News and Knowledge

In 2015, OAR’s Board of Directors authorized funding for eight new applied autism research studies in 2016. These new grants, totaling $229,794, bring OAR’s total research funding to over $3.5 million since 2002. This is the third of eight previews that will be featured in The OARacle over the next few months.

Adolescents with autism spectrum disorders (ASD) and intellectual disability (ID) are at risk for developing significant anxiety that adversely impacts participation in home, school, and community. Anxiety may contribute to social isolation, place adolescents at risk for further mental health concerns and problem behavior, and lead to more restricted school and living situations. While many families seek assistance from their teen’s school and community mental health providers, few are prepared to treat anxiety in this complex population.

OAR-funded researcher Audrey Blakeley-Smith, Ph.D., and her co-investigators, Judy Reaven, Ph.D., and Susan Hepburn, Ph.D., all clinical psychologists and associate professors in the Department of Psychiatry, University of Colorado, School of Medicine, are hoping to provide a solution to this dilemma. They have created “Facing Your Fears: Adolescents with Autism and Intellectual Disabilities,” a family-focused, group cognitive behavioral therapy treatment for an adolescent ASD and ID population. The program is a modified version of a program they developed for youth with ASD and average cognitive abilities. The young people who participated in that treatment demonstrated significant reductions in anxiety.

“Facing Your Fears: Adolescents with Autism and Intellectual Disabilities” is innovative in four aspects:

• Development of a group treatment program for teens with ASD and ID: Youth with ASD and ID are commonly excluded from research projects (because they do not meet specific IQ cut-offs) and there is little published work on anxiety treatment in this population.
• Partnering with parents in treatment: To date, most research programs that include families with ID have not focused on interventions that support parent coping. In this program, a separate parent curriculum will address the challenges of parenting an adolescent with the complex diagnostic profile of ASD, ID, and anxiety; provide support for parents in supporting each other; and offer cognitive behavior therapy techniques for anxiety reduction. Fostering a positive parent-teen relationship in addressing anxiety is important as the researchers emphasize that difficult issues can best be managed when working together.
• Use of cognitive intervention for an ID population: The use of cognitive approaches for this population has been recommended, but barely explored. Recent research identified a number of salient worries (e.g., being bullied, losing someone they are dependent upon, decisions about future, etc.) in teens with ID transitioning to adulthood that contributed to teens’ rumination and distress. The Facing Your Fears program will specifically identify worries and tackle them through cognitive interventions.
• Emphasis on healthy living: The National Center on Health, Physical Activity and Disability highlights the importance of physical activity and healthy living for individuals with ASD and ID. A module on healthy living will be created for this Facing Your Fears program that highlights the role that healthy living may play in helping to maintain optimal levels of arousal on a day-to-day basis, so that people have greater resources to manage anxiety.

Method

• Step One: Obtain feedback on modifications. Before the researchers begin the pilot study, they plan to obtain feedback on program materials from parents and clinicians through focus groups.

• Step Two: Conduct the pilot study. Sixteen adolescents between the ages of 14 and 18 with a diagnosis of ASD, an IQ between 50 and 70, and clinically significant symptoms of anxiety will be recruited with a parent to participate in the pilot program. Eight teens each will participate in two rounds of treatment.

• The treatment will consist of 16 interventions: eight with parents only and eight with parent/teen pairs working together. In the parent-only sessions, parents will learn core concepts and receive support from other parents. In the one-to-one sessions with parents and teens, the teens will receive coaching face to face and deal with their fears through common cognitive behavioral therapy strategies, such as deep breathing, positive coping statements, and graded exposure (facing fears a little at a time).

Evaluation

Pre- and post-outcome assessment measures will be administered to participating parents. An anxiety battery will assess the teen’s anxiety symptoms before and after treatment while a functional outcomes battery will assess the teens’ problem behavior, quality of life, and participation in the community before and after treatment. In addition, teens and parents will rate each session.

Outcomes

The results of this study may support further development of the Facing Your Fears intervention package, thus providing social support, psychoeducation, and anxiety treatment to a broader, and potentially more representative group of individuals with ASD.

Reductions in teen anxiety could lead to important functional outcomes for adolescents (such as increased engagement in activities, broader social experiences, better quality of life) and their families (less isolation, improved quality of life). Given that anxiety and problem behavior typically isolate and restrict families, providing an intervention that will help expand a family’s support network through a group treatment intervention is valuable.