Modified School-Based Facing Your Fears for Students with Autism Spectrum Disorder and Anxiety: A Preliminary Quasi-Experimental and Qualitative Analysis
Main Article Content
Abstract
With a high prevalence of anxiety among children with Autism Spectrum Disorder, researchers have identified implementing effective treatments in real-world settings as a priority. In the present study, multiple methods were employed to evaluate the effectiveness of educators delivering a modified school-based Facing Your Fears Cognitive Behavior Therapy program to treat anxiety among students with Autism Spectrum Disorder. Participants included 5 students, 6 educators and 7 parents. Settings were a public elementary school and private school. Multiple methods included a quasi-experimental group design, time series design, semi-structured interviews and focus groups. Quantitative results indicated that with training and on-going feedback educators obtained a modest level of fidelity in implementing the intervention. Non-significant decreases in student anxiety symptoms across all informant ratings (students, parents and teachers) were observed. Social validity ratings across participants were high. Qualitative findings revealed the following themes: (a) outcomes; (b) program structure; (c) inclusion; and (d) factors critical for success. These preliminary results offer a model for researchers to collaborate with key stakeholders in adapting interventions for use in schools, bridging the gap between research and practice. They highlight educator’s ability to deliver empirically-supported treatments to address anxiety among students with Autism Spectrum Disorder.
Keywords:
autism spectrum disorder, anxiety, Facing Your Fears, cognitive behavior therapy, school-based mental health services
Article Details
How to Cite
KESTER, Karen R.; LUCYSHYN, Joseph M.
Modified School-Based Facing Your Fears for Students with Autism Spectrum Disorder and Anxiety: A Preliminary Quasi-Experimental and Qualitative Analysis.
Medical Research Archives, [S.l.], v. 10, n. 10, oct. 2022.
ISSN 2375-1924.
Available at: <https://esmed.org/MRA/mra/article/view/3117>. Date accessed: 22 dec. 2024.
doi: https://doi.org/10.18103/mra.v10i10.3117.
Section
Research Articles
The Medical Research Archives grants authors the right to publish and reproduce the unrevised contribution in whole or in part at any time and in any form for any scholarly non-commercial purpose with the condition that all publications of the contribution include a full citation to the journal as published by the Medical Research Archives.
References
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21. Rodgers J, Wigham S, McConachie H, Freeston M, Honey E, Parr JR. Development of the anxiety scale for children with autism spectrum disorder (ASC-ASD). Autism Res. 2016;9:1205-1215. http://doi.org/10.1002/aur.1603
22. Lyneham HJ, Street AK, Abbott MJ, Rapee RM. Psychometric properties of the school anxiety scale—Teacher reported (SAS-TR). J Anxiety Disord. 2008;22(2):292–300. http://doi.org/10.1016/j.janxdis.2007.02.001.
23. Foster SL, Mash EJ. Assessing social validity in clinical treatment research: Issues and. procedures. J Consult Clin Psychol. 1999;67(3):308-319. https://psycnet.apa.org/doi/10.1037/0022-006X.67.3.308
24. Jacobson NS, Truax P. Clinical significance: A statistical approach to defining meaningful change in psychotherapy research. J Consult Clin Psychol. 1991;59(1):12-19. http://doi.org/0022-006X/91
25. Braun V, Clarke V. Using thematic analysis in psychology. Qual Res Psychol. 2006;3:77-101. http://doi.org/10.1191/1478088706qp063oa
26. Bloomberg LD, Volpe M. Completing your qualitative dissertation: A road map from beginning to end. 2nd ed. SAGE Publications; 2012.
27. Reaven J, Blakeley-Smith A, Nichols S, Hepburn S. Facing your fears: Group therapy for managing anxiety in children with high-functioning autism spectrum disorders. Paul H. Brookes Publishing; 2011.
28. Kazdin A. E. The meanings and measurement of clinical significance. J Consult Clin Psychol. 1999;67(3):332-339. http://doi.org/10.1037/0022-006X.67.3.332
29. Reaven J, Willar K. (2017). Group cognitive behavior therapy for children and adolescents with anxiety and autism spectrum disorders. In: Kerns CM, Renno P, Storch EA, et al. eds. Anxiety in children and adolescents with autism spectrum disorder: Evidence-based assessment and treatment. Elsevier Academic Press; 2017:143-169.
30. Abramowitz J. The practice of exposure therapy: Relevance of cognitive-behavioral theory and extinction theory. Behav Ther. 2013;44:548-558. http://doi.org/0005-7894/44/548-558/$1.00/0
31. Joyce BR, Showers B. Student achievement through staff development. 3rd ed. Association for Supervision and Curriculum Development; 2002.
32. Khanna M, Kendall P. Exploring the role of parent training in the treatment of child anxiety. J Consult Clin Psychol. 2009;77:981-986. http://doi.org/10.1037/a0016920
33. Rutherford T, Long JJ, Farkas G. Teacher value for professional development, self-efficacy, and student outcomes within a digital mathematics intervention. Contemp Educ Psychol. 2017;51:22-36. http://doi.org/10.1016/j.cedpsych.2017.05.005
34. Christenson S, Sheridan SM. Schools and families: Creating essential connections for learning. Guilford Press; 2001.
35. Chorpita BF, Daleiden BF (2014). Structuring in the collaboration of science and service in pursuit of a shared vision. J Clinl Child Adolesc Psychol. 2014;43(2):323-338.
36. James AC, James G, Cowdrey F, Soler A, Choke A. Cognitive behavioural therapy for anxiety in children and adolescents. Cochrane Database Syst Rev. 2015;(2):CD004690. http://doi.org/10.1002/14651858.CD004690.pub4
37. Avant DW, Lindsey BC. School social workers as response to intervention change champions. Adv Soc Work. 2016;16(2):276-291. http://doi.org/10.18060/16428
38. Weisz JR, Ugueto AM, Cheron DM, Herren J. (2013). Evidence-based youth psychotherapy in the mental health ecosystem. J Clinl Child Adolesc Psychol. 2013;42:274-286. http://doi.org/10.1080/15374416.2013.764824
2. Lecavalier L, Wood, JJ, Hallada, AK, et al. Measuring anxiety as a treatment endpoint in youth with autism spectrum disorder. J Autism Dev Disord. 2014;44(5):1128–1143. http://doi.org/10.1007/s10803-013-1974-9
3. Danial JT, Wood JJ. Cognitive behavioral therapy for children with autism: Review and considerations for future research. J Dev Behav Pediatr. 2013;34(9):702–715. http://doi.org/10.1097/DBP.0b013e31829f676c
4. Kreslins A, Robertson AE, Melville C. The effectiveness of psychosocial interventions for anxiety in children and adolescents with autism spectrum disorder: A systematic review and meta-analysis. Child Adolesc Psychiatry Ment Health, 2015;9(1):1–12. http://doi.org/10.1186/s13034-015-0054-7
5. Kester KR, Lucyshyn JM. Cognitive behavior therapy to treat anxiety among children with autism spectrum disorder; A systematic review. Res Autism Spectr Disord. 2018;52:37-50.
6. Weston L, Hodgekins J, Langdon P. Effectiveness of cognitive behavioural therapy with people who have autistic spectrum disorders: A systematic review and meta-analysis. Clin Psychol Rev. 2016;49:41–54. http://doi.org/10.1016/j.cpr.2016.08.001
7. Drmic, I. E., Aljunied, M., Reaven, J. Feasibility, acceptability and preliminary treatment outcomes in a school-based CBT intervention program for adolescents with ASD and anxiety in Singapore. J Autism Dev Disord. 2017;47(12):3909-3929. http://doi.org/10.1007/s10803-016-3007-y
8. Ludwig K, Lyon A, Ryan J. Anxiety in youth: Assessment, treatment, and school-based service delivery. In: Flanagan R, Allen K, Levine E, eds. Cognitive and behavioral interventions in the schools: Integrating theory and research into practice. Springer; 2015:45-65.
9. Mychailyszyn MP. Transporting cognitive behavior interventions to the school setting. In: Flanagan R, Allen K, Levine E, eds. Cognitive and behavioral interventions in the schools: Integrating theory and research into practice. Springer; 2015:287-305
10. Rotheram-Fuller, E. & Hodas, R. Using CBT to assist children with autism spectrum disorders/pervasive developmental disorders in the school setting. In: Flanagan R, Allen K, Levine E, eds. Cognitive and behavioral intervention in the schools: Integrating theory and research into practice. Springer; 2015:181-198
11. Clarke C, Hill V, Charman T. School based cognitive behavioural therapy targeting anxiety in children with autistic spectrum disorder: a quasi-experimental randomised controlled trail incorporating a mixed methods approach. J Autism Dev Disord. 2016;47(12):3883-3895. http://doi.org/10.1007/s10803-016-2801-x
12. Attwood, T. Exploring feelings (anxiety). Future Horizons; 2004.
13. Luxford S, Hadwin, JA, Kovshoff H. Evaluating the effectiveness of a school-based cognitive behavioural therapy intervention for anxiety in adolescents diagnosed with autism spectrum disorder. J Autism Dev Disord. 2017;47(12):3896-3908. http://doi.org/10.1007/s10803-016-2857-7
14. Ireri NW, White, SW, Mbwayo AW. Treating anxiety and social deficits in children with autism spectrum disorder in two schools in Nairobi, Kenya. J Autism Dev Disord. 2019;49(8): 3309-3315. http://doi.org/10.1007/s10803-019-04045-6
15. White S, Albano A, Johnson C, et al. Development of a cognitive-behavioral intervention program to treat anxiety and social deficits on teens with high-functioning autism. Clin Child Fam Psychol Rev. 2010;13:77-90. http://doi.org/10.1007/s10567-009-0062-3
16. Vasa R, Keefer A, Reaven J, South, M, White SW. Priorities for advancing research on youth with autism spectrum disorder and co-occurring anxiety. J Autism Dev Disord. 2018;48(3):925-934. http://doi.org/10.1007/s10803-017-3320-0
17. Parsons S, Charman T, Faulkner R, Ragan J, Wallace S, Wittemeyer K. Bridging the research and practice gap in autism: The importance of creating research partnerships with schools. Autism. 2013;17(3):268-280. http://doi.org/10.1177/1362361312472068
18. Canadian Institutes of Health Research. Guide to Knowledge Translation Planning at CIHR: Integrated and End-of-Grant Approaches. 2012. Retrieved from CIHR website: http://www.cihr-irsc.gc.ca/e/documents/kt_lm_ktplan-en.pdf
19. Kester K, Lucyshyn JM. Co-creating a school-based Facing Your Fears anxiety treatment for children with autism spectrum disorder: A model for school psychology. Psychol Sch. 2019;56: 824-839, https://doi.org/10.1002/pits.22234
20. Reaven J, Blakeley-Smith A, Beattie T, et al. Improving transportability of a cognitive-behavioral intervention for anxiety in youth with autism spectrum disorders: Results from a US-Canada collaboration. Autism. 2015;19(2):211-222. http://doi.org/10.1177/1362361313518124
21. Rodgers J, Wigham S, McConachie H, Freeston M, Honey E, Parr JR. Development of the anxiety scale for children with autism spectrum disorder (ASC-ASD). Autism Res. 2016;9:1205-1215. http://doi.org/10.1002/aur.1603
22. Lyneham HJ, Street AK, Abbott MJ, Rapee RM. Psychometric properties of the school anxiety scale—Teacher reported (SAS-TR). J Anxiety Disord. 2008;22(2):292–300. http://doi.org/10.1016/j.janxdis.2007.02.001.
23. Foster SL, Mash EJ. Assessing social validity in clinical treatment research: Issues and. procedures. J Consult Clin Psychol. 1999;67(3):308-319. https://psycnet.apa.org/doi/10.1037/0022-006X.67.3.308
24. Jacobson NS, Truax P. Clinical significance: A statistical approach to defining meaningful change in psychotherapy research. J Consult Clin Psychol. 1991;59(1):12-19. http://doi.org/0022-006X/91
25. Braun V, Clarke V. Using thematic analysis in psychology. Qual Res Psychol. 2006;3:77-101. http://doi.org/10.1191/1478088706qp063oa
26. Bloomberg LD, Volpe M. Completing your qualitative dissertation: A road map from beginning to end. 2nd ed. SAGE Publications; 2012.
27. Reaven J, Blakeley-Smith A, Nichols S, Hepburn S. Facing your fears: Group therapy for managing anxiety in children with high-functioning autism spectrum disorders. Paul H. Brookes Publishing; 2011.
28. Kazdin A. E. The meanings and measurement of clinical significance. J Consult Clin Psychol. 1999;67(3):332-339. http://doi.org/10.1037/0022-006X.67.3.332
29. Reaven J, Willar K. (2017). Group cognitive behavior therapy for children and adolescents with anxiety and autism spectrum disorders. In: Kerns CM, Renno P, Storch EA, et al. eds. Anxiety in children and adolescents with autism spectrum disorder: Evidence-based assessment and treatment. Elsevier Academic Press; 2017:143-169.
30. Abramowitz J. The practice of exposure therapy: Relevance of cognitive-behavioral theory and extinction theory. Behav Ther. 2013;44:548-558. http://doi.org/0005-7894/44/548-558/$1.00/0
31. Joyce BR, Showers B. Student achievement through staff development. 3rd ed. Association for Supervision and Curriculum Development; 2002.
32. Khanna M, Kendall P. Exploring the role of parent training in the treatment of child anxiety. J Consult Clin Psychol. 2009;77:981-986. http://doi.org/10.1037/a0016920
33. Rutherford T, Long JJ, Farkas G. Teacher value for professional development, self-efficacy, and student outcomes within a digital mathematics intervention. Contemp Educ Psychol. 2017;51:22-36. http://doi.org/10.1016/j.cedpsych.2017.05.005
34. Christenson S, Sheridan SM. Schools and families: Creating essential connections for learning. Guilford Press; 2001.
35. Chorpita BF, Daleiden BF (2014). Structuring in the collaboration of science and service in pursuit of a shared vision. J Clinl Child Adolesc Psychol. 2014;43(2):323-338.
36. James AC, James G, Cowdrey F, Soler A, Choke A. Cognitive behavioural therapy for anxiety in children and adolescents. Cochrane Database Syst Rev. 2015;(2):CD004690. http://doi.org/10.1002/14651858.CD004690.pub4
37. Avant DW, Lindsey BC. School social workers as response to intervention change champions. Adv Soc Work. 2016;16(2):276-291. http://doi.org/10.18060/16428
38. Weisz JR, Ugueto AM, Cheron DM, Herren J. (2013). Evidence-based youth psychotherapy in the mental health ecosystem. J Clinl Child Adolesc Psychol. 2013;42:274-286. http://doi.org/10.1080/15374416.2013.764824