CRITIQUE OF RESEARCH ARTICLE

Critique of Research Article

Thearticle,Exploring the Manifestations of Anxiety in Children with Autism
Spectrum Disorders, by Hallet et al. (2013), examinedthefrequencyanddistributionof
anxietysymptomsinchildrenwithASDandtherelationshipbetweenanxietyandother
measuresofproblembehaviourandadaptivefunctioning.
Thissamplewascomprisedofindividualsbetweentheagesof4to17,who
participatedinthefederallyfunded,multisitetreatmenttrailsforASDs.TheCASI
Anxietydatawereavailablefor415children,including353boysand62girls.The
majority(i.e.,81%)werediagnosedwithAutisticDisorder,51%hadanIQgreaterthan
orequalto70,and23%wereidentifiedasnonverbal.Moreover,allparticipantswere
healthyandmedicationfreeforatleast2weekspriortobaseline,andtheywereassessed
withoutthepresenceofanotherpsychiatriccondition.Intermsofethnicbackgrounds,the
samplewas70%Caucasian,11%AfricanAmerican,8%Hispanic,7%Asian,and4%of
thesamplewasofotherdescent.
Thelargesamplecontributestothestrengthofthestudysmethodologybecauseit
willmorelikelyreflectthewholepopulationofthosewithASDs,resultinasmaller
standarderror,andprovideastablefactorsolution.However,itisimportanttonotethat
thesamplepopulationalsohaslimitations,asitwasnotrandomlyselected.Furthermore,
therewasamuchlargergroupofmaleparticipantsincomparisontothefemalegroup,as
85%ofthefullsamplewasmale,creatingapotentialgenderbias.Assuch,resultsmay
not be generalizable to the general ASD population, particularly females with ASD.

CRITIQUE OF RESEARCH ARTICLE

Additionally, the majority of the sample population was Caucasian, which limits the
generalizabilityoftheresultstootherethnicitiesthatwerenotasrepresented.
Variousmeasureswereusedinthisstudy,includingseveralparentratedscales,a
semistructuredparentinterview,andaclinicianratedscalethatusestheparentasthe
primaryinformant.In addition to the subjective scales, the study used different IQ tests,
depending on the participants age and ability. Contributingtothestudysstrength,allof
theemployedmeasureshavegoodreliabilityandvalidity.However,manyitemsonone
measurethatwasused,theCASIAnxietyScale,relyonlanguageandverbalexpression
fromthechild.Assuch,theresultsmayindicatehigheranxietyinchildrenwithASD
whohavehigherIQandhigherfunctioninglevelsbecauseintellectuallydisabledchildren
wouldbeunabletoexpressexcessiveworry(Hallettetal.,2013).Also,due to the fact
that some of the aforementioned measures are subjective and rely on parent reports, the
results of this study are influenced by measurement error, which limits the confidence in
their findings and acts as a weakness of the study.
Asoutlinedintheprocedure,thisstudyusedpretreatmentassessmentdatafor
eachtrialtoexamineanxietysymptomsandadaptivefunctioning.Thisassessment
includedtestsofIQandadaptivebehaviour,aswellasmedicalandpsychiatrichistories,
aphysicalexamination,andparentratedquestionnaires.Also,anexperiencedteamof
professionalsateachsiteconducteddiagnosticassessments,andtheAutismDiagnostic
InterviewRevisedcorroboratedthediagnoses.ThediagnosisofAspergersDisorderwas
basedonDSMIVcriteriausingtheavailableclinicalinformationonparticipants.
Theprocedureofthisstudyisnotpresentedinenoughdetailduetothelackof
informationregardingthesettinginwhichthestudywasconducted;theorderinwhich

CRITIQUE OF RESEARCH ARTICLE

assessmentmeasureswereconducted;thetimelapsedbetweeneachassessment;andthe
wayinwhichmedicalandpsychiatrichistorieswereobtained.Forexample,thearticle
didnotstatefromwhomthemedicalandpsychiatrichistorieswereobtainedandhowthe
historywasacquired(e.g.,aninformalconversationoraquestionnaire).Moreover,it
doesnotspecifythecontentsoftheavailableclinicalinformationoftheparticipants
whenreferringtotheinformationusedtodiagnoseAspergers.Itisalsoimportanttonote
thattheexperiencedteamfromeachclinicaltrialsiteisnotdescribedindetail(e.g.,
credentials,numberofmembers,levelofexperience),makingthestatementquite
ambiguous.Ultimately,thelackofinformationprovidedfortheprocedureisalimitation
ofthearticle.
Inconsiderationofthedatacollectionprocedure,itisevidentthatatreatmentor
changeagentisnotincludedinthestudytoexaminetheeffectsonthedependentvariable
(i.e.,anxietysymptomsinchildrenofvaryingcognitiveabilitieswithASD).This
indicatesthatthedesignofthestudyisclosertosurveyresearchthanexperimental.
However,theuseofdiagnosticand/orstandardizedtestsisnotrepresentativeofasurvey
researchdesign,makingitdifficulttodeterminetheresearchdesign.
Although this study is free of ethical issues, there are several ways in which this
research study could be improved. Firstly, the sample population could incorporate a
larger female sample in order to make it more representative of both genders. In this way,
the results would be more generalizable to the female ASD population. Moreover, the
sample population could be randomly derived from the general population of individuals
with ASD, rather than from clinical trails. This would avoid a lack of generalizability to
those with ASD in a broader sense. The sample population could further be improved by

CRITIQUE OF RESEARCH ARTICLE

including a more culturally inclusive sample group that is not primarily comprised of one
particular ethnicity (i.e., Caucasian). Secondly, more information regarding the data
collection procedure and study design would improve the study because it would provide
the reader with more information and enable other researchers to duplicate or extend the
study in the future. Lastly, the study would benefit from the use of an anxiety scale that
does not rely solely on verbal expression, as well as from measures that do not rely on
parent reports. If such measures were incorporated, it would strengthen the study because
greater confidence in the accuracy of the anxiety levels of the participants would occur.
Ultimately, although the study had several strengths, such as the large sample population
and the reliability and validity of the measures, the aforementioned improvements could
strengthen the study.

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Reference
Hallett, V., Lecavalier, L., Sukhodolsky, D. G., Cipriano, N., Aman, M. G., McCracken,
J. T.,Scahill, L. (2013). Exploring the manifestations of anxiety in children with
autism spectrum disorders. Journal of Autism and Developmental Disorders, 43,
2341-2352. doi:10.1007/s10803-013-1775-1

CRITIQUE OF RESEARCH ARTICLE

Critique of Research Article

The article, Treating Anxiety Disorders in Children with High Functioning Autism
Spectrum Disorders: A Controlled Trial, by Chalfant, Rapee, and Carrol (2006),
examined cognitive behavioural therapy as a treatment for anxiety in children with
Autism Spectrum Disorder (ASD).
The sample of the study included 47 children with high functioning autism or
Aspergers syndrome. These children consisted of 35 boys and 12 girls between the ages
of 8 and 13 years old. The sample group was acquired through referrals from community
health centers, mental health professionals, medical practitioners, and parent referrals. All
of the participants were diagnosed with ASD by a pediatrician, clinical psychologist, or
psychiatrist. The documentation of their diagnosis was collected and the examiners
confirmed the ASD diagnosis through clinical observations during the pretreatment
assessment. This documentation revealed that all participants had age appropriate
language skills and intellectual functioning that ranged from borderline to superior.
Moreover, all participants met the criteria for one or more anxiety disorder, and the
authors noted that 27.7% of the sample has ADHD as well. It is important to note that the
participants were not currently on anti-depressant or anti-anxiety medication.
Thesmallsampleisalimitationofthestudysmethodologybecauseitwillnotbe
very reflective of the whole population of those with high functioning autism or
AspergersSyndrome.Although,thesamplegroupwasacquiredthroughreferralsfrom
variousavenues(i.e.,community,mentalhealth,medical,parent),makingitdiversified,

CRITIQUE OF RESEARCH ARTICLE

itwasnotrandomlyselected,whichisalimitation.Furthermore,therewasamuchlarger
groupofmaleparticipantsincomparisontothefemalegroup,creatingapotentialgender
bias.Assuch,resultsmaynotbehighlygeneralizabletofemaleswithhighfunctioning
autismorAspergerssyndrome.Also,thefactthat27.7% of the sample has ADHD may
indicate that other confounding factors (i.e., comorbid disorders) could have impacted the
results. Additionally,noinformationregardingtheethnicitiesoftheparticipantswere
revealed,whichmeansthattheresultsmayormaynotbegeneralizabletoallethnicities,
dependingonthedegreetowhichthesampleisrepresentativeofvariouscultures.
A multi-modal and multi-person assessment method was used, as it included
various measures. For example, a structured diagnostic measure that interviewed the
parent and child, as well as various self-, parent-, and teacher-report measures were
employed. Additionally, the chosen measures were selected based on the fact that they are
reliable, valid, and suitable for the testing purposes. Ultimately, the use of several
psychometrically sound tools with different informants to collect data contributes to the
strength of the study.
In terms of the procedure, families were contacted and interviewed over the
telephone after their referral. This was conducted to gather information regarding the
childs anxiety and to screen for physical, medical, and behavioural disorders. Once this
was completed, families were mailed the self-, parent-, and teacher- report forms to fill
out and hand in to the clinicians. After this, the families were invited to attend a clinical
interview at the Autism Association of NSW, where written informed consent was also
obtained. When this was finished and a diagnosis was established, participants were
randomly assigned to a cognitive behavioural treatment or a wait list control condition.

CRITIQUE OF RESEARCH ARTICLE

The number of children in each group ranged from six to eight children, depending on the
number of families that were recruited. The children in the treatment condition received a
12-week, group-delivered cognitive behavioural treatment for two hours per week. The
treatment was a high functioning autism adaptation of the Macquarie University,
Cool Kids program (Lyneham, Abbott, Wignall, & Rapee, 2003), with
permission from the authors. It included simplified cognitive strategies, visual aids,
structured homework/worksheets, and exposure. Although no measures were used to
track homework compliance, parents kept a daily diary to record the practice and
outcomes from their exposure exercises. Also, participants in both conditions were given
the same measures before and immediately after the treatment by the same clinicians who
led the treatment groups. Moreover, the parents with children in the treatment condition
also completed a questionnaire regarding customer satisfaction with the program. It is
important to note that the wait-list participants and their families and teachers were
informed of the data that was being collected during the waiting period and they were
aware that the treatment would be offered to them after the wait-list period.
Overall,theprocedurewasadequatelyoutlined,asitprovideddetailregardingthe
settinginwhichthestudywasconducted,thelengthandcomprehensivedescriptionof
thetreatmentprogram,andthetimelapsedbetweenthepreandposttests.However,the
orderinwhichassessmentmeasureswereconductedwasnotprovidedandinformation
regardingthecredentialsoftheclinicianswasnotspecified.Furthermore,in
considerationofthedatacollectionprocedure,itisevidentthatthestudyusedaclassic
experimentaldesignbecausethemeasuresweregivenpriortotreatmentandimmediately
aftertreatment,itincorporatedacontrolgroupandexperimentalgroup,anditused

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randomizationtocreategroups.Thisindicatesthatthestudyisrepresentativeofatrue
experimentaldesignbecauseitevaluatedtheeffectsofthetreatmentorchangeagent(i.e.,
adaptedCoolKidsprogram)onthedependentvariable(i.e.,anxietydisordersinchildren
withhighfunctioningautism/AspergersSyndrome)usingrandomization,acontrol
group,andpreandposttests.Thisisanadditionalstrengthofthestudy.
Although the study does not have ethical issues, there are several ways in which it
can be improved. For example, the study would improve with a larger sample size and a
random sample, rather than a sample derived from referrals. Moreover, a greater female
sample group would also improve the study. In this way, the results would be more
generalizabletothosewithhighfunctioningautismorAspergerssyndrome,including
femalesinthispopulation.Ultimately, although the research article was quite strong as a
result of the reliability and validity of the measures and detailed procedure, a larger,
random sample could further strengthen the study.

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References
Chalfant, A. M., Rapee, R., & Carroll, L. (2007). Treating Anxiety Disorders in Children
with High Functioning Autism Spectrum Disorders: A Controlled Trial. Journal
of Autism and Developmental Disorders, 37:18421857. doi:10.1007/s10803-0060318-4
Lyneham, H. J., Abbott, M. J., Wignall, A., & Rapee, R. M. (2003). The Cool Kids
Family Program: Therapist Manual. Sydney, AU: Macquarie University.