Amy Drahota

Cognitive behavioral therapy for anxiety in children with autism spectrum disorders: a randomized, controlled trial

BACKGROUND Children with autism spectrum disorders often present with comorbid anxiety disorders that cause significant functional impairment. This study tested a modular cognitive behavioral therapy (CBT) program for children with this profile. A standard CBT program was augmented with multiple treatment components designed to accommodate or remediate the social and adaptive skill deficits of children with ASD that could pose barriers to anxiety reduction. METHOD Forty children (7-11 years old) were randomly assigned to 16 sessions of CBT or a 3-month waitlist (36 completed treatment or waitlist). Therapists worked with individual families. The CBT model emphasized behavioral experimentation, parent-training, and school consultation. Independent evaluators blind to treatment condition conducted structured diagnostic interviews and parents and children completed anxiety symptom checklists at baseline and posttreatment/postwaitlist. RESULTS In intent-to-treat analyses, 78.5% of the CBT group met Clinical Global Impressions-Improvement scale criteria for positive treatment response at posttreatment, as compared to only 8.7% of the waitlist group. CBT also outperformed the waitlist on diagnostic outcomes and parent reports of child anxiety, but not childrens self-reports. Treatment gains were maintained at 3-month follow-up. CONCLUSIONS The CBT manual employed in this study is one of the first adaptations of an evidence-based treatment for children with autism spectrum disorders. Remission of anxiety disorders appears to be an achievable goal among high-functioning children with autism.

Parent Training Interventions for Children with Autism Spectrum Disorders

A number of parent training programs for parents of children with ASD have been developed. An overview and rationale for why parent training for ASD differs from other childhood groups will be described. An overview of the major parent training methods used for ASD, the research to support them, and the effects achieved will be discussed.

Effectiveness of Modular CBT for Child Anxiety in Elementary Schools.

Most randomized controlled trials of cognitive-behavioral therapy (CBT) for children with anxiety disorders have evaluated treatment efficacy using recruited samples treated in research settings. Clinical trials in school settings are needed to determine if CBT can be effective when delivered in real world settings. This study evaluated a modular CBT program for childhood anxiety disorders in two elementary schools. Forty children (5-12 years old) with anxiety disorders, referred by teachers and school staff, were randomly assigned to modular CBT or a 3-month waitlist. Clinicians worked with individual families as well as teachers and school staff. Evaluators blind to treatment condition conducted structured diagnostic interviews and caregivers and children completed symptom checklists at pre- and posttreatment. The primary study outcome, the Clinical Global Impressions-Improvement scale, yielded a positive treatment response at posttreatment for 95.0% of CBT participants, as compared with only 16.7% of the waitlist participants. CBT also outperformed the waitlist on diagnostic outcomes and caregiver-report measures of anxiety. Treatment effects did not extend beyond anxiety diagnoses and symptoms. Results suggest that modular CBT delivered within the elementary school setting may be effective for the treatment of child anxiety disorders. A replication of the study results with a larger sample is indicated.

Therapist Perspectives on Community Mental Health Services for Children with Autism Spectrum Disorders

This mixed methods study examined therapist perspectives on serving children with autism spectrum disorders (ASD) in community mental health (CMH) clinics. One hundred therapists completed a survey about their experiences with this population and 17 participated in subsequent focus groups to clarify and expand survey results. Results indicate that CMH therapists serve many children with ASD for behavior or other psychiatric problems and perceive serving this population as challenging and frustrating due to their limited training. Therapists are highly motivated for comprehensive ASD training on ASD characteristics and intervention strategies. These data were used to tailor and package evidence-based intervention strategies for delivery in CMH services.

Children's Health-Related Locus of Control Beliefs: Ethnicity, Gender, and Family Income

Health-related locus of control (HLC) beliefs are important predictors of health behaviors, but few studies have focused on children, and rarely have ethnicity, gender, or income been considered. Caucasian American, Latino American, and African American children (N = 167) completed the childrens Multidimensional HLC scales, measuring internal, powerful others, and chance beliefs. Latino American and African American children endorsed stronger chance beliefs than Caucasian American children; Caucasian American children showed a trend toward less belief in powerful others compared to African American children. Patterns for boys and girls were similar. For children from higher income families, African American children scored higher than Caucasian American or Latino American children on belief in powerful others and chance; there were no ethnic group differences at lower income levels. Results suggest ethnicity and family income levels may be more important than gender as determinants of childrens HLC beliefs.

Developing the Autism Model of Implementation for Autism spectrum disorder community providers: study protocol

BackgroundCurrently, 1 out of 88 children are diagnosed with an autism spectrum disorder (ASD), and the estimated cost for treatment services is

Therapist Perspectives on Training in a Package of Evidence-Based Practice Strategies for Children with Autism Spectrum Disorders Served in Community Mental Health Clinics

126 billion annually. Typically, ASD community providers (ASD-CPs) provide services to children with any severity of ASD symptoms using a combination of various treatment paradigms, some with an evidence-base and some without. When evidence-based practices (EBPs) are successfully implemented by ASD-CPs, they can result in positive outcomes. Despite this promise, EBPs are often implemented unsuccessfully and other treatments used by ASD-CPs lack supportive evidence, especially for school-age children with ASD. While it is not well understood why ASD-CPs are not implementing EBPs, organizational and individual characteristics likely play a role. As a response to this need and to improve the lives of children with ASD and their families, this study aims to develop and test the feasibility and acceptability of the Autism Model of Implementation (AMI) to support the implementation of EBPs by ASD-CPs.Methods/designAn academic-community collaboration developed to partner with ASD-CPs will facilitate the development of the AMI, a process specifically for use by ASD community-based agencies. Using a mixed methods approach, the project will assess agency and individual factors likely to facilitate or hinder implementing EBPs in this context; develop the AMI to address identified barriers and facilitators; and pilot test the AMI to examine its feasibility and acceptability using a specific EBP to treat anxiety disorders in school-age children with ASD.DiscussionThe AMI will represent a data-informed approach to facilitate implementation of EBPs by ASD-CPs by providing an implementation model specifically developed for this context. This study is designed to address the real-world implications of EBP implementation in ASD community-based agencies. In doing so, the AMI will help to provide children with ASD the best and most effective services in their own community. Moreover, the proposed study will positively impact the field of implementation science by providing an empirically supported and tested model of implementation to facilitate the identification, adoption, and use of EBPs.

Concepts of Illness in Children: A Comparison Between Children With and Without Intellectual Disability

Therapist perspectives regarding delivery of evidence-based practice (EBP) strategies are needed to understand the feasibility of implementation in routine service settings. This qualitative study examined the perspectives of 13 therapists receiving training and delivering a package of EBPs to children with autism spectrum disorders (ASDs) in community mental health clinics. Therapists perceived the training and intervention delivery as effective at improving their clinical skills, the psychotherapy process, and child and family outcomes. Results expand parent pilot study findings, and add to the literature on training community providers and limited research on training providers to deliver EBPs to children with ASD.

Understanding the Landscape of Psychosocial Intervention Practices for Social, Emotional, and Behavioral Challenges in Youth With ASD: A Study Protocol

The present study explored concepts of illness held by children with intellectual disability (ID) and compared them with the beliefs of two comparison groups of typically developing children who were matched for cognitive developmental level and chronological age (ns = 11). Content of responses to questions regarding illness causation, symptoms, treatment, and prevention was analyzed; children with ID provided significantly different responses than did children without ID. A positive association between cognitive development and prevention concepts was found for children with ID. Children with ID did not differ from developmentally matched children in sophistication of illness concepts. Thus, it appears important to assess cognitive developmental level of children with ID to provide appropriate health education and services.

Daily living skills in school‐age children with and without anxiety disorders

ABSTRACT Introduction: There is a significant gap between research and practice for mental health services for youth with autism spectrum disorder (ASD). Despite increased numbers of individuals with ASD treated in community settings, little is known about the array of practices used with this population and the extent to which providers are aware of and use evidence-based strategies. The goal of this article is to describe a protocol for developing a more comprehensive understanding of the landscape of current intervention practices and attitudes regarding the treatment of psychosocial issues in youth with ASD in community settings within the United States. Methods: This article describes our research protocol for developing a comprehensive survey—the Usual Care for Autism Survey (UCAS)—to capture the depth and breadth of practices for youth with ASD and attitudes of community-based providers. Phase 1 will involve a comprehensive review of published literature to identify intervention practices for social difficulties, anxiety, and externalizing symptoms in youth with ASD (7–22 years). Phase 2 will involve developing and piloting the UCAS using the qualitative approaches and Delphi methodology. In Phase 3, we will distribute the UCAS to approximately 700 providers across the United States to ascertain the frequency of intervention practices being delivered to youth with ASD and provider attitudes toward practices in usual care practice settings. Conclusions: Results will assist the work of researchers, clinicians, and policymakers to support the implementation of effective practices and improve the quality of services for youth with ASD.