfectionism and their relationship to anxious and depressive symptoms in boys with autism spectrum disorders. Journal of Autism and Developmental Disorders, 40, 1179–1187.

    Article  PubMed  Google Scholar 

  • Grondhuis, S. N., & Aman, M. G. (2012). Assessment of anxiety in children and adolescents with autism spectrum disorders. Research in Autism Spectrum Disorders, 6, 1345–1365.

    Article  Google Scholar 

  • Hallett, V., Ronald, A., Colvert, E., Ames, C., Woodhouse, E., Lietz, S., et al. (2013a). Exploring anxiety symptoms in a large-scale twin study of children with autism spectrum disorders, their co-twins and controls. Journal of Child Psychology and Psychiatry, 54(11), 1176–1185.

    Article  PubMed  Google Scholar 

  • Hallett, V., Lecavalier, L., Sukhodolsky, D. G., Cipriano, N., Aman, M. G., McCracken, J. T., et al. (2013b). Exploring the manifestations of anxiety in children with autism spectrum disorders. Journal of Autism and Developmental Disorders, 43(10), 2341–2352.

    Article  PubMed  Google Scholar 

  • Kaufman, J., Birmaher, B., Brent, D., Rao, U., Flynn, C., Moreci, P., et al. (1996). Schedule for affective disorders and schizophrenia for school-age children—present and lifetime version (K-SADS-PL): Initial reliability and validity data. Journal of the American Academy of Child and Adolescent Psychiatry, 36, 980–988.

    Article  Google Scholar 

  • Kerns, C. M., & Kendall, P. C. (2013). The presentation and classification of anxiety in autism spectrum disorder. Clinical Psychology: Science and Practice, 19, 323–347.

    Google Scholar 

  • Kim, J. A., Szatmari, P., Bryson, S., Streiner, D., & Wilson, F. J. (2000). The prevalence of anxiety and mood problems among children with autism and Asperger syndrome. Autism, 4, 117–132.

    Article  Google Scholar 

  • Kline, P. (1999). Handbook of psychological testing (2nd ed.). London, New York: Routledge.

    Google Scholar 

  • Lecavalier, L., Wood, J. J., Halladay, A. K., Jones, N. E., Aman, M. G., & Cook, E. H., et al. (2013). Measuring anxiety as a treatment endpoint in youth with autism spectrum disorder. Journal of Autism and Developmental Disorders. Epub published ahead of print.

  • Leyfer, O. T., Folstein, S. E., Bacalman, S., Davis, N., Dinh, E., Morgan, J., et al. (2006). Comorbid psychiatric disorders in children with autism: Interview development and rates of disorders. Journal of Autism and Developmental Disorders, 36, 849–861.

    Article  PubMed  Google Scholar 

  • Li, C. J., Lau, W., & Au, T. K. (2011). Psychometric properties of the Spence children’s Anxiety Scale in a Hong Kong Chinese sample. Journal of Anxiety Disorders, 25, 584–591.

    Article  PubMed  Google Scholar 

  • Lord, C., Rutter, M., & Le Couteur, A. (1994). Autism diagnostic interview-revised: A revised version of a diagnostic interview for caregivers of individuals with possible pervasive developmental disorders. Journal of Autism and Developmental Disorders, 24(5), 659–685.

    Article  PubMed  Google Scholar 

  • Lord, C., Risi, S., Lambrecht, L., Cook, E. H., Leventhal, B. L., DiLavore, P. C., et al. (2000). The autism diagnostic observation schedule—generic: A standard measure of social and communication deficits associated with the spectrum of autism. Journal of Autism and Developmental Disorders, 30(3), 205–223.

    Article  PubMed  Google Scholar 

  • MacNeil, B. M., Lopes, V. A., & Minnes, P. M. (2009). Anxiety in children and adolescents with autism spectrum disorders. Research in Autism Spectrum Disorders, 3, 1–21.

    Article  Google Scholar 

  • Magiati, I., Ong, C., Lim, X. Y., Tan, J. W. L., Ong, A., Patricia, F., et al. (in preparation). Factors associated with the rates and phenomenology of anxiety difficulties in children and youth with Autism Spectrum Disorders: findings from a large community study.

  • March, J. S., & Mulle, K. (1998). OCD in children and adolescents: A cognitive-behavioral treatment manual. New York: Guilford Press.

    Google Scholar 

  • Mason, J., & Scior, K. (2004). ‘Diagnostic overshadowing’ amongst clinicians working with people with intellectual disabilities in the UK. Journal of Applied Research in Intellectual Disabilities, 17(2), 85–90.

    Article  Google Scholar 

  • Matilla, M.-L., Hurtig, T., Haapsamo, H., Jussila, K., Kuusikko-Gauffin, S., Kielinen, M., et al. (2010). Comorbid psychiatric disorders associated with Asperger syndrome/high-functioning autism: A community- and clinic-based study. Journal of Autism and Developmental Disorders, 40, 1080–1093.

    Article  Google Scholar 

  • Matson, J. L., & Gonzalez, M. (2007). Autism spectrum disorder—Comorbid for children. Baton Rouge, LA: Disability Consultants, LLC.

    Google Scholar 

  • Mayes, S. D., Calhoun, S. L., Murray, M. J., Ahuja, M., & Smith, L. A. (2011). Anxiety, depression, and irritability in children with autism relative to other neuropsychiatric disorders and typical development. Research in Autism Spectrum Disorders, 5, 474–485.

    Article  Google Scholar 

  • Mazefsky, C. A., Conner, C. M., & Oswald, D. P. (2010). Association between depression and anxiety in high-functioning children with autism spectrum disorders and maternal mood symptoms. Autism Research, 3(3), 120–127.

    Article  PubMed Central  PubMed  Google Scholar 

  • Mazefsky, C. A., Kao, J., & Oswald, D. P. (2011). Preliminary evidence suggesting caution in the use of psychiatric self-report measures with adolescents with high-functioning autism spectrum disorders. Research in Autism Spectrum Disorders, 5, 164–174.

    Article  PubMed Central  PubMed  Google Scholar 

  • Meera, S. S., Kaipa, R., Thomas, J., & Shivashankar, N. (2013). Brief report: An unusual manifestation of diagnostic overshadowing of pervasive developmental disorder—not otherwise specified: A five year longitudinal case study. Journal for Autism and Developmental Disorders, 43(6), 1491–1494.

    Google Scholar 

  • Middleton, H. A., Middleton, R. G., & Brown, G. W. (1990). Convergent and discriminant validities of the scales of independent behavior and the revised Vineland Adaptive Behavior Scales. American Journal on Mental Retardation, 94(6), 669–673.

    PubMed  Google Scholar 

  • Ministry of Health. (2010). Academy of medicine Singapore-ministry of health clinical practice guidelines: Autism spectrum disorders in pre-school children. Singapore Medical Journal, 51(3), 255–263.

    Google Scholar 

  • Nauta, M. H. (2005). Anxiety disorders in children and adolescents: Assessment, cognitive behavioural therapy, and predictors of treatment outcome. Enschede: Febodruk BV.

    Google Scholar 

  • Nauta, M. H., Scholing, A., Rapee, R. M., Abbott, M., Spence, S. H., & Waters, A. (2004). A parent-report measure of children’s anxiety: Psychometric properties and comparison with child-report in a clinic and normal sample. Behaviour Research and Therapy, 42, 813–839.

    Article  PubMed  Google Scholar 

  • Norris, M., & Lecavalier, L. (2010). Screening accuracy of level 2 autism spectrum disorder rating scales: A review of Selected Instruments. Autism, 14(4), 263–284.

    Article  PubMed  Google Scholar 

  • Ollendick, T. H., & White, S. H. (2012). The presentation and classification of anxiety in autism spectrum disorder: Where to from here? Clinical Psychology Science and Practice, 19, 255–352.

    Article  Google Scholar 

  • Ozsivadjian, A., Knott, F., & Magiati, I. (2012). Parent and child perspectives on the nature of anxiety in children and young people with autism spectrum disorders: A focus group study. Autism, 16(2), 107–121.

    Article  PubMed  Google Scholar 

  • Perreault, W. D., & Leigh, L. E. (1989). Reliability of nominal data based on qualitative judgments. Journal of Marketing Research, 26, 135–148.

    Article  Google Scholar 

  • Pfeiffer, B., Kinnealey, M., Reed, C., & Herzberg, G. (2005). Sensory modulation and affective disorders in children and adolescents with Asperger’s disorder. American Journal of Occupational Therapy, 59, 335–345.

    Article  PubMed  Google Scholar 

  • Renno, P., & Wood, J. J. (2013). Discriminant and convergent validity of the anxiety construct in children with autism spectrum disorders. Journal of Autism and Developmental Disorders, 43(9), 2135–2146.

    Google Scholar 

  • Research Units on Pediatric Psychology (RUPP). (2002). The pediatric anxiety rating scale (PARS): Development and psychometric properties. Journal of the American Academy of Child and Adolescent Psychiatry, 41(9), 1061–1069.

    Article  Google Scholar 

  • Reynolds, C. R., & Kamphaus, R. W. (2004). Behavioral assessment system for children manual. Circle Pines, MN: AGS Publishing.

    Google Scholar 

  • Reynolds, C., & Richmond, B. (1985). Revised children’s manifest anxiety scale: Manual. Los Angeles: Western Psychological Services.

    Google Scholar 

  • Rieske, D. R., Matson, J. L., Davis, T. E., I. I. I., Konst, M. J., Lindsey, W. W., & Whiting, S. E. (2013). Developmental Neurorehabilitation, 16(1), 9–16.

    Article  PubMed  Google Scholar 

  • Russell, E., & Sofronoff, K. (2005). Anxiety and social worries in children with Asperger syndrome. Australian and New Zealand Journal of Psychiatry, 39, 633–638.

    Article  PubMed  Google Scholar 

  • Silverman, W. K., Saavedra, L. M., & Pina, A. A. (2001). Test–retest reliability of anxiety symptoms and diagnoses with the Anxiety Disorders Interview Schedule for DSM-IV: Child and parent versions. Journal of the American Academy for Child and Adolescent Psychiatry, 40, 937–944.

    Article  Google Scholar 

  • Simonoff, E., Pickles, A., Charman, T., Chandler, S., Loucas, T., & Baird, G. (2008). Psychiatric disorders in children with autism spectrum disorders: Prevalence, comorbidity, and associated factors in a population-derived sample. Journal of the American Academy Child and Adolescent Psychiatry, 47(8), 921–929.

    Article  Google Scholar 

  • Sofronoff, K., Attwood, T., & Hinton, S. (2005). A randomised controlled trial of a CBT intervention for anxiety in children with Asperger syndrome. Journal of Child Psychology and Psychiatry, 46(11), 1152–1160.

    Article  PubMed  Google Scholar 

  • Spence, S. (1998a). A measure of anxiety symptoms among children. Behaviour Research and Therapy, 36, 545–566.

    Article  PubMed  Google Scholar 

  • Spence, S. A. (1998b). Structure of Anxiety symptoms among children: A confirmatory factor-analytic study. Journal of Abnormal Psychology, 106(2), 280–297.

    Article  Google Scholar 

  • Steinhausen, H., & Metzke, W. C. (2004). Differentiating the behavioural profile in autism and mental retardation and testing of a screener. European Child and Adolescent Psychiatry, 13(4), 214–220.

    Article  PubMed  Google Scholar 

  • Stewart, M. E., Barnard, L., Pearson, J., Hasan, R., & O’Brien, G. (2006). Presentation of depression in autism and Asperger syndrome: A review. Autism, 10(1), 103–116.

    Article  PubMed  Google Scholar 

  • Storch, E. A., May, J. E., Wood, J. J., Jones, A. M., Jones, J. B., De Nadai, A. S., et al. (2012a). Multiple informant agreement on the anxiety disorders interview schedule in youth with autism spectrum disorders. Journal of Child and Adolescent Psychopharmacology, 22(4), 292–299.

    Article  PubMed Central  PubMed  Google Scholar 

  • Storch, E. A., Wood, J. J., Ehrenreich-May, J., Jones, A. M., Park, J. M., Lewin, A. B., et al. (2012b). Convergent and discriminant validity and reliability of the pediatric anxiety rating scale in youth with autism spectrum disorders. Journal of Autism and Developmental Disorders, 42(11), 2374–2382.

    Article  PubMed  Google Scholar 

  • Sung, M., Ooi, Y. P., Goh, T. J., Pathy, P., Fung, D. S. S., Ang, R. P., et al. (2011). Effects of cognitive behavioral therapy on anxiety in children with autism spectrum disorders: A randomized controlled trial. Child Psychiatry and Human Development, 42(6), 634–649.

    Article  PubMed  Google Scholar 

  • Trembath, D., Germano, C., Johanson, G., & Dissanayake, C. (2012). The experience of anxiety in young adults with autism spectrum disorders. Focus on Autism and Other Developmental Disabilities, 27(4), 213–224.

    Google Scholar 

  • van Steensel, F. J., Bögels, S. M., & Perrin, S. (2011). Anxiety disorders in children and adolescents with autistic spectrum disorders: A meta-analysis. Clinical Child and Family Psychology Review, 14, 302–317.

    Article  PubMed Central  PubMed  Google Scholar 

  • van Steensel, F. J., Deutschman, A. A. C. G., & Bögels, S. M. (2012). Examining the screen for child anxiety-related emotional disorder-71 as an assessment tool for anxiety in children with high-functioning autism spectrum disorders. Autism: The International Journal of Research and Practice. E-publication ahead of print.

  • Warner, J. (2004). Clinicians’ guide to evaluating diagnostic and screening tests in psychiatry. Advances in Psychiatric Treatment, 10, 446–454.

    Article  Google Scholar 

  • Weisbrot, D. M., Gadow, K. D., DeVincent, C. J., & Pomeroy, J. (2005). The presentation of anxiety in children with pervasive developmental disorders. Journal of Child and Adolescent Psychopharmacology, 15, 477–496.

    Article  PubMed  Google Scholar 

  • White, S. W., & Robertson-Nay, R. (2009). Anxiety, social deficits, and loneliness in youth with autism spectrum disorders. Journal of Autism and Developmental Disorders, 39, 1006–1013.

    Article  PubMed  Google Scholar 

  • White, S. W., Oswald, D., Ollendick, T., & Scahill, L. (2009). Anxiety in children and adolescents with autism spectrum disorders. Clinical Psychology Review, 29, 216–229.

    Article  PubMed Central  PubMed  Google Scholar 

  • White, S. W., Schry, A. R., & Maddox, B. B. (2012). Brief report: The assessment of anxiety in high-functioning adolescents with autism spectrum disorder. Journal of Autism and Developmental Disorders, 42(6), 1138–1145.

    Article  PubMed  Google Scholar 

  • Whiteside, S. P., & Brown, A. M. (2008). Exploring the utility of the spence children’s anxiety scales parent- and child-report forms in a North American sample. Journal of Anxiety Disorders, 22, 1440–1446.

    Article  PubMed  Google Scholar 

  • Wigham, S., & McConachie, H. (2014). Systematic review of the properties of tools used to measure outcomes in anxiety intervention studies for children with Autism Spectrum Disorders. PLoS ONE, 9(1), 1–17.

    Article  Google Scholar 

  • Woo, B. S., Ng, T. P., Fung, D. S., Chan, Y. H., Lee, Y. P., Koh, J. B., et al. (2007). Emotional and behavioural problems in children based on parent, teacher and child reports. Medical Journal, 48(12), 1100–1106.

    Google Scholar 

  • Wood, J. J., & Gadow, K. D. (2010). Exploring the nature and function of anxiety in youth with autism spectrum disorders. Clinical Psychology: Research and Practice, 17, 281–292.

    Google Scholar 

Download references

Acknowledgments

This research was supported by the Grant from NUS Department of Psychology Start-up Fund awarded to the second author. We would like to acknowledge Ms. Jingyi Chan and Ms. Clarissa Ong for their assistance in the clinical interviews. We are grateful to the caregivers of the youth with ASD who participated in this study and to the specialist school and teachers who facilitated recruitment.

Conflict of interest

The authors report no conflicts of interest.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Iliana Magiati.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Zainal, H., Magiati, I., Tan, J.WL. et al. A Preliminary Investigation of the Spence Children’s Anxiety Parent Scale as a Screening Tool for Anxiety in Young People with Autism Spectrum Disorders. J Autism Dev Disord 44, 1982–1994 (2014). https://doi.org/10.1007/s10803-014-2075-0

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10803-014-2075-0

Keywords

Navigation