(PS4-47) How Do Discrepancies Between Parent and Self Report of Anxiety Relate to Parental Accommodation Behaviors in Autistic Teens with ID?

Background: Autistic adolescents with intellectual disabilities (ID) have historically been underrepresented in anxiety research, despite experiencing anxiety disorders at greater rates than the general population (Skwerer et al., 2019). Self-report measures of anxiety have been particularly underutilized, given concerns around the impact of cognition and language, despite clinical utility of multi-informant reports (Hagiopan & Jennett, 2008). With anxiety, many symptoms relate to internal experiences and can be difficult for parents to observe or infer, particularly for teens with less verbal communication. Prior research shows discrepancies in informant reporting among parent-teen dyads can be predictive of CBT treatment response and outcomes (Becker-Haimes et al., 2017). Finally, parents of teens with anxiety often find themselves inadvertently involved in the maintenance of their teens’ anxiety symptoms via accommodation behaviors, or responses that result in further avoidance of the feared situation. These arise in two main patterns: excessive verbal reassurance and changes to family routines (Lebowitz et al., 2013). This current study aimed to understand how parent-teen discrepancies in anxiety reporting for autistic teens with ID relate to family accommodation behaviors. 


Methods: Adolescent self-report of anxiety using the Glasgow Anxiety Scale for people with an intellectual disability (GAS-ID) was available for 58 of 72 teens (12 – 18 yrs; M = 14.7; Mean IQ = 56) participating in a larger RCT of CBT adapted for autistic teens with ID (FYF:IDD; DoD W81XWH-20-ARP-CTRA). IQ, adaptive behavior, and language level (i.e., phrase speech or above) were significant predictors of GAS-ID completion. The general anxiety subscale of the ADAMS was used for parent report of anxiety, the Family Accommodation Scale for Anxiety (FASA) was used to measure family accommodation. Mean splits were used to classify parent-teen reporting discrepancies (parent-teen high; parent-teen low, parent high/teen low, parent low/teen high). ANOVAs and pairwise post-hoc tests (Tukey HSD) were used to examine differences between groups on FASA scores.



Results: Across FASA subscales, high levels of parent-reported teen anxiety were related to higher family accommodation scores, regardless of teen report (p’s < .05). Accommodation behaviors were lowest for families where parents reported low levels of teen anxiety, including the parent low/teen high group (p’s < .05).

Discussion: This study found parents’ appraisal of their teen’s anxiety, rather than their teen’s self-report of anxiety, was predictive of family accommodation (i.e., reassurance and change in routine). One interpretation is that the degree to which parents engage in accommodation behaviors impact parent ratings of anxiety. Discrepancies may also be related to how effectively teens communicate their anxiety, which may be a clinically useful treatment target. As not all teens were able to utilize the GAS-ID as a self-report measure, additional research is needed on ways to further adapt anxiety measures to decrease verbal demands, to promote inclusion. Other future directions include investigating how parent-teen reporting discrepancies change following CBT participation.