Assessing anxiety in Iranian children with Autism Spectrum Disorder

Background: Children with Autism Spectrum Disorders (ASD) experience higher levels of anxiety than their non-ASD peers. This can result in a poorer quality of life and significant mental health problems. To date, there is no readily available instrument for Iranian practitioners to assess anxiety in children with ASD. Method: A translated version of a 24 item scale developed in the UK was tested with 254 parents drawn from different cities in Iran who rated their child's anxiety. In addition, a subsample of 58 of these children rated themselves. Results: Analysis of parents' ratings identified three factors reflecting different forms of anxiety: Performance Anxiety, Uncertainty and Anxious Arousal. The fourth subscale from the original English version (Separation anxiety) was not replicated, with three of these items not loading on to any subscale and the remaining one loading on the Uncertainty subscale. The total scale score and three subscale scores had good internal consistency and test-retest reliability for both the parent and child ratings. However parents tended to underestimate their children's level of anxiety; particularly anxious arousal. Conclusions: The study demonstrated the need to adapt scales to other cultures and to obtain children's perspectives as well as that of parents. The availability of a reliable assessment tool will help practitioners to identify and evaluate intervention strategies to ameliorate anxiety in children with ASD.