School of Psychology, College of Health and Life Sciences, Aston University, Birmingham, B4 7 ET, United Kingdom.
School of Health and Care, Coventry University, Priory St, Coventry, CV1 5FB, England.
J Neurodev Disord. 2024 Jul 27;16(1):43. doi: 10.1186/s11689-024-09554-9.
There is a critical need for the development of dependable and valid anxiety assessment tools suitable for people with moderate to severe intellectual disabilities, particularly those who speak few or no words. Distinguishing anxiety from distress caused by physical discomfort (pain) or characteristics associated with autism, prevalent in this population, necessitates specialised assessment tools. This study (a) developed a parent-report anxiety questionnaire tailored for individuals with severe to moderate intellectual disabilities, potentially with a co-diagnosis of autism, and (b) evaluated the psychometric attributes of this novel measure.
A comprehensive approach involving literature reviews, inspection of existing tools, and interviews with clinicians and parents guided the creation of the Clinical Anxiety Scale for People with Intellectual Disabilities. The tool was completed by parents or caregivers (N = 311) reporting on individuals aged 4 or older with intellectual disabilities.
Exploratory factor analysis indicated a four-factor structure encompassing anxiety, pain, low energy/withdrawal, and consolability. The anxiety factor explained the most variance in scores (26.3%). The anxiety, pain, low energy/withdrawal subscales demonstrated robust internal consistency (α = 0.81-0.92), and convergent, divergent, and discriminant validity. Robustness of these subscales was further evidenced by test-retest reliability (ICC = 0.79-0.88) and inter-rater reliability (ICC = 0.64-0.71). Subgroup analyses consistently demonstrated strong psychometric properties among individuals diagnosed with non-syndromic autism (N = 98), children (N = 135), adults (N = 175), and across diverse communication abilities within the sample. Moreover, individuals diagnosed with both autism and anxiety exhibited significantly higher scores on the anxiety subscale compared to those without an anxiety diagnosis, while showing no difference in autism characteristic scores.
The findings indicate that the Clinical Anxiety Scale for People with Intellectual Disabilities is a promising measure for use across diverse diagnostic groups, varying communication abilities, and with people with moderate to severe intellectual disabilities.
对于开发适用于中度至重度智力残疾人群的可靠且有效的焦虑评估工具存在迫切需求，特别是那些言语能力有限或无言语能力的人群。与该人群中普遍存在的身体不适（疼痛）或自闭症相关特征引起的痛苦区分开来，需要专门的评估工具。本研究（a）为可能伴有自闭症共诊断的严重至中度智力残疾个体开发了一种家长报告焦虑问卷，（b）评估了该新型测量工具的心理计量学属性。
综合文献综述、现有工具检查以及与临床医生和家长的访谈，指导了《智力障碍人群临床焦虑量表》的编制。该工具由报告年龄在 4 岁及以上智力残疾个体的家长或照顾者填写（N=311）。
探索性因素分析表明，该工具包含焦虑、疼痛、低能量/退缩和安抚性四个因子结构。焦虑因子解释了评分中最大的变异（26.3%）。焦虑、疼痛、低能量/退缩子量表表现出较强的内部一致性（α=0.81-0.92），并具有收敛、发散和区分效度。这些子量表的稳健性还通过测试-重测信度（ICC=0.79-0.88）和评分者间信度（ICC=0.64-0.71）得到了进一步证明。亚组分析表明，在非综合征型自闭症（N=98）、儿童（N=135）、成人（N=175）以及样本中具有不同沟通能力的个体中，这些子量表均具有良好的心理计量学特性。此外，与没有焦虑诊断的个体相比，同时被诊断为自闭症和焦虑的个体在焦虑子量表上的得分明显更高，而在自闭症特征得分上没有差异。
研究结果表明，《智力障碍人群临床焦虑量表》是一种有前途的测量工具，可用于不同的诊断群体、不同的沟通能力，并适用于中度至重度智力残疾人群。
