Group Cognitive Behavioral Treatment for Anxiety in Adolescents with ASD and Intellectual Disability: A Randomized Controlled Trial
Abstract
Adolescents with ASD and intellectual disability (ID) are a complex and underserved population. Approximately 50% of individuals with ASD/ID experience significant anxiety (Bakken et al., 2010) that can contribute to avoidance, increased challenging behavior, and reduced community participation. Parents of youth with ASD/ID report limited support in teaching their child how to independently cope with daily stressors (O’Nions et al., 2018). Thus, teens often finish high school with reduced coping abilities and consequently experience heightened anxiety in the workplace and poor job retention (Hurlbutt and Chalmers, 2004). Yet, when coping skills are taught early in adolescence, there is an opportunity to practice these strategies, leading to better employment rates, decreased clinical service use, and increased long-term wages (Cimera et al., 2013). Addressing anxiety and building coping skills for teens with ASD/ID is of critical importance, as these are prerequisite skills for successful transition to adulthood. The lack of evidenced-based interventions supporting coping and targeting anxiety for this population is a significant barrier to appropriate mental health care and can contribute to the marginalization of individuals with ASD/ID. This application proposes a FY20 Clinical Translational Research program to target the critical needs of the Autism Spectrum Disorder (ASD) community via: (1) a cognitive-behavioral treatment that (2) supports success in transition to adulthood for individuals living with ASD. Our research team adapted a cognitive behavioral treatment (CBT) manualized intervention, Facing Your Fears (Reaven et al., 2011), for adolescents with ASD/ID (FYF:ASD/ID) and completed a pilot study with 23 teens. Preliminary outcome measures indicated significant improvements in anxiety and mood symptoms. The proposed study seeks to test whether FYF:ASD/ID is more effective in reducing anxiety than treatment-as-usual (TAU). We propose a Randomized Control Trial (RCT) with 36 adolescents with ASD/ID (12-18 years) randomized to FYF:ASD/ID and 36 adolescents randomized to TAU for 14 weeks. The 36 teens randomized to TAU will then cross over and complete FYF:ASD/ID. Evaluations will take place at Baseline, Post-Intervention, and 6-month follow-up. Teens in the TAU will have two baseline assessments prior to crossing over to FYF:ASD/ID; both groups will complete a 6-month follow-up assessment after finishing FYF:ASD/ID. There are three aims for this project: (1) examine the efficacy of FYF: ASD/ID relative to TAU in improving anxiety as measured by parent report, self-report, and objective behavioral tasks and determine whether any gains noted in the FYF:ASD/ID are maintained at 6-month follow-up; (2) examine secondary outcomes of anxiety such as how emotion regulation, problem behavior, parenting self-efficacy, family accommodation of anxiety, and quality of life are affected by participation in FYF:ASD/ID; and (3) examine whether adolescents’ independent use of CBT skills (as assessed by goal attainment ratings of prompting level required to use strategies) to manage anxiety are increased following participation in FYF:ASD/ID. As an exploratory aim, exit interviews will be completed with a sub-sample of participants at 6-month follow-up with the goal to obtain nuanced information regarding continued CBT skill use, advocacy, community engagement, and other skills that would suggest the more sustained impact of FYF:ASD/ID on adolescent transition. It is necessary to close the gap in the availability of anxiety interventions and ensure effective mental health care for all individuals on the spectrum. The present study would represent the first RCT of a CBT intervention for adolescents with ASD/ID, a critical step toward establishing an evidence base for anxiety treatment for this underserved and vulnerable population. It is important to support the study of interventions that can contribute to
Document Details
- Document Type
- DoD Grant Award
- Publication Date
- Dec 05, 2021
- Source ID
- W81XWH2110673
Entities
People
- Audrey Blakeley-smith
Organizations
- United States Army
- University of Colorado Denver