Development of the Parent-Rated Anxiety Scale for Youth With Autism Spectrum Disorder

J Am Acad Child Adolesc Psychiatry. 2019 Sep;58(9):887-896.e2. doi: 10.1016/j.jaac.2018.10.016. Epub 2019 Feb 21.


Objective: Anxiety is common in youth with autism spectrum disorder (ASD). There is no accepted outcome measure for anxiety in this population.

Method: Following a series of focus groups with parents of youth with ASD, we generated 72 items (scored 0-3). Parents of 990 youth with ASD (aged 5-17 years; 80.8% male) completed an online survey. Factor analysis and item response theory analyses reduced the content to a single factor with 25 items. Youth with at least mild anxiety (n = 116; aged 5-17 years; 79.3% male) participated in a comprehensive clinical assessment to evaluate the validity and reliability of the 25-item Parent-Rated Anxiety Scale for ASD (PRAS-ASD).

Results: In the online sample, the mean PRAS-ASD score was 29.04 ± 14.9 (range, 0-75). The coefficient α was 0.93. The item response theory results indicated excellent reliability across a wide range of scores with low standard errors. In the clinical sample (n = 116), the PRAS-ASD mean was 31.0 ± 15.6 (range, 1-65). Pearson correlations with parent ratings of ASD symptom severity, repetitive behavior, and disruptive behavior ranged 0.33 to 0.66, supporting divergent validity of the PRAS-ASD. Pearson correlation with a parent-rated measure of anxiety used in the general pediatric population of 0.83 supported convergent validity. A total of 40 participants (32 boys, 8 girls; mean age, 11.9 ± 3.4 years) returned at time 2 (mean, 12.2 days) and time 3 (mean, 24.2 days). Intraclass correlation showed test-retest reliabilities of 0.88 and 0.86 at time 2 and time 3, respectively.

Conclusion: The 25-item PRAS-ASD is a reliable and valid scale for measuring anxiety in youth with ASD.

Keywords: anxiety; autism; outcome measurement.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't
  • Validation Study

MeSH terms

  • Adolescent
  • Anxiety / complications
  • Anxiety / diagnosis*
  • Anxiety / psychology
  • Anxiety Disorders / complications
  • Anxiety Disorders / diagnosis*
  • Anxiety Disorders / psychology
  • Autism Spectrum Disorder / complications
  • Autism Spectrum Disorder / diagnosis*
  • Autism Spectrum Disorder / psychology
  • Child
  • Child, Preschool
  • Factor Analysis, Statistical
  • Female
  • Humans
  • Male
  • Parents
  • Psychiatric Status Rating Scales*
  • Psychometrics / instrumentation
  • Reproducibility of Results
  • Severity of Illness Index
  • Surveys and Questionnaires