In November, OAR’s Board of Directors authorized funding for six new applied autism research studies in 2021. These new grants, totaling $240,000, bring OAR’s total research funding to more than $4.4 million since 2002. This study was entirely supported by funds raised by Team Robby. This is the last of the six previews to be featured in The OARacle this year.
The numbers of autistic students opting for higher education are steadily increasing. In response, more and more higher education institutions have created programs to support them. Most of those programs, however, do not include mental health interventions, a critical need, especially given the numbers of autistic individuals who experience co-occurring anxiety. Few empirical studies have evaluated the impact of mental health interventions for autistic college students.
This study proposes to do just that — evaluate the initial effectiveness, feasibility, and acceptability of Facing Your Fears, a cognitive behavioral therapy (CBT) intervention for autistic college students with co-occurring anxiety. Brian Freedman, Ph.D., senior associate director, Center for Disabilities Studies, and assistant professor at the University of Delaware, will lead the study, Facing Your Fears On Campus: An Anxiety Intervention for College Autistic Students.
The study includes two phases:
- Adapting the intervention: Dr. Freedman and his team will adapt Facing Your Fears, which was created for adolescents and young adults, for use with college students on campus. An advisory group of autistic young adults as well as other end users will make recommendations based on their experience. The research team will also use the results of data collected from a pilot group of five students that will participate in the intervention during this phase.
- Randomized controlled trial: The research team will recruit 21 University of Delaware students to participate in the intervention, including those who will be in the pilot group. Six students will serve as the control group and will be offered the intervention in 2022. The other students will be divided into two intervention groups.
Adapting the Intervention
Facing Your Fears has been shown to significantly reduce anxiety symptoms both at the end of treatment and at a three-month follow-up. It uses CBT, which is one of the most widely used treatments for anxiety and has been identified as an evidence-based practice for autistic people. A limited-time psychotherapy, CBT teaches patients how thought patterns impact emotional experiences and behaviors and then how to change those patterns and use coping strategies to reduce stressful thoughts and feelings.
Dr. Freedman and his research team will set up an advisory board, composed of autistic college students and recent graduates, Counseling Center staff, community mental health practitioners, and faculty/trainees in psychology/counseling, to refine the curriculum and provide feedback. The research team will also conduct remote focus groups with autistic college students, faculty members, and key staff at the university in order to better understand the needs of autistic students experiencing anxiety on a college campus, the existing resources, and gaps.
Based on feedback from the advisory board and the focus groups as well as data from the pilot group, Dr. Freedman and his team will have the information they need to modify and adapt the intervention to the college setting. Examples of potential modifications include removing the parent coaching component and replacing it with a trusted peer coaching component and modifying the exposure activities. The intent is to create an adapted curriculum that could be implemented by a variety of service providers in higher education, including counseling center staff, community mental health practitioners, and faculty/trainees in psychology/counseling, for example.
Randomized Controlled Trial
Dr. Freedman plans to recruit a diverse group of autistic students to participate, including those from different racial and ethnic backgrounds as well as those who identify as LGBTQIA+ and first-generation college students. Dr. Freedman, who is a clinical psychologist, will be the lead therapist for treatment. One or two additional facilitators will be recruited from graduate students and postdoctoral residents in clinical or school psychology. The intervention will take place over one semester.
The research team will collect data on global mental health, anxiety, feasibility, and social validity. To measure anxiety as well as other aspects of global mental health, all students will complete the CCAPS-34, a widely-used instrument in college counseling centers, and the Anxiety Scale for Autism-Adults (ASA-A), the only instrument that measures anxiety in autistic adults and has evidence of initial validity and reliability. Students will also complete a brief, semi-structured interview examining qualitative change in their anxiety symptoms at pre- and post-intervention. Each facilitator will also complete a “facilitator log” that will ask about the feasibility of implementing Facing Your Future in higher education.
The study will produce an intervention that could be immediately applied and replicated at other colleges and universities at the same time the intervention is continuing to be evaluated. Rapid dissemination of the intervention after the completion of the study can be conducted through the networks that already exist among college programs supporting autistic students, such as the College Autism Network.
In addition, if the study results show that Facing Your Fears is effective, they can be used to promote greater use of a group-based CBT treatment at more college counseling centers. The findings of the feasibility and acceptability components of this study will also help inform applied researchers interested in adapting evidence-based interventions for autistic young adults in the college environment.
The research team also plans to share its process with the autism community as one model in order for others to consider how to meaningfully include adults on the autism spectrum in the design and study of other interventions.
Research has shown that when students have good mental health, they are more likely to succeed in higher education and employment. Positive results from this study could lead to an improvement in the lives of autistic college students by providing initial evidence of an effective treatment for reducing their anxiety.
Sherri Alms is the freelance editor of The OARacle, a role she took on in 2007. She has been a freelance writer and editor for more than 20 years.