Psychometric properties of the revised children's anxiety and depression scale (RCADS) for autistic youth without co-occurring intellectual disability

Applicability and Psychometric Properties of General Mental Health Assessment Tools in Autistic People: A Systematic Review

In recent years, there has been a proliferation of instruments for assessing mental health (MH) among autistic people. This study aimed to review the psychometric properties of broadband instruments used to assess MH problems among autistic people. In accordance with the PRISMA guidelines (PROSPERO: CRD42022316571) we searched the APA PsycINFO via Ovid, Ovid MEDLINE, Ovid Embase and the Web of Science via Clarivate databases from 1980 to March 2022, with an updated search in January 2024, to identify very recent empirical studies. Independent reviewers evaluated the titles and abstracts of the retrieved records (n = 11,577) and full-text articles (n = 1000). Data were extracted from eligible studies, and the quality of the included papers was appraised. In all, 164empirical articles reporting on 35 instruments were included. The review showed variable evidence of reliability and validity of the various instruments. Among the instruments reported in more than one study, the Aberrant Behavior Checklist had consistently good or excellent psychometric evidence. The reliability and validity of other instruments, including: the Developmental Behavior Checklist, Emotion Dysregulation Inventory, Eyberg Child Behavior Inventory, Autism Spectrum Disorder-Comorbid for Children Scale, and Psychopathology in Autism Checklist, were less documented. There is a need for a greater evidence-base for MH assessment tools for autistic people.

Anxiety Disorders in Autistic People: A Narrative Review

Anxiety is the most common co-occurring mental health condition across the lifespan for autistic people. The authors summarize the extant research on prevalence, correlates and predictors, measurement, and treatment of anxiety disorders in autistic people, which has rapidly expanded in the past decade. In addition to addressing gaps within each of these areas, the authors propose that there is a need for future work to center autistic perspectives, employ longitudinal designs, and expand the focus to include autistic adults and those with co-occurring intellectual disability.

Psychometric Validation of the Slovenian Version of the Revised Child Anxiety and Depression Scale - Child and Parent Versions (RCADS and RCADS-P)

Objective

Anxiety and depression are common disorders in children and adolescents and can have a negative impact on their lives. The Revised Child Anxiety and Depression Scale - Child and Parent versions (RCADS and RCADS-P) are widely used standardized measurement tools, but the Slovenian versions have not yet been validated. The aim of the present study was to examine the psychometric properties of the Slovenian version of RCADS and RCADS-P in a representative Slovenian school sample.

Methods

We examined the psychometric properties (factor structure, internal reliability, short-term stability, inter-rater agreement and convergent validity) of the Slovenian version of the RCADS and the RCADS-P in 754 primary and secondary school students and parents of 485 students. The short-term stability of anxiety and depressive symptoms in youth was assessed in a subsample of 117 children and adolescents.

Results

Confirmatory factor analysis showed an acceptable fit of the 6-factor model with CFI=0.92, TLI=0.92 and RMSEA=0.056 for RCADS and with CFI=0.93, TLI=0.92 and RMSEA=0.047 for RCADS-P. Cronbach's α and McDonald's ω ranged from 0.70 to 0.95 for the total scale and the six subscales. The subscales correlated significantly positively with the total Child Anxiety Life Interference Scale score.

Conclusion

The results affirm the good psychometric properties of the Slovenian versions of RCADS and RCADS-P within a school-based sample. There is a need in the future to examine psychometric properties in clinical samples and to provide normative data.

Exploring and comparing the relationship between maternal anxiety and children's anxiety during admission, hospitalization, and discharge in pediatric wards of Iranian hospitals

BACKGROUND

Parental anxiety levels increase during their child's hospitalization. Consequently, anxiety can disrupt parental functioning as a caregiver and potentially transfer distress to the child. This study seeks to explore how maternal anxiety affects the anxiety levels of hospitalized children across three key stages: admission, in-hospital stay, and discharge.

METHODS

A cross-sectional study was conducted with hospitalized children aged 8 to 15 years their mothers. The sample size was determined based on the formula. Data were collected using demographic questionnaires and validated tools, including the State-Trait Anxiety Inventory (STAI) and the Spence Children's Anxiety Scale (SCAS). The STAI measures state and trait anxiety, while the SCAS assesses various domains of child anxiety. Data analysis involved descriptive statistics, Pearson correlation coefficients, and fractional polynomial modeling to assess anxiety trends.

RESULTS

The study involved 179 participants, with mothers averaging 36.95 years old. Most participants were homemakers (82.7%) and had less than a high school education (62.6%). The average number of children per mother was 2.02, and only 2.8% utilized assisted reproductive technologies. Maternal anxiety levels were notably high, with mean state anxiety scores decreasing slightly from 45.74 at admission to 44.53 at discharge. Trait anxiety scores followed a similar trend, averaging 42.79 at admission and dropping to 41.60 at discharge. The Spence Children's Anxiety Scale scores were relatively stable, starting at 50.93 at admission and ending at 50.89 at discharge. Severe state anxiety affected 25.7% of participants, while 11.2% experienced severe trait anxiety. Importantly, significant positive correlations were identified between maternal anxiety and children's anxiety throughout the hospitalization period.

CONCLUSION

This study reveals high levels of both maternal and pediatric anxiety throughout hospitalization. Mean scores for state and trait anxiety remained elevated at all stages, with significant correlations between maternal and child anxiety. These results highlight the need for targeted interventions to address and manage anxiety in both mothers and children during hospital stays. Future research should focus on strategies to mitigate these anxieties and improve support for families.

Exploring the association between social camouflaging and self- versus caregiver-report discrepancies in anxiety and depressive symptoms in autistic and non-autistic socially anxious adolescents

LAY ABSTRACT

Social camouflaging or masking refers to strategies autistic individuals adopt to hide their autism persona when trying to fit in. It is unclear whether camouflaging is only applicable to social differences unique to autism, or more generally to any types of social difference, such as experiences of mental health difficulties. We asked 43 autistic and 39 non-autistic adolescents (aged 14-19 years, all of whom showed similarly high levels of social anxiety) and their primary caregivers to complete questionnaires about their mental health (anxiety and depression) and autistic traits, and adolescents self-reported camouflaging behaviours. We wondered if camouflaging may be used to hide mental health difficulties reported by young people and affect caregiver report on symptom severity. We found that adolescents who self-reported greater levels of autistic traits, anxiety and depression symptoms compared with their caregivers reported greater camouflaging. Adolescents who agreed on having high levels of autistic traits and anxiety symptoms with their caregivers reported greater camouflaging behaviours. We discuss how having high levels of autistic traits and anxiety may increase adolescents' camouflaging behaviours to hide social differences, which may contribute towards poor mental health outcomes. We think it is important to talk with adolescents about how camouflaging social and mental health difference can have negative impacts for mental health as well as possible positive social gains.

Community-guided, autism-adapted group cognitive behavioral therapy for depression in autistic youth (CBT-DAY): Preliminary feasibility, acceptability, and efficacy

LAY ABSTRACT

Depression in youth is a significant public health problem worldwide, particularly for autistic youth who are over twice as likely to experience depression than their non-autistic peers. Although pathways to depression are complex, emotional reactivity and negative self-esteem are two risk factors for depression in autistic and non-autistic youth. Although autistic youth are more likely to experience depression than their non-autistic peers, psychotherapy options for autistic youth are very limited; community guidance in the development and testing of psychotherapy programs is a promising approach in autism. Therefore, in this study, we designed an autism-adapted CBT-DAY, in collaboration with autistic community members. Specifically, CBT-DAY combined neurodiversity-affirming and cognitive behavioral approaches to target emotional reactivity and self-esteem in youth to improve depressive symptom severity in a group setting across 12 weeks. We examined the preliminary feasibility, acceptability, and efficacy of CBT-DAY in a pilot non-randomized trial. In addition, we implemented a rigorous protocol for assessing, monitoring, and addressing potential harms in this intervention. Results from 24 autistic youth (11-17 years old) suggest that CBT-DAY may be feasible to use in an outpatient clinical setting and generally acceptable to youth and their caregivers. Participation in CBT-DAY may be associated with significant improvements in youth emotional reactivity and self-esteem, as well as depressive symptom severity per self-report only. Exploratory analyses showed that participation in CBT-DAY may also be associated with significant improvements in internalizing symptoms. Findings demonstrate the potential promise of neurodiversity-affirming and cognitive behavioral approaches to treating depressive symptoms in some autistic youth.