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The Relationship Between Treatment Acceptability and Youth Outcome in Group CBT for Youth with ASD and Anxiety

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Abstract

Anxiety is one of the most common co-occurring diagnoses in youth with autism spectrum disorder (ASD). Cognitive behavior therapy (CBT) is an evidence-based treatment that has been tailored for youth with ASD and anxiety and has shown good efficacy in reducing youth anxiety immediately after treatment. One area that has not been widely studied is acceptability of CBT for anxiety in this population. Acceptability includes beliefs about the potential helpfulness and satisfaction with a given treatment and may be important in understanding treatment outcomes. This study focuses on parent, youth, and clinician acceptability of a well-researched CBT program, Facing Your Fears, for youth with ASD and anxiety. Data was collected as part of a larger multi-site study that compared three different instructional conditions for clinicians learning the intervention. Results indicated that parents rated acceptability as higher for the overall treatment compared to youth. Further, youth and parents rated exposure related sessions as more acceptable than psychoeducation, and higher exposure acceptability ratings were predictive of lower youth anxiety levels post-treatment. Clinicians who received ongoing consultation rated treatment acceptability lower than clinicians in the other training conditions. While some clinicians may be hesitant to implement exposure techniques with this population, findings suggest that it is the technique that parents and youth rated as the most acceptable. Results are discussed in terms of treatment and research implications for youth with ASD and their families.

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References

  • Abramowitz, J. S., Franklin, M. E., & Foa, E. B. (2002). Empirical status of cognitive behavioral therapy for obsessive-compulsive disorder: A meta-analytic review. Romanian Journal of Cognitive & Behavioral Psychotherapies, 2, 89–104.

    Google Scholar 

  • Allinder, R. M., & Oats, R. G. (1997). Effects of acceptability on teachers’ implementation of curriculum-based measurement and student achievement in mathematics computation. Remedial and Special Education, 18, 113–120. https://doi.org/10.1177/074193259701800205.

    Article  Google Scholar 

  • Berument, S. K., Rutter, M., Lord, C., Pickles, A., & Bailey, A. (1999). Autism screening questionnaire: Diagnostic validity. The British Journal of Psychiatry, 175(5), 444–451. https://doi.org/10.1192/bjp.175.5.444.

    Article  PubMed  CAS  Google Scholar 

  • Birmaher, B., Brent, D. A., Chiappetta, L., Bridge, J., Monga, S., & Baugher, M. (1999). Psychometric properties of the screen for child anxiety related emotional disorders (SCARED): A replication study. Journal of the American Academy of Child & Adolescent Psychiatry, 38(10), 1230–1236. https://doi.org/10.1097/00004583-199910000-00011.

    Article  CAS  Google Scholar 

  • Blakeley-Smith, A., Reaven, J., Ridge, K., & Hepburn, S. (2012). Parent-child agreement of anxiety symptoms in youth with autism spectrum disorders. Research in Autism Spectrum Disorders, 6, 707–716. https://doi.org/10.1016/j.rasd.2011.07.020.

    Article  Google Scholar 

  • Calvert, S. C., & Johnston, C. (1990). Acceptability of treatments for child behavior problems: Issues and implications for future research. Journal of Clinical Child Psychology, 19, 61–74. https://doi.org/10.1207/s15374424jccp1901_8.

    Article  Google Scholar 

  • de Bruin, E. I., Ferdinand, R. F., Meester, S., de Nijs, P. F. A., & Verheij, F. (2007). High rates of psychiatric co-morbidity in PDD-NOS. Journal of Autism and Developmental Disorders, 37, 877–886. https://doi.org/10.1007/s10803-006-0215-x.

    Article  PubMed  Google Scholar 

  • Finn, C. A., & Sladeczek, I. E. (2001). Assessing the social validity of behavioral interventions: A review of treatment acceptability measures. School Psychology Quarterly, 16, 176–206. https://doi.org/10.1521/scpq.16.2.176.18703.

    Article  Google Scholar 

  • Hale, W. W., Crocetti, E., Raaijmakers, Q. A., & Meeus, W. H. (2011). A meta-analysis of the cross-cultural psychometric properties of the screen for child anxiety related emotional disorders (SCARED). Journal of Child Psychology and Psychiatry, 52, 80–90. https://doi.org/10.1111/j.1469-7610.2010.02285.x.

    Article  PubMed  Google Scholar 

  • Kaczkurkin, A. N., & Foa, E. B. (2015). Cognitive-behavioral therapy for anxiety disorders: An update on the empirical evidence. Dialogues in Clinical Neuroscience, 17, 337–346.

    PubMed  PubMed Central  Google Scholar 

  • Kazdin, A. E. (1980). Acceptability of alternative treatments for deviant youth behavior. Journal of Applied Behavior Analysis, 13, 259–273. https://doi.org/10.1901/jaba.1980.13259.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  • Kazdin, A. E. (2000). Perceived barriers to treatment participation and treatment acceptability among antisocial children and their families. Journal of Child and Family Studies, 9, 157–174. https://doi.org/10.1023/A:1009414904228.

    Article  Google Scholar 

  • Kazdin, A. E., Bass, D., Siegel, T., & Thomas, C. (1989). Cognitive-behavioral therapy and relationship therapy in the treatment of children referred for antisocial behavior. Journal of Consulting and Clinical Psychology, 57, 522–535. https://doi.org/10.1037/0022-006X.57.4.522.

    Article  PubMed  CAS  Google Scholar 

  • Kendall, P. C. (1994). Treating anxiety disorders in children: Results of a randomized clinical trial. Journal of Consulting and Clinical Psychology, 62, 100–110. https://doi.org/10.1037/0022-006X.62.1.100.

    Article  PubMed  CAS  Google Scholar 

  • Kendall, P. C., Comer, J. S., Marker, C. D., Creed, T. A., Puliafico, A. C., Hughes, A. A.,… Hudson, J. (2009). In-session exposure tasks and therapeutic alliance across the treatment of childhood anxiety disorders. Journal of Consulting and Clinical Psychology, 77, 517–525. https://doi.org/10.1037/a0013686.

    Article  PubMed  Google Scholar 

  • Lord, C., Rutter, M., DiLavore, P., Risi, S., Gotham, K., & Bishop, S. (2012). Autism diagnostic observation schedule (2nd ed.). Torrance, CA: Western Psychological Services.

    Google Scholar 

  • Miltenberger, R. G. (1990). Assessment of treatment acceptability: A review of the literature. Topics in Early Childhood Special Education, 10, 24–38. https://doi.org/10.1177/027112149001000304.

    Article  Google Scholar 

  • O’Brien, S., & Karsh, K. (1991). Treatment acceptability: Consumer, therapist and society. In A. Repp & N. Singh (Eds.), Perspectives on the use of nonaversive and aversive interventions for persons with developmental disabilities (pp. 503 516). Sycamore: Sycamore Publishing Company.

    Google Scholar 

  • Reaven, J., Blakeley-Smith, A., Beattie, T. L., Sullivan, A., Moody, E. J., Stern, J. A., Hepburn, S. L., et al. (2014). Improving transportability of a CBT intervention for anxiety in youth with ASD: Results from a US-Canada collaboration. Autism, 19, 211–222. https://doi.org/10.1177/1362361313518124.

    Article  PubMed  PubMed Central  Google Scholar 

  • Reaven, J., Blakeley-Smith, A., Culhane-Shelburne, K., & Hepburn, S. L. (2012). Group cognitive behavior therapy for youth with high-functioning autism spectrum disorders and anxiety: A randomized trial. The Journal of Youth Psychology and Psychiatry, 53, 410–419. https://doi.org/10.1111/j.1469-7610.2011.02486.x.

    Article  Google Scholar 

  • Reaven, J., Blakeley-Smith, A., Nichols, S., & Hepburn, S. (2011). Facing your fears: Group therapy for managing anxiety in youth with high-functioning autism spectrum disorders. Baltimore: Paul Brookes Publishing.

    Google Scholar 

  • Reaven, J., Moody, E., Klinger, L., Keefer, A., Duncan, A., O’Kelley, S., … Blakeley Smith, A. (in press). Training clinicians to deliver group CBT to manage anxiety in youth with ASD: Results of a multi-site trial. Journal of Consulting and Clinical Psychology.

  • Reimers, T. M., Wacker, D. P., Cooper, L. J., & de Raad, A. O. (1992). Acceptability of behavioral treatments for children: Analog and naturalistic evaluations by parents. School Psychology Review, 21, 628–643.

    Google Scholar 

  • Silverman, W., & Albano, A. (1996). Anxiety disorders interview schedule for children for DSM-IV: (Child and Parent Versions). San Antonio: Psychological Corporation.

    Google Scholar 

  • Stern, J. A., Gadgil, M. S., Blakeley-Smith, A., Reaven, J. A., & Hepburn, S. L. (2014). Psychometric properties of the SCARED in youth with autism spectrum disorder. Research in Autism Spectrum Disorders, 8(9), 1225–1234. https://doi.org/10.1016/j.rasd.2014.06.008.

    Article  PubMed  PubMed Central  Google Scholar 

  • Taylor, S., Abramowitz, J. S., & McKay, D. (2012). Non-adherence and non-response in the treatment of anxiety disorders. Journal of Anxiety Disorders, 26, 583–589. https://doi.org/10.1016/j.janxdis.2012.02.010.

    Article  PubMed  Google Scholar 

  • Van Steensel, F. J., Bogels, S. M., & Perrin, S. (2011). Anxiety disorders in children and adolescents with autistic spectrum disorders: A meta-analysis. Clinical Child and Family Psychology Review, 14, 302–317. https://doi.org/10.1007/s10567-011-0097-0.

    Article  PubMed  PubMed Central  Google Scholar 

  • Walkup, J. T., Albano, A. M., Piacentini, J., Birmaher, B., Compton, S. N., Sherrill, J. T., & Iyengar, S. (2008). Cognitive behavioral therapy, sertraline, or a combination in childhood anxiety. New England Journal of Medicine, 359(26), 2753–2766. https://doi.org/10.1056/NEJMoa0804633.

    Article  PubMed  CAS  Google Scholar 

  • Wergeland, G. J. H., Fjermedtada, K. W., Marind, C. E., Storm-Mowatt Hauglanda, B., Silvermand, W. K., Ost, L. G., Havika, O. E., & Heiervanga, E. R. (2015). Predictors of dropout from community clinic youth CBT for anxiety disorders. Journal of Anxiety Disorders, 31, 1–10. https://doi.org/10.1016/j.janxdis.2015.01.004.

    Article  PubMed  Google Scholar 

  • Wood, J. J., Drahota, A., Sze, K., Har, K., Chiu, A., & Langer, D. A. (2009). Cognitive behavioral therapy for anxiety in children with autism spectrum disorder: A randomized, controlled trial. Journal of Child Psychology and Psychiatry, 50, 224–234. https://doi.org/10.1111/j.1469-7610.2008.01948.x.

    Article  PubMed  Google Scholar 

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Acknowledgements

The authors extend a special thanks to the clinicians, children, and parents who participated in this study.

Funding

This research is supported in part, by the Health Resources and Services Administration (HRSA) under the Leadership Education in Neurodevelopmental Disabilities (LEND) Grant T73MC11044 and by the Administration on Intellectual and Developmental Disabilities (AIDD) under the University Center of Excellence in Developmental Disabilities (UCDEDD) Grant 90DD0632 of the U.S. Department of Health and Human Services (HHS). This research was also supported in part by the National Institutes of Health (NIH) Grant R33MH089291-03. This information or content and conclusions are those of the authors and should not be construed as the official position or policy of, nor should any endorsements be inferred by NIH, HRSA, HHS, or the US Government.

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Authors and Affiliations

  1. Department of Pediatrics, University of Colorado, 13123 E. 16th Ave., Box 140, Aurora, CO, 80045, USA

    Caitlin E. Walsh

  2. Department of Psychiatry & Pediatrics, University of Colorado, JFK Partners, 13121 E. 17th Ave., Box C-234, Aurora, CO, 80045, USA

    Eric Moody, Audrey Blakeley-Smith, Allison Meyer & Judy Reaven

  3. Division of Developmental and Behavioral Pediatrics, The Kelly O’Leary Center for Autism Spectrum Disorders, Cincinnati Children’s Hospital, 333 Burnet Ave., Cincinnati, OH, 45229, USA

    Amie Duncan

  4. Department of Human Development and Family Studies, Colorado State University, 1510 Pitkin Street, Campus Box 1570, Fort Collins, CO, 80524, USA

    Susan Hepburn

  5. Center for Autism and Related Disorders, Kennedy Krieger Institute, Baltimore, MD, USA

    Amy Keefer

  6. Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA

    Amy Keefer

  7. TEACCH Autism Program & Department of Psychiatry, University of North Carolina at Chapel Hill, CB#7180, Chapel Hill, NC, 27599-7180, USA

    Laura Klinger

  8. Department of Psychology, The University of Alabama at Birmingham, Campbell Hall 415, 1720 2nd Avenue South, Birmingham, AL, 35294-1170, USA

    Sarah O’Kelley

Authors
  1. Caitlin E. Walsh
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  2. Eric Moody
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  3. Audrey Blakeley-Smith
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  7. Laura Klinger
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  9. Sarah O’Kelley
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  10. Judy Reaven
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Corresponding author

Correspondence to Caitlin E. Walsh.

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Conflict of interest

Authors Audrey Blakeley-Smith, Ph.D., Susan Hepburn, Ph.D., and Judy Reaven, Ph.D. receive royalties from Paul Brookes Publishing for the Facing Your Fears Manual.

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Walsh, C.E., Moody, E., Blakeley-Smith, A. et al. The Relationship Between Treatment Acceptability and Youth Outcome in Group CBT for Youth with ASD and Anxiety. J Contemp Psychother 48, 123–132 (2018). https://doi.org/10.1007/s10879-018-9380-4

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  • DOI: https://doi.org/10.1007/s10879-018-9380-4

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