In October, OAR’s Board of Directors authorized funding for eight new applied autism research studies in 2019. These new grants, totaling $228,036, bring OAR’s total research funding to over $3.7 million since 2002. This is the third of eight previews to be featured in The OARacle this year.
As many as 84 percent of children with autism spectrum disorder (ASD) experience significant fear or anxiety that interferes with their daily lives, including frequent, intense, debilitating, and unusual fears. For example, the research proposal for this study noted that a child who had a phobia of balloons, due to the loud noise they make when popped, had quit attending school and parties. Researchers have studied anxiety along with therapies to treat it, yet little research has involved phobias specifically.
That is exactly what Thomas Ollendick, Ph.D., proposes to do in his OAR-funded study, “Modification of One-Session Phobia Treatment for Children with Autism Spectrum Disorder: A Feasibility Study.” Dr. Ollendick is University Distinguished Professor in clinical psychology at Virginia Polytechnic Institute and State University and director of the university’s Child Study Center.
The goal of his study is to modify a proven intervention for treating phobias in neurotypical children for use with children with ASD. This study seeks to address three primary areas:
Ollendick and his research team will recruit 30 children with ASD between the ages of 7 and 16 and their parents to participate in the study. Fifteen of the children will receive the intervention modified for children with ASD while a control group of 15 children will receive the standard treatment.
Both groups will receive three hours of exposure-based therapy in one session. The session used for neurotypical children in previous trials done by Dr. Ollendick included psychoeducation, in vivo exposure, cognitive challenges, participant modeling, and positive reinforcement. In that trial, he found that a one-session treatment was more effective in treating specific phobias than education/support treatment.
ASD-specific treatment for the experimental group will include modifications such as use of visual aids, incorporation of specific interests, and attention to sensory sensitivities. Dr. Ollendick anticipates that these strategies will make children with ASD more receptive to the treatment. Both groups will include praise and rewards. However, in the experimental group, the children will receive an additional set of rewards when they complete specific treatment steps and a larger reward at the end of the treatment session.
Parents will also be actively involved in the experimental group. In this group, the parent and a parent clinician will observe the treatment from behind a one-way mirror for the first hour. In addition to observing how to conduct exposures, the parent will discuss how their child’s sensory sensitivities and restricted repetitive behaviors interact with the child’s specific phobia. The clinician will provide instructions on how to reinforce appropriate approach behaviors, use the visual schedule, and decrease avoidance behaviors and distress associated with the phobic stimuli. In the second hour, parents will be in the treatment room learning behaviors from the therapist and practicing and modeling those behaviors. The therapist will provide feedback in the third hour and the parent will gradually take over the session.
After the treatment session, the therapist will conduct brief (45 minutes to an hour) in-clinic sessions weekly for four weeks with parents in the experimental group to ensure they feel competent in continuing exposures with their child independently. Parents in the control group will receive a 15-minute telephone session weekly for four weeks.
Dr. Ollendick and his research team created this study to determine whether using a one-session treatment model to treat specific phobias in children with ASD is feasible, as the study title notes. Feasibility will be measured by recruitment success and therapist fidelity ratings. Parents and children will take a survey on treatment satisfaction so the research team can evaluate the acceptability of the treatment. Additionally, the research team will collect data on sensory difficulties and other restricted and repetitive behaviors to explore potential predictors of treatment outcomes.
By modifying this evidence-based treatment for children with ASD, Dr. Ollendick hopes to show that this treatment will be both feasible and acceptable for youth with ASD and their families. Moreover, he hopes to show, at least preliminarily, reductions in both parent and child ratings of fear and avoidance related to the phobic situation or object.
Assuming this study finds the model feasible to treat children with ASD, Dr. Ollendick plans to continue his research of its effectiveness with a larger trial in a community setting. In addition, the research team will develop a treatment manual for treating children with ASD who have phobias.
This study will directly target the treatment of phobias in a way that is accessible to children with ASD and requires families to spend a relatively short period of time in treatment in the clinic setting. Giving parents the skills they need to help their children overcome their phobias and increase understanding of sensory sensitivities issues in their child will provide a means for parents to deal with this issue on an ongoing basis.
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