Development and Initial Evaluation of the Anxiety Scale for Autism-Adults

Abstract

Background: Anxiety is highly prevalent in autistic adults and can cause a significant impact on functioning and quality of life. There are no existing measures of anxiety designed and validated specifically for autistic adults. In this study, we aimed to adapt an existing anxiety measure designed for autistic children, in collaboration with autistic adults and other professionals, to make it suitable for use for autistic adults and to examine the measurement properties of the newly designed measure. Methods: Through consultation with autistic adults and professionals working with autistic people, we developed a preliminary self-report anxiety measure. Five hundred fifty-one autistic adults completed the measure and another measure of anxiety and depression (the Hospital Anxiety and Depression Scale). Participants completed measures again after 1 month to determine test/retest reliability. We split the sample to enable exploratory and confirmatory factor analyses to be undertaken on different samples. We conducted internal consistency and convergent and divergent validity analyses. We completed receiver operator curve (ROC) analyses to investigate sensitivity and specificity and identify an indicative clinical cutoff. Results: Our findings indicate that the Anxiety Scale for Autism-Adults (ASA-A) has promising psychometric properties. Factor analysis indicated that a bifactor solution with orthogonal general and specific factors was an adequate fit and that minimal measurement bias would occur if the scale were treated as unidimensional, so the total score could be used as a valid measure of anxiety. We identified a General Anxiety factor and three group factors (Social Anxiety, Uncertainty, and Anxious Arousal). ROC analysis indicated a score of 28 could be considered an indicative clinical cutoff. Conclusion: The ASA-A is the first self-report anxiety questionnaire specifically developed and validated for autistic adults. Preliminary evaluation of the measurement properties indicates that the scale will be a useful tool in research and clinical contexts.

Creating Accessible Survey Instruments for Use with Autistic Adults and People with Intellectual Disability: Lessons Learned and Recommendations

“…36,37 While their methods may differ from ours, like us, they found that the existing measure did not fully capture the intended construct, so they worked with autistic adults to create additional items. Similarly, Rodgers et al 65 consulted with autistic adults to adapt an anxiety scale to be more accessible to this population. Moreover, research teams have used participatory approaches to create new instruments on topics such as autistic adults' vulnerability to negative life experiences.…”

Development and Validation of the Suicide Behaviours Questionnaire – Autism Spectrum Conditions in Autistic, Possibly Autistic and Non-Autistic Adults.

“…Each item is rated on a scale from "Never" (0) -"Always" (3), with total scores ranging from 0-60. Scores at or above 28 indicate clinically signi cant levels of [35]. The ASA-A has strong evidence in support of its measurement properties (factor structure, internal consistency, test re-test reliability, convergent and divergent validity) in autistic adults [35].…”

“…Scores at or above 28 indicate clinically signi cant levels of [35]. The ASA-A has strong evidence in support of its measurement properties (factor structure, internal consistency, test re-test reliability, convergent and divergent validity) in autistic adults [35]. Cronbach's alpha for whole scale: Autistic group a=.921, possibly autistic group a=.926, non-autistic group a=.943.…”

“…The ASA-A [35] is a 20-item self-report measure of anxiety designed with and for autistic adults, adapted from the Anxiety Scale for Autism Spectrum Disorder (ASC-ASD) (REF). The ASA-A measures four components of anxiety: Social Phobia (e.g.…”

Treating anxiety in autistic adults: study protocol for the Personalised Anxiety Treatment–Autism (PAT-A©) pilot randomised controlled feasibility trial

“…Social Responsiveness Scale (SRS-2; [53]: the SRS-2 is a standardised self-report questionnaire used extensively to rate the social communication difficulties of autistic adults and children. Estimates of internal consistency of between .94 to .96 have been reported whilst the predictive validity of the adult form found a specificity level of .60 and sensitivity of .86 [54] Anxiety Scale for Autism-Adult (ASA-A©; [55]): the ASA-A© is a 20-item self-report measure designed to measure anxiety in autistic adults. It consists of four subscales: Social Phobia (SP), Anxious Arousal (AA) and Uncertainty (U).…”