asperger 7

7/25/2019 Asperger 7

1/12

Anxiety in

Adolescents

With

Asperger

Syndrome:

Negative

Thoughts,

Behavioral Problems,

and Life Interference

Sylvana

Farrugia and

Jennifer Hudson

This study

examined

anxiety symptoms

in

29

adolescents with

Asperger

syndrome (AS)

aged 12 to 16 years, compared

to 30

nonclinical

(NC)

adolescents

and 34 adolescents

with anxiety

disorders

(AD). Comorbidity

between anxiety

symptoms

and

negative

thoughts, behavioral problems, and life

interference

was also examined. Self- and

parental reports revealed

significantly higher

levels of anxiety in both the AS

group

and the AD group

than in the NC group. Negative

thoughts,

behavioral

problems, and life interference

were significantly

higher for the

AS

group than

for

the two

comparison

groups.

sperger syndrome

(AS) is

one

of

the five

pervasive de-

velopmental

disorders PDDs) that

share a cluster of

developmental

problems in reciprocal

social interac-

tion,

communication,

and stereotyped

interests

and

behaviors

American

Psychiatric

Association

[APA],

2000).

S

is,

how-

ever,

a distinctive subtype

of PDD, characterized

by social

dysfunction

and idiosyncratic

interests,

without clinically sig-

nificant delay in language

and

cognitive development. Diag-

nosing individuals

with AS is complicated.

First, there

is

no

universal agreement

on diagnostic criteria

(Klin, Volkmar,

Sparrow,

2000).

Second,

the

term

Aspe ger

syndrome

is often

used synonymously

with high-functioning

autism HFA),

characterizing those who

function at the

high

end of the autis-

tic

spectrum disorders ASD),

a term used synonymously

with

PDD Ghaziuddin, 2002).Third,

individuals

with

S

present

with high rates

of comorbid disorders,

which might delay or

obscure

the diagnosis of AS Sverd, 2003).

Common

comorbid

problems in the AS population in -

dude

emotional disorders such as anxiety

and

depression

Ghaziuddin,

Weidmer,

Ghaziuddin, 1998; Wing, 1981) as

well as behavioral disorders

such as conduct disorder

CD),

oppositional defiant

disorder ODD),

and attention-deficit/

hyperactivity

disorder ADHD)

Barnhill et al.,

2000;

Gill-

berg,

2002).

Anxiety and depressive disorders

are conceptual-

ized as internalizing

disorder, while behavior disorders a

considered externalizing disorders

(Achenbach, 1985). D

spite this evidence,

most

of the studies

on comorbidity in

A

have focused

mainly on depression, rather than

anxiety and b

havioral

problems, which

are the focus

of

the present study

Comorbid

Anxiety Disorders

in

Adolescents With

AS

In the PDD population,

fears are

very

common and

occ

more

frequently

than

in

nondisabled controls (Matson

Lov

1990).

Clinically significant

anxiety, which differs from fe

on

level ofseverity, associated

distress, and life

interference, h

also

been documented. For

example,

Gillott,

Furniss,

and

W

ter (2001)

found that children

with HFA

reported

signi

candy higher

anxiety

levels

than

typically developing

childre

however, when

compared

to

the

clinically anxious

populatio

mean,

children with

HFA obtained

lower

anxiety scores. O

the

other hand, two studies using structured

clinical intervie

found

that

individuals with

PDD met

full

criteria

for at lea

one anxiety

disorder

(Muris

Steerneman,

1998;

Rumse

Rapoport, Sceery, 1985).

Clinicians

have also observed high

levels of anxiety

in

t

adolescent

population

(Attwood,

1998;

Szatmari,

1991; Ta

tam, 2000; Wing,

1996). Despite

these clinical accounts,

well as the strong evidence

that

anxiety

disorders are one

the most common forms

ofadolescent psychopathology

(Don

van

Spence, 2000), research

on

anxiety in

adolescents wi

AS

is still lacking.

However, the few

studies that

have

emerge

in recent

years

found

that both

self- and parental reports

sho

that

adolescents

with AS have

significantly

higher

levels

anxiety than

adolescents in the general

population (Bellin

2004;

Kim, Szatmari,

Bryson, Streiner,

Wilson, 200

Tonge, Brereton,

Gray, Einfeld,

1999) and adolescents w,

CD

(Green,

Gilchrist,

Burton,

Cox, 2000).

In

addition


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FOCUS ON

UTISM

ND OTHER DEVELOPMENT L

DISABILITIES

26

these

high internalizing

symptoms,

adolescents

with AS

have

high levels of

externalizing

problems

(Kim

et al., 2000).

In

fact,

levels of

conduct

and

overactivity

symptoms

are so high

that adolescents

with

AS

are sometimes

misdiagnosed

as

hav-

ing

CD

(Green

et al.,

2000)

or ADHD

(Attwood,

1998).

Comorbid

Behavior

Disorders

in

Adolescents

With S

In a

study

by Green

and

colleagues

2000), adolescents

with

AS

and

their parents

reported levels

of CD,

ODD,

and/or

ADHD

as

high as

adolescents

with

CD,

who like

adolescents

with

AS,

show a

failure

of

social adaptation,

even

though ofa

different

etiology. Kim

and

colleagues

2000)

also

found

clin-

ically

relevant scores

ofPADHD

and

ODD

in 9-

to 14-year-old

adolescents

with AS;

however,

based on

parental reports,

these

adolescents

did

not

reach clinically

significantly

levels

of CD .

Tonge

and colleagues

(1999)

found

that the

level of

behav-

ioral

problems in

adolescents

with

AS was higher

than that

found in

general

childhood populations

(Rutter,

1989) and

even

higher

than

that found

in populations

with

intellectual

disabilities

(Einfeld

Tonge,

1996).

The

point

illustrated

by these

studies is

that

adolescents

with AS

present

with both

emotional

and behavioral

problems.

But

what

are the risk

factors

for these

comorbid

problems

in

adolescents?

Apart

from

the

complex

interplay

between

bio-

logical,

psychological,

and

environmental factors

(Cooper,

2000),

cognition

has a

major

role

in

the

development

and

maintenance of

internalizing

and

externalizing

problems

in

clinical

and community

samples

of

adolescents (Schniering

Rapee,

2002,

2004a,

2004b).

Cognitive

Factors

in Adolescents

With S

According to

IFrith

(1991),

deficits

in cognitive

processes

also

have

a

role in

the

multiple behavioral

manifestations

exhibited

by

adolescents

with AS.

Individuals

with AS have

difficulties

in

conceptualizing

and

appreciating the thoughts

and feelings

of other

people Ozonoff

Miller,

1995).

They

are

also rigid

in their thinking (Church,

Alisanski,

&Amanullah,

2000),

which

makes

them

unable to

learn

from mistakes

(Prior

Hoff-

mann, 1990),

to cope

with

being wrong

(Attwood,

1998),

and

to

change

their behavior to

meet

environmental

demands

(Szatmari,

Bremner,

Nagy,

1989).

However,

to our

knowledge, there

is no

research investi-

gating

cognitive

biases

that

may

predispose or

maintain anxi-

ety

and behavioral

problems

in adolescents

with AS.

On

the

other hand,

cognitive

factors

related to depression

have

been

investigated

by

two studies

using the same

sample

of thirty-

three 12-

to

18-year-olds

with AS

(Barnhill, 2001;

Barnhill

Myles,

2001).

Barnhill found

a

significant

positive

relationship

between depressive

symptoms

and

ability

attributions

for

so-

cial failure.

Barnhill

and Myles

found

that adolescents

with AS

have

a learned

helplessness

style, meaning

that

the

more de-

pressive

symptoms

reported by the

adolescents, the

more

the

adolescents

explained

negative

events

by internal,

stable, and

global

causes.

These

results

are

consistent with

studies involv-

ing clinical

and

nonclinical adolescents

without AS,

whose de-

pressive

symptoms

were strongly

predicted by

thoughts

on

personal failure

(Schniering

Rapee,

2002, 2004a,

2004b).

These

researchers

also

found

that anxiety

symptoms

were

strongly

predicted

by thoughts

on social

threat,

whereas

ex-

ternalizing

symptoms

were strongly

predicted by

thoughts

on

hostility. Thus,

research

needs to be

conducted

to see if

the

cognitions of

adolescents

with AS are

also

related

to

specific

internalizing

and

externalizing

problems, which

in the

general

population have

been found

to

be

highly

distressing,

leading

to significant

life

interference

(Schniering

Rapee, 2002).

Level

of

Distress and

Life

Interference

in

Adolescents

With

S

Adolescents

with

AS experience difficulties

arising

from

their

core

symptoms

(Steyn Le

Couteur,

2003). In

addition, they

have

to deal

with the

transitional

changes

of adolescence,

which is a

difficult

time

for many teenagers,

but more so

for

adolescents

with

AS,

who

have

major

problems

with

peer

group identification

and peer relationships

(Green

et al.,

2000).

In fact,

Tantam

(1991) asserted

that

AS may cause

the

great-

est disability

in adolescence, when

social

relationships

are

the

key

to

almost every achievement. Even

though

at times ado-

lescents

with AS do not

consider

themselves

to

be at risk for

any of

these

problems (Barnhill

et

al., 2000),

these

complexi-

ties

dearly

provide difficulties

for

them

(Groden,

Cantela,

Prince,

Berryman, 1994),

affecting

their

overall

life

adapta-

tion

and leading to

a

highly disabling

condition

(Tantam,

2000).

Thus

it

is important

that adolescents

with AS are

iden-

tified

as

early

as possible

and

provided with

appropriate

inter-

ventions.

The

Present

Study

Recent

years have

witnessed

numerous

studies

on anxiety

and

behavior

disorders in

adolescents,

but

the

presence

of

these

problems in adolescents

with

AS has rarely

been

studied. In

the

few

studies that have

been

conducted,

individuals

with AS

demonstrated

high

levels of

both anxiety

and behavioral

prob-

lems.

However,

none of

these

studies

examined

anxiety

and

behavioral

problems specifically

in adolescents

with AS and

used

comparison

groups to

tease

apart

the

specificity

or

gen-

erality of

these

problems.

It

is

important

to

examine anxiety

and behavioral symp-

toms

in adolescents

with AS

because

they

might represent

ad-

I


3/12

VOLUME 21, NUMBER

1 SPRING 6

ditional

debilitating problems,

which

if left untreated might

lead

to significant life interference

and

persist

through adult-

hood. In addition, the potential comorbidity

of

these

two

problems

might increase

the

overall severity

of the

condition.

This comorbidity of

emotional and

behavioral problems,

as

well as

their impact on quality of

life,

are

two other areas

that

have

not

been

covered

in

the

studies

of

adolescents

with

AS.

In this population

there is also a paucity of research on cogni-

tion,

which in

the general population has

been found to be

a

critical

factor

in the development

and maintenance

ofboth

in-

ternalizing and

externalizing disorders.

The

reviewed

studies

on adolescents

with AS

were

further limited because

they

(a) used

only

one-tailed

statistical analysis,

thus

predicting

the

direction

of

the results,

and

(b) used either

a parent or

self-

report,

between which

there is a demonstrated low

level of

agreement

(Engel, Rodrigue,

Geften, 1994) that could

skew

the results.

In an effort to address

these issues,

the present

study

ex-

amined anxiety symptoms in adolescents

with

AS

and

provided

two

comparison

groups,

a

group

of

individuals

with

anxiety

disorders

(AD) and

a group of individuals from

the

general

population

(nonclinical;

NC). The

relationship

betveen

anxi-

ety

symptoms and negative

automatic thoughts, behavioral

problems, and life

interference was also examined.

The meth-

odology

of

this study was

strengthened

by

the

use of

nondi-

rectional

two-tailed

analyses and information

obtained from

both adolescents and

parents.

The

purpose of

the

present

study was to

answer the

following

questions:

1.

Are adolescents

diagnosed

wvith

AS

more

likely

to

experience symptoms of

anxiety

than

adolescents in

the general population?

And is the level

of

anxiety

experienced

by adolescents

with AS as high as that

experienced

by adolescents

with

AD? It

was anticipated

that

adolescents

with AS and adolescents

wvith AD

would

both

manifest

significantly

higher

levels

of

anxiety

than

the

NC group.

2.

Do the three diagnostic groups

differ significantly on

levels

of

negative

automatic thoughts, behavioral prob-

lems, and life interference?

Is there a

correlation between

any

of these three

factors and anxiety

symptoms? And

are the negative automatic

thoughts correlated

with

the

anxiety and

behavioral

problems

exhibited

by adolescents

with AS?

It

was

expected

that

due to the equivalent

levels

of

anxiety

symptoms exhibited by adolescents

wiith AS and

adolescents

with

AD,

both

would

exhibit

more negative

thoughts, behav-

ioral

problems,

and life

interference when compared to

the NC

group. It was also

anticipated that

threat-based

thoughts

would

correlate

with

anxiety

symptoms, whereas

hostility cog-

nitions would

correlate wvith behavioral problems

in all

three

diagnostic groups.

2

Method

rticip nts

The sample consisted of 93 adolescents and one of

their par

ents:

29 adolescents with

AS, 34

adolescents

with

AD, and

3

NC

adolescents.

The 64

(69 )

boys

and 29

(31 )

girls

wer

between 12 and

16 years

of age,

with

a

mean age of 13.8

years

The AD and

NC groups had similar

proportions

of boys

and

girls,

but

the AS group

had a higher

boy

to girl ratio, which

consistent

with the

gender ratio found in the AS

population

(AD:

19

boys,

15

girls;

NC:

19

boys,

11 girls; AS: 26 boys

3 girls).

Asperger Group. Adolescents with

AS

were

recruited v

two sources:

20 from local

support groups and

the remain

ing 80 via the Autism

Association of

New South Wale

(NSW).

All of the

adolescents

in this

group

had

been diag

nosed

with AS by qualified

mental health

professionals:

31

by psychiatrists,

28

by

clinical psychologists,

21 by child pe

diatricians

and

clinical

psychologists, 17

by child pediatri

cians, and

one adolescent diagnosed by

a

clinical

psychologis

and

a

psychiatrist.

These adolescents were

diagnosed

within

the last

8

years in

the following settings: private

practice (55 )

the Autism Association of

NSW (24 ); Forestville

Autism Aus

tralia

(10 ); and the

Child

and

Family Health Center,

Delphi

Anxiety,

and Westmead

Children's Hospital, with

the

latte

three settings

diagnosing one adolescent

each.

Anxious

Group.

Adolescents from

the

AD

sample

pre

sented

for assessment and

treatment

at

the Macquarie

Un

versity

Child and

Adolescent Anxiety

Clinic,

Sydney, A ustralia

Postgraduate students in

clinical

psychology,

under the super

vision of experienced

clinical psychologists,

interviewed th

adolescents

and their

parents

separately,

using

the Anxiety Dis

orders

Interview

Schedule for DSM IV Child and Parent

Ver

sion

ADIS-IV-C/P;

Silverman

Albano, 1996). From th

assessed 88 participants,

54 met criteria

for another disorde

in

addition

to anxiety.

The present

study

included the 34

ado

lescents who

only

met criteria for anxiety disorders,

with d

agnosis based

on

interviews

with both

parents

and adolescents

The

principal diagnosis

in

the

AD

group

included

the

follow

ing:

generalized

anxiety

disorder

(41 ),

separation

anxiety dis

order

(18 ),

social

phobia

(18 ),

obsessive

compulsive

disorde

(15 ), specific

phobia

(6 ) and panic

(3 ),

with

73

diag

nosed with

more than one anxiety disorder.

Nonclinical Group.

The NC group

consisted

of

adoles

cents

recruited

from

the

community

via an advertisemen

placed in

a local

newspaper.

To avoid bias,

the advertisemen

provided

a general statement

that the study was investigatin

factors affecting

adolescents.

The inclusion criterion

was tha

these

adolescents

have never sought

treatment from a

menta

health

professional.

These participants

were

not

interviewed


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FOCUS ON AUTISM

AND

OTHER

DEVELOPMENTAL DISABILITIES

28

because

we

did

not

want

to select a

diagnosis-free

group.

Rather,

we

wanted

to make

comparisons with a more

normally

distributed

nonclinical group.

It

is recognized,

therefore, that

some of these

adolescents

may have

met

criteria

for some

forms

of

psychopathology.

Since

the NC group was the

most

difficult to recruit,

these participants received monetary

com-

pensation.

e sures

Questionnaires. The Children sAutomaticThoughts

Scale

(CATS; Schniering

Rapee, 2002) is a self-report

of negative

automatic thoughts

in children

aged

7-16

years. It consists

of

40 items yielding a total score

and

four cognitive

subscales:

(a)

Physical Threat, (b) Social Threat,

(c) Personal Failure, and

(d)

Hostile Intent. The

scale

effectively

discriminates between

nonclinical and clinical

anxious,

depressed, or

behavior disor-

dered

children,

with a

mean total score

for the

community

group

significantly lower

than

the

mean for

the

anxious

group

(mean difference

= -25.88), the depressed group

(mean dif-

ference =

-30.52), and

the

behavior disordered group

(mean

difference =

-11.85). Internal consistency was also

very high

(.95), and

test-retest correlation

coefficient

for the total score

was

.76 at

3

months (Schniering

Rapee, 2004a, 2004b).

The present study slightly

modified the CATS

self-report

and

used

it

as

an informant report

for the

AS

group,

in

addition

to

self-report.

The Spence Children sAnxiety

Scale

(SCAS;

Spence, 1998)

is a

measure

of overall

levels

of anxiety

in children

and adoles-

cents.

In

addition

to the total score,

it

includes six

subscales

based

on

DSM-IV

criteria:

(a)

Panic/Agoraphobia,

(b)

So-

cial Phobia, (c)

Separation Anxiety, (d) Generalized

Anxiety,

(e) Obsessive-Compulsiveness,

and (f) Fears

of Physical

Injury,

with the latter

closely

resembling Specific

Phobias in

DSM-IV.

The SCAS has

been found to

have

sound

psychometric prop-

erties, with

a

convergent validity of .75

and

an

internal relia-

bility

coefficient

of

.93

and

a

Guttman

split-half

reliability

of

.92 (Spence, Barrett, Turner,

2003).

The present study used

both the SCAS

self-report and parent report,

which correlate

well

with each other, with parent-child agreement

ranging

from

.41 to

.66

(Nauta et al.,

2004).

The

Strengthsand DifficultiesQuestionnaire

SDQ; Good-

man, 1997)

is

a

brief

behavioral screening measure consisting

of

25 positive

and negative attributes that generates scores for

five

subscales: (a) Emotional

Symptoms, (b) Conduct

Prob-

lems, (c) Hyperactivity/Inattention,

(d) Peer Relationship

Prob-

lems,

and (e)

Prosocial

Behavior. The first

four

subscales

are

added to

provide a

valid

total difficulty

score

with

an

internal

reliability of.82

(Goodman, 2001). The SDQ reliability

is sat-

isfactory, whether judged

by

internal

consistency

(mean = .73),

cross-informant correlation (mean = .34), or retest stability

up

to

6

months

(mean = .62) (Goodman, 2001). In the

present

study, adolescents

completed

the

self-report

version

suitable

for ages

11 to 16,

and

parents

completed the informant-rated

version, which covers

the

same

25 items, thus

increasing com

parability

of

scores obtained

from children and parents (Good

man, Meltzer, Bailey, 2003).

The

Life

nterference

Measure

(LIM;

Lyneham, Abbott,

Rapee,

2003) is

a new self-report questionnaire

consisting

of

31

items scored

on a scale

from

0 to 4,

which

when added to

gether

give a

global

life

interference score.

The

self-report ver

sion was slightly

modified and used as an informant report

for

the

AS group. This measure

has not

yet

been

analyzed

for

psy

chometric properties; however, an analysis using

the data

from

the present

study showed high

internal

reliability

for

both

the adolescents' (alpha = .95)

and parents'

(alpha = .91)

tota

score.

Additional Questions. In

addition to completing

the

four questionnaires (SCAS, SDQ, CATS,

LIM),

the parents

o

adolescents

with AS were

asked

to

answer

the

following six ad

ditional

questions

written

by

the

researchers: (a)

In

which

clinic/center

was

your

child diagnosed?

(b)

Which

of

these

professionals (child

pediatrician, clinical psychologist, psychia-

trist,

other)

diagnosed

your

child? (c) How long ago was

you

child diagnosed?

(d)

Has

your

child ever been given psycho

logical

treatment? If

yes, what

type of

treatment?

(e)

Has

you

child ever

been

given

treatment for

anxiety symptoms?

If yes

what type of

treatment?

(f)

Is your child

taking

any

medica

tion?

If

yes, what type of

medication and for what problem?

Procedure

This

research

was

approved

by

Macquarie

University Ethic

Review

Committee, the

Macquarie University Anxiety Re-

search

Unit,

and

the

Education and Research Committee

o

the Autism Association

of

NSW.

In the

AD group,

parents

seeking treatment

for their

chil

dren's anxiety contacted

the

Child and Adolescent

Anxiet

Clinic

for

an initial

assessment. The clinic sent the

family the

information/consent form to be signed by

parents and

ado

lescents,

as well as

the four parent

questionnaires

(SCAS

CATS, SDQ,

LIM) and

the

two self-questionnaires (SCAS

SDQ). Participants

returned the

questionnaires and consen

form at

the time

of the assessment;

postgraduate clinical psy

chology students

interviewed the parents and adolescents sep

arately,

using the

ADIS-IV-C/P.

In

the AS group,

an

information

sheet

explaining the

na

ture

of

the

present study

was sent

to five AS support

groups

The

parents

of interested

participants were asked to

contac

the

researchers by

phone. The self-report and parent report o

the

four questionnaires

(SCAS,

CATS,

SDQ,

LIM) were sen

to

these participants, together with the six

additional question

and

the information/consent

form.

Parents and

adolescent

were

asked to

separately fill

in

the

questionnaires, which would

take approximately a

half

hour,

and

return them

in

the self

addressed envelope.

Recruitment of other adolescents with AS

was

completed through

the Autism Association of

NSW. On


5/12

21, NUMBER

1,

SPRING 2006

2

hundred

self-addressed

envelopes, each

containing the pack-

age

of questionnaires,

additional questions, and information/

consent forms, were given

to

the principals of four

different

schools,

situated at Central

Coast, South

East

Sydney,

West-

ern Sydney,

and North

Sydney,

who

sent the

envelopes

to the

families of students

with

AS;

participation

was

voluntary.

To

attend

these

particular

schools,

the

adolescents

had

to

have

been diagnosed

with

AS by qualified

mental

health profes-

sionals.

To validate the self-report

method of this

study,

rather than

relying

only

on

the answers

provided by adolescents

Nith AS,

who

might

have

misunderstood the items due

to

their

diffi-

culties with abstract terms,

a parent version of each

measure

was

included,

thus

increasing

our

confidence

that the

results

obtained are reliable.

In the NC group, those interested were

asked to contact

the researchers by

phone.

After

ensuring

that they

had

never

sought

treatment from mental

health professionals,

the re-

searchers sent

them a

self-addressed

envelope containing

the

SCAS

and

SDQ parent version

and

the

SCAS, CATS,

SDQ,

and LIM self version,

together with the

information/consent

form. Participants

indicated their willingness

to participate

in

the study by returning

the signed consent

form,

together with

the

completed questionnaires,

to the researchers. These

par-

ticipants

then

received

monetary comp ensation for their

par-

ticipation.

Results

Preliminary

Analyses

Gender.

Although the

three

diagnostic

groups

differed

significantly

with

respect

to gender,

c

2

(2, N =

93)

= 8.94,

p

< .05, no significant

difference was found

between

male and

female

scores on the administered measures,

so gender

was not

used as a covariate in

later

analyses.

Age.

The

adolescents'

age was not significantly

different

across the three

diagnostic

groups,

F(2, 90) =

.78,

p

>

.05

(AS

group, M = 13.76,

SD = 1.27;

AD

group, M =

13.82,

SD

1.29; NC group,

M=

13.90, SD 1.56). In

addition,

no

sig-

nificant

correlation

was

found

between

age

and

anxiety

levels

as

measured

by the

SCAS self-report

total score: AS group,

r(29) = .27, p >

.05;

AD

group, r(34) = .07, p > .05, and NC

group, ;(30)

= .35, p > .05.

Analyses

Differences

betveen the three

diagnostic

groups

were investi-

gated using one-way

analysis

of variance

(ANOVA).

The

de-

pendent

measures

for the analyses included

the raw total scores

and subscales of

the SCAS, CATS,

SDQ,

and

LIM,

both

par-

ent and self-report.

A

Bonferroni correction was used

to

adjust

for

inflation

of

the Type

1

error

rate

on

follow-up comparisons.

TABLE 1

Correlation

Between Adolescent Self-Reports and

Parent

Reports in Each Group on All Four Measures

Asperger Anxious

Nonclinica

Measure (n = 29)

n

= 34)

(n = 30)

SCAS

.697 *

.527**

.433*

CATS .727**

SDQ .515** .566**

.410*

L M

.688**

Note.

SCAS

= Spence

Children s

Anxiety Scale

(Spence, 1998 ; CATS =

Children s

Automatic Thoughts Scale (Schniering

Rapee, 2002); SDQ

Strengths

and Difficulties

QuestionnaireGoodman,

1997 ; LIM = Life

Interference Measure

(Lyneham,

Abbott, Rapee,

2003 . Dashes indicate

that

the

CATS

and

LIM

measures

were not

administered

to parents

of

adolescents in the

anxiety

disorders and nonclinical

groups.

p

asperger 7

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