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Profiles and Correlates of Parent-Child Agreement on Social Anxiety Symptoms in Youth with Autism Spectrum Disorder

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Title: Profiles and Correlates of Parent-Child Agreement on Social Anxiety Symptoms in Youth with Autism Spectrum Disorder
Language: English
Authors: Burrows, Catherine A., Usher, Lauren V., Becker-Haimes, Emily M., McMahon, Camilla M., Mundy, Peter C., Jensen-Doss, Amanda, Henderson, Heather A.
Source: Journal of Autism and Developmental Disorders. Jun 2018 48(6):2023-2037.
Availability: Springer. 233 Spring Street, New York, NY 10013. Tel: 800-777-4643; Tel: 212-460-1500; Fax: 212-348-4505; e-mail: service-ny@springer.com; Web site: http://www.springerlink.com
Peer Reviewed: Y
Page Count: 15
Publication Date: 2018
Sponsoring Agency: National Institutes of Health (DHHS)
Contract Number: R01MH71273
Document Type: Journal Articles
Reports - Research
Descriptors: Correlation, Parent Child Relationship, Anxiety, Symptoms (Individual Disorders), Pervasive Developmental Disorders, Autism, Children, Adolescents
DOI: 10.1007/s10803-018-3461-9
ISSN: 0162-3257
Abstract: This study characterized patterns and correlates of parent-youth agreement on social anxiety in youth with and without autism spectrum disorder (ASD). Participants (279 verbally-fluent youth aged 8-16 years, NASD = 144, NTD = 135) completed the SASC-R. Youth with ASD exhibited higher social anxiety across informants. While TD youth endorsed higher anxiety than did parents, self- and parent-reports did not differ in youth with ASD. For children with ASD, higher parent-youth agreement was associated with lower lifetime ASD symptoms and higher adaptive skills. For TD youth, agreement on high anxiety was associated with lowest adaptive skills. Demographic factors (age, verbal IQ, gender) did not relate to agreement for either group. In ASD, parent-child agreement on youth anxiety, either high or low, was associated with better outcomes.
Abstractor: As Provided
Number of References: 74
Entry Date: 2018
Accession Number: EJ1179106
Database: ERIC
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  Value: <anid>AN0129572143;aut01jun.18;2018May14.10:34;v2.2.500</anid> <title id="AN0129572143-1">Profiles and Correlates of Parent-Child Agreement on Social Anxiety Symptoms in Youth with Autism Spectrum Disorder </title> <p>This study characterized patterns and correlates of parent-youth agreement on social anxiety in youth with and without autism spectrum disorder (ASD). Participants (279 verbally-fluent youth aged 8-16 years, N<sub>ASD</sub> = 144, N<sub>TD</sub> = 135) completed the SASC-R. Youth with ASD exhibited higher social anxiety across informants. While TD youth endorsed higher anxiety than did parents, self- and parent-reports did not differ in youth with ASD. For children with ASD, higher parent-youth agreement was associated with lower lifetime ASD symptoms and higher adaptive skills. For TD youth, agreement on high anxiety was associated with lowest adaptive skills. Demographic factors (age, verbal IQ, gender) did not relate to agreement for either group. In ASD, parent-child agreement on youth anxiety, either high or low, was associated with better outcomes.</p> <p>Autism spectrum disorder; Social anxiety; Informant discrepancies; Measurement</p> <hd id="AN0129572143-2">Introduction</hd> <p>In addition to exhibiting the socio-communicative difficulties and restricted and repetitive behaviors that accompany autism spectrum disorder (ASD; APA [<reflink idref="bib5" id="ref1">5</reflink>] ), youth with ASD display a host of co-occurring psychopathologies (Mazurek [<reflink idref="bib44" id="ref2">44</reflink>] ; van Steensel et al. [<reflink idref="bib66" id="ref3">66</reflink>] ; White et al. [<reflink idref="bib70" id="ref4">70</reflink>] ). Social anxiety is one of the most commonly-endorsed comorbid conditions in ASD, but also one of the hardest to disentangle from the social difficulties inherent to the ASD diagnosis (Kerns et al. [<reflink idref="bib30" id="ref5">30</reflink>] ). Accurate assessment of social anxiety in youth with ASD is critical to identifying additional impairment beyond what can be attributed to ASD symptoms, and may help inform treatment (White et al. [<reflink idref="bib70" id="ref6">70</reflink>] ). Evidence-based assessment guidelines indicate that accurate assessment of anxiety should rely on multiple informants’ ratings (Mash and Hunsley [<reflink idref="bib41" id="ref7">41</reflink>] ; Silverman and Ollendick [<reflink idref="bib60" id="ref8">60</reflink>] ). However, different informants (e.g., parents, youth, teachers) often report discrepant information about youth symptoms (Achenbach et al. [<reflink idref="bib1" id="ref9">1</reflink>] ; De Los Reyes et al. [<reflink idref="bib16" id="ref10">16</reflink>] ; De Los Reyes and Kazdin [<reflink idref="bib17" id="ref11">17</reflink>] ; Kraemer et al. [<reflink idref="bib32" id="ref12">32</reflink>] ).</p> <p>While several studies have investigated profiles and correlates of informant agreement/discrepancy on social anxiety in typically developing youth with anxiety (Affrunti and Woodruff-Borden [<reflink idref="bib3" id="ref13">3</reflink>] ; Becker et al. [<reflink idref="bib6" id="ref14">6</reflink>] ; Ohannessian and De Los Reyes [<reflink idref="bib52" id="ref15">52</reflink>] ), there have been no comprehensive evaluations of concordance of youth self- and parent-reports in youth with ASD (Kreiser and White [<reflink idref="bib33" id="ref16">33</reflink>] ). Understanding patterns and unique correlates of parent-youth informant agreement for social anxiety in ASD youth may facilitate diagnostic decisions and treatment in this population. Therefore, we examined patterns and correlates of parent-youth informant agreement on youth social anxiety symptoms in matched samples of youth with and without ASD.</p> <p>Symptoms of social anxiety include worry about social performance and fear of negative evaluation by others (Bellini [<reflink idref="bib7" id="ref17">7</reflink>] ; Kuusikko et al. [<reflink idref="bib34" id="ref18">34</reflink>] ; La Greca and Stone [<reflink idref="bib35" id="ref19">35</reflink>] ; White and Roberson-Nay [<reflink idref="bib71" id="ref20">71</reflink>] ). Social anxiety typically onsets in late childhood and may hinder a child’s adaptive response to real-world challenges (i.e., adaptive skill; Pfeiffer et al. [<reflink idref="bib54" id="ref21">54</reflink>] ). Given the bidirectional relationships between social skills deficits and anxiety in social situations, it is unsurprising that rates of social anxiety are high in samples of youth with ASD, particularly in verbally-fluent youth (Mayes et al. [<reflink idref="bib42" id="ref22">42</reflink>] ; White et al. [<reflink idref="bib70" id="ref23">70</reflink>] ). However, understanding social anxiety in youth broadly, as well as ASD specifically, is complicated by frequent discrepancy between parent and youth reports of youth social anxiety.</p> <p>De Los Reyes and Kazdin ([<reflink idref="bib17" id="ref24">17</reflink>] ) proposed the attribution bias context (ABC) model to conceptualize informant disagreement. In this model, it is hypothesized that disagreement on symptoms arises due to differences in informants’ attribution of behaviors, unique perspectives, and the nature of the assessment process. Domains of symptoms that are experienced internally (i.e., internalizing problems) are likely to demonstrate lower levels of agreement between reporters. Assessing agreement on social anxiety is of critical interest, as it is one of the most commonly occurring disorders but often manifests outside of parental observation. Furthermore, severity and presentation may change as youths’ social worlds evolve in adolescence (Mian et al. [<reflink idref="bib48" id="ref25">48</reflink>] ). Studies of profiles and correlates of agreement on social anxiety symptoms may help better understand the incremental utility of parent- versus self-reports, and whether similar patterns emerge across clinical groups.</p> <p>In typical development, youth tend to endorse higher levels of anxiety symptoms, including social anxiety (Affrunti and Woodruff-Borden [<reflink idref="bib3" id="ref26">3</reflink>] ), than their parents report the youth experience (Achenbach et al. [<reflink idref="bib1" id="ref27">1</reflink>] ; Achenbach and Rescorla [<reflink idref="bib2" id="ref28">2</reflink>] ; Rescorla et al. [<reflink idref="bib57" id="ref29">57</reflink>] ). Several factors contribute to informant agreement or discrepancy on youth anxiety symptoms. With regard to age, younger children may lack insight into, or understanding of, the symptoms they experience, leading parents to report higher symptoms than children (Becker et al. [<reflink idref="bib6" id="ref30">6</reflink>] ; Berg-Nielsen et al. [<reflink idref="bib8" id="ref31">8</reflink>] ; Choudhury et al. [<reflink idref="bib15" id="ref32">15</reflink>] ; Dirks et al. [<reflink idref="bib19" id="ref33">19</reflink>] ; Grills and Ollendick [<reflink idref="bib25" id="ref34">25</reflink>] ). Conversely, at older ages, parents may have fewer opportunities to observe adolescents in developmentally-salient contexts (Achenbach et al. [<reflink idref="bib1" id="ref35">1</reflink>] ; Bellini [<reflink idref="bib7" id="ref36">7</reflink>] ; Kuusikko et al. [<reflink idref="bib34" id="ref37">34</reflink>] ; La Greca and Stone [<reflink idref="bib35" id="ref38">35</reflink>] ; White and Roberson-Nay [<reflink idref="bib71" id="ref39">71</reflink>] ), and adolescents may mask their emotions (Grills and Ollendick [<reflink idref="bib25" id="ref40">25</reflink>] ). With respect to social anxiety, age has not shown a reliable association with informant concordance (Affrunti and Woodruff-Borden [<reflink idref="bib3" id="ref41">3</reflink>] ; Becker et al. [<reflink idref="bib6" id="ref42">6</reflink>] ).</p> <p>Characteristics of parents may also influence their perceptions and reports of child anxiety. In typical development, parental psychopathology is commonly associated with greater informant disagreement, with parents with higher anxiety symptoms themselves reporting higher youth social anxiety symptoms than youth report (Becker et al. [<reflink idref="bib6" id="ref43">6</reflink>] ; Niditch and Varela [<reflink idref="bib51" id="ref44">51</reflink>] ). Parents with high anxiety levels may be more attuned to cues of their child’s anxiety, or may misinterpret their child’s behavior as indicative of higher anxiety, which may be further compounded by the fact that parental internalizing problems confer risk for anxiety in the child (Boyle and Pickles [<reflink idref="bib11" id="ref45">11</reflink>] ; Müller et al. [<reflink idref="bib50" id="ref46">50</reflink>] ). Further characterization of correlates of social anxiety in typically developing youth, as well as evaluating whether similar correlates emerge in ASD youth may help identify whether the processes are comparable in ASD.</p> <p>A recent meta-analysis found moderate levels of parent-child agreement (mean weighted correlation of.42) across 16 studies of youth broadband internalizing symptoms in ASD, which is comparable to levels reported in normative samples (Stratis and Lecavalier [<reflink idref="bib62" id="ref47">62</reflink>] ). This meta-analysis found that agreement increased as the average age and IQ of the sample increased, and suggest that other youth characteristics may also relate to informant agreement on internalizing symptoms broadly. However, no studies have investigated correlates of informant discrepancies on social anxiety specifically. Another common comorbid difficulty in ASD, attention problems, may limit youths’ ability to accurately report on symptoms of psychopathology (Mazefsky et al. [<reflink idref="bib43" id="ref48">43</reflink>] ; Mogg et al. [<reflink idref="bib49" id="ref49">49</reflink>] ), as they may have difficulty sustaining the attention necessary to complete questionnaires.</p> <p>Autism symptoms and associated difficulties relate to an individual informant’s report of child social anxiety symptoms in ASD, yet no studies have investigated whether these characteristics relate to informant agreement beyond individual informants’ reports. Symptoms of ASD have previously also been associated with heightened parental reports of youth anxiety (Mayes et al. [<reflink idref="bib42" id="ref50">42</reflink>] ; Sukhodolsky et al. [<reflink idref="bib63" id="ref51">63</reflink>] ). Furthermore, the language difficulties inherent to the autism diagnosis may limit the ability of certain individuals with ASD to report on their social anxiety (Tantam [<reflink idref="bib64" id="ref52">64</reflink>] ). Interestingly, there is evidence that parents report higher anxiety for children with more mature adaptive functioning, particularly in children with intact verbal abilities (i.e., verbal IQ > 70; Sukhodolsky et al. [<reflink idref="bib63" id="ref53">63</reflink>] ). Thus, factors contributing to anxiety, such as self-monitoring and self-awareness, may simultaneously be associated with adaptive benefits for youth with ASD (Henderson et al. [<reflink idref="bib26" id="ref54">26</reflink>] ; McMahon and Henderson [<reflink idref="bib45" id="ref55">45</reflink>] ).</p> <p>However, the extant literature is complicated by methodological challenges, with many studies assessing correlates of disagreement using standardized difference scores (SDSs) between informant reports, which has several drawbacks that can lead to misinterpretation (Laird and De Los Reyes [<reflink idref="bib36" id="ref56">36</reflink>] ; Laird and Weems [<reflink idref="bib37" id="ref57">37</reflink>] ). To avoid these confounds, the use of polynomial regression analyses is recommended (described in more detail below), which utilizes an interaction to isolate the effect of agreement/disagreement correlates of interest.</p> <p>While several studies have used the polynomial regression approach with anxiety populations, no studies have used this method to probe correlates of agreement/disagreement on social anxiety symptoms in youth with ASD. Applying conclusions from correlates of agreement in typically developing youth to youth with ASD is complicated by several unique considerations to characterizing levels and correlates of agreement on social anxiety symptoms in samples of cognitively able youth with ASD (Kreiser and White [<reflink idref="bib33" id="ref58">33</reflink>] ). First, previous research has questioned the level of insight that youth with ASD have into their own internal states, such as social anxiety (Tantam [<reflink idref="bib64" id="ref59">64</reflink>] ), particularly given the wide range of verbal abilities in youth with ASD. However, many youth with ASD possess the insight necessary to report on their social anxiety symptoms (Kaat and Lecavalier [<reflink idref="bib29" id="ref60">29</reflink>] ; Schiltz et al. [<reflink idref="bib59" id="ref61">59</reflink>] ; Simon and Corbett [<reflink idref="bib61" id="ref62">61</reflink>] ). Additionally, there is a question of how to distinguish between symptoms of social anxiety versus ASD symptoms, particularly concerning social difficulties and social avoidance (Kreiser and White [<reflink idref="bib33" id="ref63">33</reflink>] ). Finally, youth with ASD may exhibit limited and atypical expression of emotions (Brewer et al. [<reflink idref="bib12" id="ref64">12</reflink>] ; Macdonald et al. [<reflink idref="bib40" id="ref65">40</reflink>] ; Yoshimura et al. [<reflink idref="bib74" id="ref66">74</reflink>] ). The youth themselves may have difficulty identifying their emotions and their causes (Hobson et al. [<reflink idref="bib28" id="ref67">28</reflink>] ). Additionally, parents may have trouble discerning the emotional response that youth are displaying. Despite these challenges to assessing anxiety in ASD, it remains critically important to understand presentation of and functional impairment associated with social anxiety in youth with ASD to assist with assessment and treatment of the pervasive symptoms of social anxiety and to clarify the utility of self- and parent-reports in ASD.</p> <hd id="AN0129572143-3">Present Study</hd> <p>With several studies reporting that many youth with ASD are able to reliably report on their own internal states, including social anxiety (Kaat and Lecavalier [<reflink idref="bib29" id="ref68">29</reflink>] ; Schiltz et al. [<reflink idref="bib59" id="ref69">59</reflink>] ; Simon and Corbett [<reflink idref="bib61" id="ref70">61</reflink>] ), but few investigations into informant agreement on social anxiety (Kreiser and White [<reflink idref="bib33" id="ref71">33</reflink>] ), investigation into the unique information provided by parent and youth reports, as well as the agreement between the two, is needed.</p> <p>In this study, we address gaps in previous literature by using current statistical recommendations for the study of informant agreement (Laird and De Los Reyes [<reflink idref="bib36" id="ref72">36</reflink>] ). First, we examined differences in the magnitude and patterns of parent-youth discrepancies on reports of social anxiety between youth with ASD and a typically developing comparison sample (COM). We measured social anxiety symptoms using the Social Anxiety Scale for Children-Revised (SASC-R; La Greca and Stone [<reflink idref="bib35" id="ref73">35</reflink>] ), as it has comparable items and scoring on the parent- and youth-report versions. We then investigated correlates of informant agreement/discrepancy, including demographic (age, gender, verbal IQ) and diagnostic (autism symptom severity) factors, characteristics of the parent (self-reported anxiety symptoms), and characteristics of the youth (parent-reported attention problems and adaptive skills). Given the previous literature relating various informants’ characteristics to youth anxiety, as well as previous research on correlates of parent-youth agreement/discrepancy on anxiety symptoms, we hypothesized that for both groups, high parent psychopathology, high youth attention problems, and low adaptive skills would be associated with greater parent-child discrepancies in social anxiety symptoms.</p> <hd id="AN0129572143-4">Methods</hd> <hd id="AN0129572143-5">Participants</hd> <p>Participants in this study included a community sample of 279 youth (8-16 years old, 144 ASD, 135 COM) and their parents who participated in two separate studies of social-emotional functioning (Study 1 and Study 2) at the University of Miami (UM). Recruitment occurred between November 2005 and February 2010 (Study 1; N = 203), and between July 2013 and September 2015 (Study 2; N = 76). Interested families were invited to take part in two laboratory visits that included intelligence assessment, diagnostic assessments, and several additional psychophysiological and behavioral assessments. Informed consent and assent were obtained from all parents and youth participants, respectively. Recruitment and data collection procedures were comparable across both studies, and no participants overlapped between the two studies. To ensure participants would understand directions and questionnaire and assessment items, all participants were required to have verbal IQ ≥ 70 to be eligible.</p> <p>Participants in the ASD group were recruited through a letter or e-mail to parents of children with autism spectrum disorder from the Center for Autism and Related Disabilities (CARD) at UM. All participants with ASD had community diagnoses using DSM-IV or DSM-5 criteria. Diagnoses for all participants with ASD were confirmed using the Autism Diagnostic Observation Schedule (ADOS), Social Communication Questionnaire (SCQ) and Autism Spectrum Screening Questionnaire (ASSQ). Participants were required to meet clinical levels of ASD symptomatology (see below) on the ADOS and at least 1 of 2 parent-reported measures of symptom severity to be included.</p> <p>Participants in the comparison sample were recruited through letters sent home with students in the Miami-Dade County Public Schools school system, community groups [Study 1 and Study 2] and additionally through publicly available mailing lists [Study 2]. The parents of all COM participants completed the SCQ and ASSQ and in Study 1, COM participants were also administered the ADOS. For Study 1, COM participants were excluded if they met criteria for ASD on the ADOS, or if parents reported significant symptoms of ASD on both questionnaires. Since COM participants in Study 2 were not administered the ADOS, more conservative exclusionary criteria were implemented with regard to questionnaires. In Study 2, COM participants were excluded if parents reported that they exceeded the clinical cutoff for ASD symptoms on either of the parent-reported diagnostic measures. Of the initial sample, 56 participants (22 COM, 34 ASD) were enrolled but excluded due to not meeting inclusion criteria (ASD group—verbal IQ < 70: 5 participants, low ASD symptoms reported on questionnaires: 6 participants, low ADOS score: 23 participants; COM group—Verbal IQ < 70: 2 participants; high ASD symptoms reported on questionnaires: 11 participants; high ADOS score: 9 participants).</p> <p>The final sample was primarily Hispanic (46.6%) and non-Hispanic Caucasian (37.2%). The remaining participants were African-American (6.9%), Asian (0.8%), mixed race (4.9%), or chose not to report their ethnicities (3.6%). The sample included parents who had completed an advanced or professional degree (24.7%), some graduate school (23.4%), a 4-year college education (26.3%), some college education (18.6%), and a high school diploma (4.0%). The remaining parents chose not to report their education levels (3.2%). Participants’ annual household income fell within the ranges of $100,000+ (34.4%), $75,000-99,000 (15.8%), $50,000-74,999 (20.6%), $25,000-49,000 (11.3%), $10,000-24,999 (8.5%), and less than $10,000 (2.4%). The remaining participants (6.1%) chose not to report family household income. Diagnostic groups did not differ on ethnicity, parental education or family income, all p’s > .05.</p> <hd id="AN0129572143-6">Measures</hd> <hd id="AN0129572143-7">Social Anxiety</hd> <p>The Social Anxiety Scale for Children-Revised (SASC-R; La Greca and Stone [<reflink idref="bib35" id="ref74">35</reflink>] ) assessed parent- and self-reported social anxiety. Parent and child versions include 22 parallel items rated on a 5-point scale from 1 (not at all) to 5 (all the time), making it an ideal measure to index agreement between parents and youth. This scale assesses common symptoms of social anxiety, including distress in new situations, general social avoidance and distress, and fear of negative evaluation from peers. Eighteen items are summed, yielding a total score ranging from 18 to 90; the remaining four items are distractor items not included in the total scores. The SASC-R has good internal consistency, discriminant and concordant validity, and test-retest reliability (La Greca and Stone [<reflink idref="bib35" id="ref75">35</reflink>] ), and has been used in previous studies investigating youth self-reports of social anxiety in ASD (Kuusikko et al. [<reflink idref="bib34" id="ref76">34</reflink>] ). In this sample, internal consistency was high for both diagnostic groups and both informants (ASD youth-report α = 0.90; COM youth-report α = 0.91; ASD parent-report α = 0.91; COM parent-report α = 0.94).</p> <hd id="AN0129572143-8">Intelligence</hd> <p>A brief version of the Wechsler Intelligence Scale for Children-Fourth Edition (WISC-IV; Wechsler [<reflink idref="bib68" id="ref77">68</reflink>] ) was administered to all participants to obtain a verbal comprehension index (VCI). Additional subtests were administered but not reported here, as the VCI was of primary interest for the present analyses due to its role in youth ability to complete self-reports. The vocabulary and similarities subtests were selected because of their high loadings on the VCI factor, strong test-retest reliabilities, and good internal consistencies among the WISC-IV scales (Williams et al. [<reflink idref="bib72" id="ref78">72</reflink>] ).</p> <hd id="AN0129572143-9">Autism Symptoms</hd> <p>The Social Communication Questionnaire (Berument et al. [<reflink idref="bib9" id="ref79">9</reflink>] ) is a parent-report instrument for the assessment of lifetime symptoms of ASD in children. It is a compilation of the 40 critical items of the autism diagnostic interview, which parents endorse as either “true” or “not true” for their child. A criterion score of 12 or higher indicates likely presence of ASD, with higher scores representing more ASD symptoms. The SCQ has demonstrated valid discrimination of individuals with and without ASD.</p> <p>The Autism Spectrum Screening Questionnaire (Ehlers et al. [<reflink idref="bib20" id="ref80">20</reflink>] ) is a 27-item parent-report questionnaire designed to identify symptoms frequently displayed by youth with ASD. Parents rated their children’s current symptoms on a three-point scale: “not true” (0), “somewhat true” (<reflink idref="bib1" id="ref81">1</reflink>), or “true” (<reflink idref="bib2" id="ref82">2</reflink>). A cutoff score of 13 was used, as recommended by the questionnaire authors, to capture clinically-significant symptoms of ASD while discriminating from children without social impairments. Higher scores represent more ASD symptoms.</p> <p>The Autism Diagnostic Observation Schedule (Lord et al. [<reflink idref="bib38" id="ref83">38</reflink>] , [<reflink idref="bib39" id="ref84">39</reflink>] ) is a semi-structured standardized observational assessment of ASD that was used for screening purposes. It captures communication, social interaction, and the imaginative use of materials in a series of activities. The ADOS has four modules for children and adults of varying language levels, and in this study, all participants received Modules 3 or 4 for verbally-fluent adolescents. The ADOS-G was administered to participants in Study 1, and ADOS-2 was administered to those in Study 2. A cutoff total score of 7 on the revised algorithms (Gotham et al. [<reflink idref="bib24" id="ref85">24</reflink>] ), which is comparable across ADOS-G and ADOS-2 administrations, was used to determine whether the participant exhibited clinically-significant levels of ASD.</p> <hd id="AN0129572143-10">Attention Problems and Adaptive Skills</hd> <p>The Behavior Assessment System for Children-Parent Rating Scale, Second Edition (BASC-2; Reynolds [<reflink idref="bib58" id="ref86">58</reflink>] ) is a questionnaire assessing youth social and emotional functioning. Two versions are available depending on the youth’s age: child (ages 6-11) and adolescent (ages 12-21). The BASC-2 contains between 139 and 176 questions, depending on age. Questions are answered regarding the youth’s behavior over the last several months on a scale from ‘never’ to ‘almost always.’ Items are aggregated into clinical and adaptive behavior T-scores, with a mean of 50 and standard deviation of 10. For attention problems, higher scores indicate greater impairment, whereas for adaptive skills, lower scores indicate greater difficulties.</p> <hd id="AN0129572143-11">Parent Psychopathology (Study 1 Only)</hd> <p>The symptoms checklist (SCL-90; Derogatis et al. [<reflink idref="bib18" id="ref87">18</reflink>] ) is a 90-item self-report questionnaire used to assess parent symptoms of psychopathology. Individuals are asked to respond to each item on a five-point scale, where 0 = not at all, 1 = a little bit, 2 = moderately, 3 = quite a bit, and 4 = extremely. The stem for all items is “How much were you bothered or distressed over the past 4 weeks by…” All scores are converted to T-scores, with a mean of 50 and standard deviation of 10, where higher scores indicate greater severity of psychopathology. Of interest in this study was anxiety symptoms.</p> <p>Mean values of all primary study variables are presented in Table 1.</p> <p></p> <hd id="AN0129572143-12">Analytic Approach</hd> <p>Preliminary analyses tested whether demographic variables, including age, gender and verbal IQ differed by diagnostic group. For these analyses comparing ASD and COM groups, we controlled for demographic variables that differed by group to ensure that group differences were not due to these variables.</p> <p>For our first aim, we examined whether groups differed on informant reports of the youth’s social anxiety symptoms (i.e., SASC-R raw total score). First, we examined whether groups differed in the reliability of their reports using the Feldt test (Feldt [<reflink idref="bib21" id="ref88">21</reflink>] ), which compares Cronbach alpha values across two independent samples. We also examined mean-level differences in youth and parent agreement using a repeated-measures ANCOVA, with informant (2 levels: parent, youth) as a within-subjects factor and group (2 levels: ASD, COM) as the between-subjects factor.</p> <p>For our second aim, we tested whether informant characteristics were associated with patterns of agreement using a polynomial regression approach, following guidelines provided by Laird and De Los Reyes ([<reflink idref="bib36" id="ref89">36</reflink>] ). This analysis tests whether each informant’s report, and an interaction between parent and youth reports, is associated with correlates of interest. Significant interaction terms indicate that the level of agreement/discrepancy on social anxiety symptoms are associated with differences in the outcome of interest, above and beyond each informant’s individual report. Quadratic terms for the main effects were also included so as not to interpret an interaction between parent and youth reports and the correlate of interest when it is better explained by a quadratic effect. We also examined whether diagnostic group moderated the association between informant agreement/discrepancy and correlates of interest by adding in group by informant interactions, and a three-way interaction of group by youth-report by parent-report (as in Wolfe et al. [<reflink idref="bib73" id="ref90">73</reflink>] ). Hierarchical regressions were used for all analyses, where main effects (linear and quadratic) were entered in step 1, two-way interactions were entered in step 2, and the three-way interaction was entered in step 3.</p> <p>Significant interaction terms were probed using simple slopes as is typically done in moderation analyses (Aiken et al. [<reflink idref="bib4" id="ref91">4</reflink>] ; Laird and De Los Reyes [<reflink idref="bib36" id="ref92">36</reflink>] ). This tests whether profiles of agreement/disagreement differed significantly from each other on the outcome of interest. Though parent- and youth-reports and their interactions were entered as predictors, we interpreted results of regression in a correlational way, as the cross-sectional study design does not allow us to infer directionality. When group significantly moderated the association with the outcome of interest, we probed the parent by youth interaction in each group. We probed predicted values at one standard deviation above and below the mean of parent and youth SASC-R reports in each diagnostic group. For each group, this yielded the following profiles of agreement both informants reporting higher than average levels of social anxiety (parent high/youth high; parent coefficient = 1, youth coefficient = 1) or both informants reporting lower than average levels of social anxiety (parent low/youth low; parent coefficient = − 1, youth coefficient = − 1). Profiles of disagreement included parent reporting high levels of social anxiety when the youth reported low social anxiety (parent high/youth low; parent coefficient = 1, youth coefficient = − 1) and parents reporting low anxiety when the youth reported high anxiety (parent low/youth high; parent coefficient = − 1, youth coefficient = 1). Statistical values associated with the simple slopes analyses are available upon request from the first author.</p> <hd id="AN0129572143-13">Results</hd> <hd id="AN0129572143-14">Preliminary Analyses</hd> <p>Preliminary analyses indicated no significant differences between ASD and COM participants on age, t (<reflink idref="bib221" id="ref93">221</reflink>) = − 1.74, p > .05, Cohen’s d = 0.23. However, youth in the ASD group had lower verbal IQ, t(<reflink idref="bib221" id="ref94">221</reflink>) = − 4.35, p < .001, Cohen’s d = 0.58, and a greater proportion of males, χ<sups>2</sups>(<reflink idref="bib1" id="ref95">1</reflink>) = 5.05, p = .03, Campbell’s r = .15, compared to the COM group. Therefore, we included verbal IQ and gender as covariates in between-group comparisons for our first aim.</p> <p>The Feldt test was used to test whether groups and informants differed in the reliability of their reports (Feldt [<reflink idref="bib21" id="ref96">21</reflink>] ). There were no significant differences in internal consistency between ASD and COM groups on parent-reports, W = 1.53, p = .98, or youth-reports, W = 1.07, p = .64. In addition, there were no differences within groups between parent and youth reports in either the ASD group, W = 1.13, p = .74, or COM group, W = 1.62, p = .99.</p> <p>First, the assumption of parallel regression slopes was tested to examine whether covariates interacted with diagnostic group to influence results. No interaction terms were significant (all p’s > .05). Thus, the assumption of parallel regression slopes was met, and the interaction terms of covariates with diagnostic group were not included in hypothesis testing.</p> <p>To investigate group and informant differences in reports of social anxiety, a two by two repeated-measures ANCOVA was conducted to examine the unique and interactive effects of informant (youth, parent) and group (ASD, COM) on SASC-R total scores, controlling for gender and verbal IQ. The informant by group interaction was significant, F(<reflink idref="bib1" id="ref97">1</reflink>, 219) = 7.67, p = .006, partial η<sups>2</sups> = .03 (Fig. 1). To probe this interaction, we subtracted youth self-reports from parent-reports of social anxiety. High scores indicate that parents endorsed higher social anxiety symptoms in their child than the youth self-report. Follow-up one-sample t tests were conducted to determine whether the difference between informants’ reports significantly differed from zero for each group. The difference score significantly differed from zero in the COM group, t(<reflink idref="bib112" id="ref98">112</reflink>) = − 4.19, p < .001, Cohen’s d = 0.79, indicating that youth self-reported higher symptoms of social anxiety than parents. In contrast, the ASD group did not significantly differ from zero, t(<reflink idref="bib109" id="ref99">109</reflink>) = 0.31, p = .76, Cohen’s d = 0.06, indicating that parent and youth reports of anxiety did not differ in the ASD group. Levene’s test of equality of variances revealed unequal error variances between ASD and COM groups for both youth- and parent-reported SASC-R total score and on differences between parent and youth reports. The ASD group consistently displayed greater variability, youth-report: F(<reflink idref="bib1" id="ref100">1</reflink>, 221) = 8.16, p = .005, Parent-report: F(<reflink idref="bib1" id="ref101">1</reflink>, 221) = 8.56, p = .004, Difference: F(<reflink idref="bib1" id="ref102">1</reflink>, 221) = 12.06, p = .001.</p> <p>Youth- and parent-reports on the SASC-R for the ASD and COM groups. Box-and-whisker plots denote the median (middle line), 25th and 75th percentiles (extension of boxes) and range (whiskers) of SASC-R scores for each group. Note ASD individuals with autism spectrum disorder, COM comparison individuals without autism diagnosis, SASC-R Social Anxiety Scale for Children, Revised</p> <p>A significant main effect of group also emerged, F(<reflink idref="bib1" id="ref103">1</reflink>, 219) = 98.06, p < .001, partial η<sups>2</sups> = .31, such that participants with ASD (M<subs>adj</subs> = 49.90, SE = 1.00) were rated as having higher social anxiety than COM participants (M<subs>adj</subs> = 35.57, SE = 0.99) across informants. There was no main effect of informant, F(<reflink idref="bib1" id="ref104">1</reflink>, 219) = 0.29, p = .59, partial η<sups>2</sups> = .001. In terms of covariates, there was no main effect of verbal IQ, F(<reflink idref="bib1" id="ref105">1</reflink>, 219) = 2.56, p = .11, partial η<sups>2</sups> = .01, but there was an effect of gender, F(<reflink idref="bib1" id="ref106">1</reflink>, 219) = 12.69, p < .001, partial η<sups>2</sups> = .06. Females (M<subs>adj</subs> = 46.73, SE = 1.47) were rated as having higher anxiety than males (M<subs>adj</subs> = 41.32, SE = 0.78). There were no interactions between covariates and informant, p<subs>s</subs> > .05.</p> <hd id="AN0129572143-15">Correlates of Agreement/Discrepancy Between Reports of Social Anxiety Symptoms</hd> <p>Statistical values for full regression models on each outcome are presented in Table 2. Follow-up analyses to significant three-way probing parent by youth interactions in each group are presented in Table 3.</p> <p></p> <p></p> <hd id="AN0129572143-16">ASD Diagnostic Measures</hd> <p>Polynomial regressions examining associations with current (i.e., ASSQ) and lifetime (i.e., SCQ) symptoms of ASD were tested in the ASD group only, as there was limited variability in the COM group. ADOS scores were not included in these analyses as scores are intended for diagnostic determination, and are not intended to be used as continuous measures of ASD symptoms severity (Gotham et al. [<reflink idref="bib23" id="ref107">23</reflink>] ; Lord et al. [<reflink idref="bib39" id="ref108">39</reflink>] ). On the ASSQ, higher parent-reported youth anxiety symptoms related to higher parent-reported current youth symptoms of ASD, b = 0.24, p = .017, independent of how many symptoms youth reported. However, no other main effects or interactions were significant.</p> <p>The interaction of parent- and youth-reports of the youth’s anxiety symptoms were associated with parent-reported lifetime symptoms of ASD on the SCQ, b = − 0.25, p = .017. Probing via simple slopes revealed that a profile characterized by agreement on low levels of social anxiety symptoms was associated with lowest lifetime symptoms of ASD (parent low/youth low SCQ M = 16.88). All other profiles were not significantly different from each other on the SCQ (parent high/youth high SCQ M = 19.08; parent high/youth low SCQ M = 22.56; parent low/youth high SCQ M = 20.98). See Fig. 2.</p> <p>Association between profiles of agreement of reports of social anxiety symptoms (SASC-R) and lifetime autism symptoms (SCQ) in the ASD group. Note Lines represent the simple slopes follow-ups, where dashed lines are not significant and solid lines are significant at p < .05; Circle markers indicate profiles of agreement; box markers indicate profiles of disagreement; SCQ Social Communication Questionnaire</p> <hd id="AN0129572143-17">Demographic Features</hd> <p>Overall, youth demographic variables (age, gender, and verbal IQ) were not associated with main effects of either informant, nor the interaction of the two, nor did diagnostic group moderate associations between patterns of agreement and demographic correlates of interest, all p’s > .05. However, as described above, there was a main effect of parent-reported social anxiety symptoms on gender, such that, regardless of diagnostic group, females were rated as having higher social anxiety symptoms than males.</p> <hd id="AN0129572143-18">Parent Anxiety</hd> <p>Higher parent-reported youth anxiety symptoms were associated with higher self-reported parent anxiety symptoms across the full sample, independent of how many anxiety symptoms youth reported, b = 0.38, p = .033. However, no other main effects or interactions were significant. There were also no diagnostic group differences in parental anxiety levels, all p’s > .05.</p> <hd id="AN0129572143-19">Youth Attention Problems</hd> <p>For youth attention problems, a significant effect of group emerged (Fig. 3), b = 0.54, p < .001, with the ASD group rated as having higher attention problems than the COM group. However, this was qualified by a significant group by parent by youth interaction, b = − 0.28, p = .018, indicating that there were group differences in the association between patterns of agreement/discrepancy and youth attention problems. We followed this up by testing the youth by parent interaction in each group. For the ASD group, youth attention problems tended to be lower in profiles of agreement (parent high/youth high M = 59.29, parent low/youth low M = 59.77) than in profiles of disagreement (parent high/youth low M = 64.15; parent low/youth high M = 63.55). However, for COM participants, no main effects or interactions emerged, indicating that attention problems were not related to individual informants’ reports or patterns of agreement/discrepancy.</p> <p>Association between profiles of agreement of reports of social anxiety symptoms (SASC-R) and attention problems (BASC-PRS) in the ASD group (a) and COM (b) groups. Note Lines represent the simple slopes follow-ups, where dashed lines are not significant and solid lines are p < .05; Circle markers indicate profiles of agreement, box markers indicate profiles of disagreement; ASD individuals with autism spectrum disorder, COM comparison individuals without autism diagnosis, SASC-R Social Anxiety Scale for Children, Revised; BASC-PRS Behavior Assessment System for Children-Parent Rating Scale</p> <hd id="AN0129572143-20">Youth Adaptive Skills</hd> <p>The ASD group was rated by parents as having lower adaptive skills than the COM group, b = − 0.73, p < .001. There was a significant diagnostic group by parent by youth interaction (Fig. 4), b = 0.30, p < .001, indicating that there were group differences in the association between patterns of agreement/discrepancy and youth adaptive skills. We conducted follow-up analyses testing the youth by parent interaction in each group. For the ASD group, youth adaptive skills were highest when parents and youth agreed on anxiety symptom severity (parent high/youth high M = 37.89; parent low/youth low M = 39.22), and lowest when parents and youth disagreed on anxiety symptoms (parent high/youth low M = 32.13; parent low/youth high M = 34.04). However, for the COM group, profiles characterized by agreement on high anxiety symptoms were associated with the lowest adaptive skills (parent high/youth high M = 48.43). All other profiles did not significantly differ from each other in the COM group (parent low/youth low M = 57.74; parent high/youth low M = 53.33; parent low/youth high M = 59.19).</p> <p>Association between profiles of agreement of reports of social anxiety symptoms (SASC-R) and adaptive skills (BASC-PRS) in the ASD group (a) and COM (b) groups. Note Lines represent the simple slopes follow-ups, where dashed lines are not significant and solid lines are p < .05; Circle markers indicate profiles of agreement, box markers indicate profiles of disagreement; ASD individuals with autism spectrum disorder, COM comparison individuals without autism diagnosis, SASC-R Social Anxiety Scale for Children, Revised; BASC-PRS Behavior Assessment System for Children-Parent Rating Scale</p> <hd id="AN0129572143-21">Discussion</hd> <p>This was the first study to examine group differences in, and correlates of, agreement between parent- and self-reports of social anxiety in youth with ASD and a typically developing comparison sample. We replicated previous research demonstrating higher rates of reported social anxiety symptoms in youth with ASD, regardless of informant. While COM youth demonstrated the expected discrepancy of endorsing higher social anxiety symptoms than parents reported, reports of youth with ASD did not differ from their parents. However, youth with ASD demonstrated greater heterogeneity in mean levels of symptoms relative to youth without ASD, replicating previous studies. We also extended previous findings by identifying greater overall variability in the amount to which parents and youth differ on their endorsement of the youth’s social anxiety symptoms, highlighting the importance of identifying correlates of informant agreement. For the ASD group, profiles of higher agreement on anxiety symptoms were generally associated with better outcomes, particularly for attention problems and adaptive skills. A different pattern emerged in the comparison sample, suggesting that alternative processes may be at play in ASD parent/child dyads relative to typically developing youth.</p> <p>Several factors may account for differences in agreement between informant reports of youth anxiety between individuals with and without ASD. Agreement between parents and youth on reports of social anxiety were not related to verbal IQ, gender, or age for either diagnostic group, indicating comparable levels of agreement across age, gender and functioning levels of participants. Additionally, all informants displayed high levels of reliability in reports of youth social anxiety symptoms. This is consistent with previous research demonstrating that youth with ASD are able to report on their own anxiety symptoms (Simon and Corbett [<reflink idref="bib61" id="ref109">61</reflink>] ).</p> <p>For all participants, parental reports of their own anxiety were related to parent reports of youth anxiety, over and above the youth self-report, suggesting that parents with higher anxiety may over-estimate anxiety in their child (Boyle and Pickles [<reflink idref="bib11" id="ref110">11</reflink>] ; Müller et al. [<reflink idref="bib50" id="ref111">50</reflink>] ). While this finding has been widely replicated across populations, parental psychopathology is rarely accounted for in studies that use parent report of youth internalizing problems in ASD.</p> <p>Youth with ASD who agreed with their parents on their level of social anxiety symptoms were also rated as more attentive, and those who disagreed on symptoms were more likely to be described as less attentive. Difficulty sustaining focus, particularly when completing a questionnaire, may influence the validity of youth self-reports, and should be considered in both clinical practice and research. Alternatively, youth with better attention spans may be better able to sustain conversations with their parents related to their experiences and anxiety symptoms, thereby facilitating agreement in symptom reporting. Furthermore, in cases where youth endorse differing levels of anxiety from their parents, it is possible that one informant may be attributing anxiety symptoms (e.g., fidgeting, limited eye contact) to other difficulties, such as inattention in social situations, rather than attempting to avoid sustained conversation.</p> <p>Symptoms of ASD have previously been associated with more internalizing problems (Mayes et al. [<reflink idref="bib42" id="ref112">42</reflink>] ; Sukhodolsky et al. [<reflink idref="bib63" id="ref113">63</reflink>] ). Our results replicate this association for current symptoms of ASD (i.e., ASSQ score), where higher parent-reported symptoms of social anxiety related to higher symptoms of ASD. However, agreement only on low levels of social anxiety was associated with lowest lifetime ASD symptoms (i.e., SCQ score), above and beyond parent report of youth anxiety. While this finding is complicated by the retrospective nature of the ASD measure, it raises some interesting hypotheses. Youth with fewer symptoms of ASD at early ages may experience fewer psychosocial risk factors (e.g., social inhibition, peer victimization, inflexibility) across development. Bellini ([<reflink idref="bib7" id="ref114">7</reflink>] ) described a developmental cascade model, where inhibited temperament increases risk for social withdrawal, resulting in social skill deficits and negative peer interactions. Together, these factors may result in the development of social anxiety, which may be further compounded in adolescence when peer interactions are particularly salient (Picci and Scherf [<reflink idref="bib55" id="ref115">55</reflink>] ). In contrast, fewer early symptoms of autism may protect against this cascade of difficulties across development.</p> <p>For typically developing youth, social anxiety may impair youths’ adaptive skills needed for interpersonal success, such as social skills and effective communication on one’s experiences (Ollendick and Hirshfeld-Becker [<reflink idref="bib53" id="ref116">53</reflink>] ; Rapee and Spence [<reflink idref="bib56" id="ref117">56</reflink>] ). However, for individuals with ASD, high parent/youth agreement on high levels of social anxiety was actually associated with the highest adaptive skills, suggesting a different relationship for youth with ASD and anxiety than youth with anxiety alone. Youth with ASD may agree with their parents on levels of social anxiety due to stronger functional communication. Alternatively, a third variable, such as insight into one’s challenges, may contribute to both adaptive skills and agreement on social anxiety. Future studies should investigate informant agreement within the larger context environmental contributions to youth functioning.</p> <hd id="AN0129572143-22">Strengths/Limitations and Future Directions</hd> <p>This study has several strengths. Because of the complex nature of polynomial regression analyses, large sample sizes are needed to probe correlates of different patterns of agreement with confidence, as well as group differences in these associations. The sample size employed in this study allowed for comprehensive exploration of the presence and correlates of informant agreement of youth social anxiety using a measure with comparable items for parent and youth reports. Our findings highlight the critical need to account for both parent and youth reports in research examining correlates of social anxiety.</p> <p>However, these findings should be considered in light of potential limitations. First, the study is cross-sectional in design, limiting our ability to test directions of effects. While we interpret informants’ reports of social anxiety as predictors due to the analytic approach, the opposite direction could also apply. Specifically, attention problems and adaptive functioning could influence the tendency of youth and their parents to interpret behaviors and emotions comparably, and therefore agree on their ratings of youth social anxiety. Longitudinal studies are needed to parse apart the directions of these effects.</p> <p>Our study was also narrow in its focus of youth with verbal IQs over 70. Patterns of agreement or discrepancy may differ with youth with lower IQs, and other methods may be necessary to assess social anxiety in minimally-verbal youth. We also chose to focus on social anxiety specifically, as it is one of the highest co-occurring conditions in ASD (Kuusikko et al. [<reflink idref="bib34" id="ref118">34</reflink>] ). Understanding how different informants view the emergence of social anxiety within the broader history of social functioning is likely useful for understanding contributors to social anxiety in ASD (Kerns et al. [<reflink idref="bib30" id="ref119">30</reflink>] ). Furthermore, examining informant agreement in clinically-elevated youth with ASD, and other clinical comparison groups, as well as on other symptom clusters (e.g., other domains of internalizing problems, externalizing problems), would provide a better understanding of the similarity of correlates of informant agreement across populations and symptoms.</p> <p>Collecting information from multiple informants is considered the gold standard for research and clinical practice (Mash and Hunsley [<reflink idref="bib41" id="ref120">41</reflink>] ; Silverman and Ollendick [<reflink idref="bib60" id="ref121">60</reflink>] ). However, when reports from different informants differ, it is difficult to determine the “true” level of the construct of interest. Many of our correlates of interest were measured using parent report (e.g., autism symptoms, attention problems, adaptive functioning), somewhat limiting our interpretation of the results. For example, the association between parent-reported social anxiety symptoms and parent reported ASD symptoms may be reflecting shared variance of the reporter, not necessarily that the parent possesses better insight into the youth’s anxiety. Objective measures of anxiety, such as the Trier social stress task (Kirschbaum et al. [<reflink idref="bib31" id="ref122">31</reflink>] ) or unstructured social interaction tasks (Usher et al. [<reflink idref="bib65" id="ref123">65</reflink>] ) may provide ecologically-valid assessments of anxiety. Collecting measures across other contexts, such as teacher- or peer-reports, or sociometric nominations may also help uncover environmental contributions to discrepant reports of anxiety.</p> <hd id="AN0129572143-23">Implications</hd> <p>This was the first study to comprehensively examine patterns and correlates of agreement and discrepancy on social anxiety symptoms between youth with and without ASD and their parents. Identifying different profiles of agreement on youth and parent reports also has implications for clinical practice, including informing evidence-based assessment and treatment. Many norm-referenced questionnaires (e.g., BASC, CBCL, BRIEF) convert raw scores to T-scores based on the distribution of raw scores in the general population. Norm-referenced samples may have raw values that differ between parent and youth reports, but are then converted to T-scores that do not differ (e.g., the mean for each informant is set to 50). In ASD, converting raw scores to T-scores may be imposing a structure that does not match the true structure in the population of individuals with ASD. Thus, if a clinician were comparing mean values across informant reports for one individual, it may be prudent to examine raw scores, or norms derived from the population of individuals with ASD.</p> <p>Agreement with parents on symptoms of anxiety may reflect more self-understanding, with youth displaying insight into their own thoughts, feelings and behaviors, and the intentions of others (Blakeley-Smith et al. [<reflink idref="bib10" id="ref124">10</reflink>] ; McMahon et al. [<reflink idref="bib46" id="ref125">46</reflink>] ). While certain aspects of social anxiety may be detrimental, there may also be benefits associated with moderate amounts of self-monitoring and anxiety in youth with ASD (Gotham et al. [<reflink idref="bib22" id="ref126">22</reflink>] ; Henderson et al. [<reflink idref="bib27" id="ref127">27</reflink>] ; Usher et al. [<reflink idref="bib65" id="ref128">65</reflink>] ). Exhibiting fear of negative evaluations, a core component of social anxiety, reflects an awareness of the self in a social context, which is often impacted in ASD (Burrows et al. [<reflink idref="bib14" id="ref129">14</reflink>] ; Hobson et al. [<reflink idref="bib28" id="ref130">28</reflink>] ). Furthermore, communicating these feelings effectively to one’s parents may help individuals experiencing anxiety obtain needed support. Future studies may benefit from examining individuals’ self-understanding as a mechanism linking agreement on anxiety symptoms and adaptive functioning. Conversely, some youth with ASD may under-report true levels of anxiety. It may be helpful to alert these individuals to the influence of their anxiety symptoms on their functioning. Future studies should examine whether facilitated discussions between parents and children aimed at arriving at consensus on anxiety symptoms may confer beneficial outcomes.</p> <p>Informant discrepancies have previously demonstrated important clinical effects for youth, with greater informant agreement related to increased attendance of therapy sessions in typical development (Brookman-Frazee et al. [<reflink idref="bib13" id="ref131">13</reflink>] ) as well as improvements in treatment outcome for youth with ASD (Verhoeven et al. [<reflink idref="bib67" id="ref132">67</reflink>] ). This has significant potential impact for individuals with ASD, for whom interventions often have limited generalizability (McMahon et al. [<reflink idref="bib47" id="ref133">47</reflink>] ; White et al. [<reflink idref="bib69" id="ref134">69</reflink>] ). Treatments for anxiety in ASD may benefit from integrating open discussions of the concrete behavioral, as well as more nebulous internal signs of social anxiety between youth and their parents. Creating a shared vocabulary and understanding of the youth’s anxiety may improve the efficacy of treatment.</p> <hd id="AN0129572143-24">Funding</hd> <p>This research was Supported by NIH R01 MH71273 (Motivation, Self-Monitoring, & Family Process in Autism, Henderson & Mundy, PIs), and the Marino Autism Research Institute (Henderson, PI).</p> <hd id="AN0129572143-25">Author Contributions</hd> <p>CAB conceived of and executed Study 2, performed the statistical analyses, and drafted the manuscript; LVU conceived of and executed Study 2, and assisted in statistical analyses and drafting the manuscript; EMBH provided statistical consultation and provided revisions the manuscript; CMM provided revisions the manuscript; PCM conceived of Study 1, and provided revisions the manuscript; AJD provided revisions the manuscript; and HAH conceived of Study 1 and 2, and provided revisions the manuscript.</p> <hd id="AN0129572143-26">Compliance with Ethical Standards</hd> <hd id="AN0129572143-27">Conflict of interest</hd> <p>All authors declare that they have no conflicts of interest.</p> <hd id="AN0129572143-28">Ethical Approval</hd> <p>All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.</p> <hd id="AN0129572143-29">References</hd> <hd id="AN0129572143-30">Citations</hd> <p>1 Achenbach TM, McConaughy SH, Howell CT, Child/adolescent behavioral and emotional problems: Implications of cross-informant correlations for situational specificity, Psychological Bulletin, 1987, 101, 2, 213, 10.1037/0033-2909.101.2.213</p> <ulist> <item>2 Achenbach TM, Rescorla L, ASEBA school-age forms & profiles, 2001, Burlington, VT, ASEBA</item> <item>3 Affrunti NW, Woodruff-Borden J, The effect of maternal psychopathology on parent-child agreement of child anxiety symptoms: A hierarchical linear modeling approach, Journal of Anxiety Disorders, 2015, 32, Supplement C, 56, 65, 10.1016/j.janxdis.2015.03.010</item> <item>4 Aiken LS, West SG, Reno RR, Multiple regression: Testing and interpreting interactions, 1991, Thousand Oaks, CA, Sage</item> <item>5 Diagnostic and statistical manual of mental disorders, (DSM-5®), 2013, Arlington, VA, American Psychiatric Pub</item> <item>6 Becker EM, Jensen-Doss A, Kendall PC, Birmaher B, Ginsburg GS, All anxiety is not created equal: Correlates of parent/youth agreement vary across subtypes of anxiety, Journal of Psychopathology and Behavioral Assessment, 20165386505</item> <item>7 Bellini S, The development of social anxiety in adolescents with autism spectrum disorders, Focus on Autism and Other Developmental Disabilities, 2006, 21, 3, 138, 145, 10.1177/10883576060210030201</item> <item>8 Berg-Nielsen TS, Vika A, Dahl AA, When adolescents disagree with their mothers: CBCL-YSR discrepancies related to maternal depression and adolescent self-esteem, Child: Care, Health and Development, 2003, 29, 3, 207, 213</item> <item>9 Berument SK, Rutter M, Lord C, Pickles A, Bailey A, Autism screening questionnaire: Diagnostic validity, The British Journal of Psychiatry, 1999, 175, 5, 444, 451, 10.1192/bjp.175.5.444</item> <item>10 Blakeley-Smith A, Reaven J, Ridge K, Hepburn S, Parent-child agreement of anxiety symptoms in youth with autism spectrum disorders, Research in Autism Spectrum Disorders, 2012, 6, 2, 707, 716, 10.1016/j.rasd.2011.07.020</item> <item>11 Boyle MH, Pickles AR, Influence of maternal depressive symptoms on ratings of childhood behavior, Journal of Abnormal Child Psychology, 1997, 25, 5, 399, 412, 10.1023/A:1025737124888</item> <item>12 Brewer R, Biotti F, Catmur C, Press C, Happé F, Cook R, Bird G, Can neurotypical individuals read autistic facial expressions? 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Items – Name: Title
  Label: Title
  Group: Ti
  Data: Profiles and Correlates of Parent-Child Agreement on Social Anxiety Symptoms in Youth with Autism Spectrum Disorder
– Name: Language
  Label: Language
  Group: Lang
  Data: English
– Name: Author
  Label: Authors
  Group: Au
  Data: <searchLink fieldCode="AR" term="%22Burrows%2C+Catherine+A%2E%22">Burrows, Catherine A.</searchLink><br /><searchLink fieldCode="AR" term="%22Usher%2C+Lauren+V%2E%22">Usher, Lauren V.</searchLink><br /><searchLink fieldCode="AR" term="%22Becker-Haimes%2C+Emily+M%2E%22">Becker-Haimes, Emily M.</searchLink><br /><searchLink fieldCode="AR" term="%22McMahon%2C+Camilla+M%2E%22">McMahon, Camilla M.</searchLink><br /><searchLink fieldCode="AR" term="%22Mundy%2C+Peter+C%2E%22">Mundy, Peter C.</searchLink><br /><searchLink fieldCode="AR" term="%22Jensen-Doss%2C+Amanda%22">Jensen-Doss, Amanda</searchLink><br /><searchLink fieldCode="AR" term="%22Henderson%2C+Heather+A%2E%22">Henderson, Heather A.</searchLink>
– Name: TitleSource
  Label: Source
  Group: Src
  Data: <searchLink fieldCode="SO" term="%22Journal+of+Autism+and+Developmental+Disorders%22"><i>Journal of Autism and Developmental Disorders</i></searchLink>. Jun 2018 48(6):2023-2037.
– Name: Avail
  Label: Availability
  Group: Avail
  Data: Springer. 233 Spring Street, New York, NY 10013. Tel: 800-777-4643; Tel: 212-460-1500; Fax: 212-348-4505; e-mail: service-ny@springer.com; Web site: http://www.springerlink.com
– Name: PeerReviewed
  Label: Peer Reviewed
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  Data: Y
– Name: Pages
  Label: Page Count
  Group: Src
  Data: 15
– Name: DatePubCY
  Label: Publication Date
  Group: Date
  Data: 2018
– Name: SourceSuprt
  Label: Sponsoring Agency
  Group: SrcSuprt
  Data: National Institutes of Health (DHHS)
– Name: NumberContract
  Label: Contract Number
  Group: NumCntrct
  Data: R01MH71273
– Name: TypeDocument
  Label: Document Type
  Group: TypDoc
  Data: Journal Articles<br />Reports - Research
– Name: Subject
  Label: Descriptors
  Group: Su
  Data: <searchLink fieldCode="DE" term="%22Correlation%22">Correlation</searchLink><br /><searchLink fieldCode="DE" term="%22Parent+Child+Relationship%22">Parent Child Relationship</searchLink><br /><searchLink fieldCode="DE" term="%22Anxiety%22">Anxiety</searchLink><br /><searchLink fieldCode="DE" term="%22Symptoms+%28Individual+Disorders%29%22">Symptoms (Individual Disorders)</searchLink><br /><searchLink fieldCode="DE" term="%22Pervasive+Developmental+Disorders%22">Pervasive Developmental Disorders</searchLink><br /><searchLink fieldCode="DE" term="%22Autism%22">Autism</searchLink><br /><searchLink fieldCode="DE" term="%22Children%22">Children</searchLink><br /><searchLink fieldCode="DE" term="%22Adolescents%22">Adolescents</searchLink>
– Name: DOI
  Label: DOI
  Group: ID
  Data: 10.1007/s10803-018-3461-9
– Name: ISSN
  Label: ISSN
  Group: ISSN
  Data: 0162-3257
– Name: Abstract
  Label: Abstract
  Group: Ab
  Data: This study characterized patterns and correlates of parent-youth agreement on social anxiety in youth with and without autism spectrum disorder (ASD). Participants (279 verbally-fluent youth aged 8-16 years, NASD = 144, NTD = 135) completed the SASC-R. Youth with ASD exhibited higher social anxiety across informants. While TD youth endorsed higher anxiety than did parents, self- and parent-reports did not differ in youth with ASD. For children with ASD, higher parent-youth agreement was associated with lower lifetime ASD symptoms and higher adaptive skills. For TD youth, agreement on high anxiety was associated with lowest adaptive skills. Demographic factors (age, verbal IQ, gender) did not relate to agreement for either group. In ASD, parent-child agreement on youth anxiety, either high or low, was associated with better outcomes.
– Name: AbstractInfo
  Label: Abstractor
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  Data: As Provided
– Name: Ref
  Label: Number of References
  Group: RefInfo
  Data: 74
– Name: DateEntry
  Label: Entry Date
  Group: Date
  Data: 2018
– Name: AN
  Label: Accession Number
  Group: ID
  Data: EJ1179106
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    Identifiers:
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        Value: 10.1007/s10803-018-3461-9
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      – Text: English
    PhysicalDescription:
      Pagination:
        PageCount: 15
        StartPage: 2023
    Subjects:
      – SubjectFull: Correlation
        Type: general
      – SubjectFull: Parent Child Relationship
        Type: general
      – SubjectFull: Anxiety
        Type: general
      – SubjectFull: Symptoms (Individual Disorders)
        Type: general
      – SubjectFull: Pervasive Developmental Disorders
        Type: general
      – SubjectFull: Autism
        Type: general
      – SubjectFull: Children
        Type: general
      – SubjectFull: Adolescents
        Type: general
    Titles:
      – TitleFull: Profiles and Correlates of Parent-Child Agreement on Social Anxiety Symptoms in Youth with Autism Spectrum Disorder
        Type: main
  BibRelationships:
    HasContributorRelationships:
      – PersonEntity:
          Name:
            NameFull: Burrows, Catherine A.
      – PersonEntity:
          Name:
            NameFull: Usher, Lauren V.
      – PersonEntity:
          Name:
            NameFull: Becker-Haimes, Emily M.
      – PersonEntity:
          Name:
            NameFull: McMahon, Camilla M.
      – PersonEntity:
          Name:
            NameFull: Mundy, Peter C.
      – PersonEntity:
          Name:
            NameFull: Jensen-Doss, Amanda
      – PersonEntity:
          Name:
            NameFull: Henderson, Heather A.
    IsPartOfRelationships:
      – BibEntity:
          Dates:
            – D: 01
              M: 06
              Type: published
              Y: 2018
          Identifiers:
            – Type: issn-print
              Value: 0162-3257
          Numbering:
            – Type: volume
              Value: 48
            – Type: issue
              Value: 6
          Titles:
            – TitleFull: Journal of Autism and Developmental Disorders
              Type: main
ResultId 1