News and Knowledge

In November, OAR’s Board of Directors authorized funding for seven new applied autism research studies in 2020. These new grants, totaling $275,000, bring OAR’s total research funding to more than $4 million since 2002. This is the final of seven previews to be featured in The OARacle this year.

Children with autism spectrum disorder (ASD) are more likely to experience a traumatic event due to a complex interplay of individual factors, such as social and communication difficulties, and environmental factors, such as family stress and isolation, cultural attitudes, and increased interaction with multiple service systems. The stress of traumatic events contributes to lifelong psychological and physical health concerns.

OAR-funded researcher, Christina McDonnell, Ph.D., assistant professor in psychology at Virginia Polytechnic Institute & State University and a faculty affiliate at the Virginia Tech Center for Autism Research, will lead a two-year study of trauma treatment specifically for children with ASD, Supporting the Most Vulnerable: A Randomized Feasibility Trial of Trauma-Focused Cognitive Behavioral Therapy for Youth with ASD. The study will investigate the feasibility and initial efficacy of treating trauma-related symptoms using trauma-focused cognitive behavioral therapy (TF-CBT), which is effective for neurotypical children but has not been widely evaluated for effectiveness with children with ASD.

Methodology

Dr. McDonnell will recruit 30 young people with ASD, both boys and girls, between the ages of 10 and 17 to participate in the study. Participants will meet criteria for PTSD and/or present with clinically elevated traumatic stress symptoms.

Half of the participants will receive standard TF-CBT treatment while the other half will receive enhanced TF-CBT treatment designed to address the needs of children with ASD. The standard treatment will include 12 weekly sessions:

• The first four will focus on psychoeducation/parenting skills, relaxation, affective regulation, and cognitive coping.
• The next four sessions will focus on trauma narrative development and in-vivo graduated exposure.
• The final four sessions will focus on parent-child sessions and enhancing safety and future development.

Most of the sessions will include separate 40-minute sessions for the child and parent, followed by a 10-minute session that includes both. The final four sessions will be held with both the parent and child together.

In addition to the weekly therapy sessions, the enhanced treatment will incorporate:

• Use of a visual schedule and written reward system at the start of treatment and each session
• Use of a child’s special interest in each session to increase motivation and make skills more concrete
• Increased parental involvement via a weekly 15-minute phone check-in to promote generalization of treatment content
• ASD-specific psychoeducation regarding functional behavior assessment, social skills, and adaptive behavior

The child, parent, and therapist will rate treatment at the beginning, middle, and end of the process. All sessions will be videotaped to allow for observation of therapist adherence to protocol. The therapist will also provide a brief rating of the level of child and parent involvement in each session and ratings at the end of each session on the applicability and helpfulness of the TF-CBT techniques.

Evaluation

The research team will evaluate treatment through use of:

• The Anxiety Disorders Interview Schedule-Parent and Child Report, a measure that has been recommended as the most reliable for assessing traumatic symptoms among children with ASD
• The Child and Adolescent Trauma Screen – Parent and Youth Report, which measures traumatic symptoms
• Short Mood and Feelings Questionnaire – Caregiver and Child Report, which has been successfully been used in ASD and provides a brief assessment of child depressive symptoms
• The Alabama Parenting Questionnaire-Short Form, which yields positive parenting, inconsistent discipline, and poor supervision subscales
• The Parenting Stress Index – Short Form, a self-report measure that will be used to measure parenting stress in a manner validated for use in ASD

Outcomes

This study will form the foundation for a larger study of TF-CBT for youth with ASD. The goals for the OAR-funded study include:

• Increased knowledge of how to best support children with ASD who have also experienced trauma
• Advanced understanding of therapist perceptions of trauma-informed care for ASD
• Increased access to trauma-informed services for children with ASD and their families

The study will result in a treatment manual describing how to adjust treatment for the needs of the autism community. Dr. McDonnell and her research team also plan to train community clinicians and implement trauma-focused services for youth with ASD in schools, primary care, and remote service settings (e.g., telehealth) to ensure equitable reduction of disparities in trauma services for youth with ASD and their families.

By partnering with community agencies in the area serving traumatized youth and their families, Dr. McDonnell and the research team will also build broader community capacity for trauma-informed services for youth with ASD.

This study has the potential to improve youth safety and physical health, enhance daily living skills, reduce family stress, and provide treatment materials for mental health clinicians.

Note: This research study has been extended due to disruptions associated with COVID-19. The researcher tentatively plans to resume study activities this fall, completing the project in December 2022.