Systematic review of the properties of tools used to measure outcomes in anxiety intervention studies for children with autism spectrum disorders

PLoS One. 2014 Jan 21;9(1):e85268. doi: 10.1371/journal.pone.0085268. eCollection 2014.


Background: Evidence about relevant outcomes is required in the evaluation of clinical interventions for children with autism spectrum disorders (ASD). However, to date, the variety of outcome measurement tools being used, and lack of knowledge about the measurement properties of some, compromise conclusions regarding the most effective interventions.

Objectives: This two-stage systematic review aimed to identify the tools used in studies evaluating interventions for anxiety for high-functioning children with ASD in middle childhood, and then to evaluate the tools for their appropriateness and measurement properties.

Methods: Electronic databases including Medline, PsychInfo, Embase, and the Cochrane database and registers were searched for anxiety intervention studies for children with ASD in middle childhood. Articles examining the measurement properties of the tools used were then searched for using a methodological filter in PubMed, and the quality of the papers evaluated using the COSMIN checklist.

Results: Ten intervention studies were identified in which six tools measuring anxiety and one of overall symptom change were used as primary outcomes. One further tool was included as it is recommended for standard use in UK children's mental health services. Sixty three articles on the properties of the tools were evaluated for the quality of evidence, and the quality of the measurement properties of each tool was summarised.

Conclusions: Overall three questionnaires were found robust in their measurement properties, the Spence Children's Anxiety Scale, its revised version - the Revised Children's Anxiety and Depression Scale, and also the Screen for Child Anxiety Related Emotional Disorders. Crucially the articles on measurement properties provided almost no evidence on responsiveness to change, nor on the validity of use of the tools for evaluation of interventions for children with ASD.

Prospero registration number: CRD42012002684.

Publication types

  • Research Support, Non-U.S. Gov't
  • Review
  • Systematic Review

MeSH terms

  • Anti-Anxiety Agents / therapeutic use
  • Anxiety / diagnosis*
  • Anxiety / drug therapy
  • Anxiety / physiopathology
  • Child
  • Child Development Disorders, Pervasive / diagnosis*
  • Child Development Disorders, Pervasive / drug therapy
  • Child Development Disorders, Pervasive / physiopathology
  • Child, Preschool
  • Databases, Bibliographic
  • Female
  • Humans
  • Male
  • Mental Status Schedule
  • Outcome Assessment, Health Care / methods*
  • Research Design*
  • Surveys and Questionnaires


  • Anti-Anxiety Agents

Grant support

The review was funded by Research Capacity Funding from the Northumberland Tyne and Wear National Health Service Foundation Trust. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.