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J Am Acad Child Adolesc Psychiatry. 2019 Feb 21. pii: S0890-8567(19)30124-8. doi: 10.1016/j.jaac.2018.10.016. [Epub ahead of print]

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

Author information

Marcus Autism Center, Emory University School of Medicine, Atlanta, GA. Electronic address:
Ohio State University, Nisonger Center, Columbus, OH.
Center for Autism Research, Children's Hospital of Philadelphia and Perelman School of Medicine, University of Pennsylvania, Philadelphia.
Marcus Autism Center, Emory University School of Medicine, Atlanta, GA.
University of Washington, Seattle.
State University of New York at Stony Brook, NY.
Arizona State University, Tempe, AZ.



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


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).


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.


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


anxiety; autism; outcome measurement


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