Title: CHAAMPS: Childhood Anxiety in Autism Managed by Parents Study.
Funder: Department of Health and Social Care

Abstract: Background: Autism Spectrum Disorder (Autism) is a common neurodevelopmental disorder [1, 2] that frequently co-occurs with anxiety problems [3]. The presentation and causes of anxiety problems in autism are often markedly different to that in neurotypical children [4], and therefore need a specifically designed treatment approach. Such interventions have yet to be developed in ways that can easily be implemented within Children and Adolescent Mental Health Services (CAMHS) in the United Kingdom (UK) and many autistic children with anxiety problems are not provided adequate support [5]. Aim: We will adapt a brief, manualised form of guided parent-led Cognitive Behavioural Therapy (CBT), that has been shown to effectively reduce anxiety problems in preadolescent neurotypical (non-autistic) children [6], to meet the needs of autistic children. Method: The adapted intervention will be co-constructed using Experience-Based Co-Design (EBCD) adapted for mental health settings [7]. We will combine insights drawn from focus groups and individual qualitative interviews with parents of autistic children with anxiety problems, autistic children, and an Expert Reference Group (ERG). Analysis: Qualitative data will be analysed using case-level Interpretative Phenomenological Analysis combined with Template Analysis [8]. Co-adaptation: An ERG combining experts by experience (parents of autistic children with anxiety problems and autistic adults with experience of anxiety problems) and clinicians will work with the research team to make the necessary adaptions to the programme using the data obtained from the interviews and focus groups. Dissemination: Findings will be shared with clinicians and the public through social media, briefings, and two academic papers (one on the co-production process, one on the adapted programme). The whole team will support Dr Cullingham in a National Institute for Health Research (NIHR) Doctoral Research Fellowship application, which will then take the programme beyond this critical underpinning work into effectiveness testing.

Lay abstract: Aim: To adapt the programme &ldquo;Helping your child with fears and worries&rdquo; (HYC) to meet the needs of autistic children with anxiety problems. Background: Many autistic children struggle with anxiety problems, but often do not get specialist support. Guidelines have highlighted the importance of adapting anxiety treatment programmes to meet the needs of autistic children, but existing programmes are typically long and not easily delivered within child and adolescent mental health settings. The programme: &ldquo;Helping your child with fears and worries&rdquo; is an effective brief parent-led anxiety programme for non-autistic children. It is widely used across the National Health Service (NHS) and local authorities. Parents are provided with resources and support from a therapist to help them help their child. When support is provided through parents, children who cannot access traditional support can benefit as they do not need to go to appointments or speak with the therapist. This might be a particularly useful approach for autistic children. The need: Clinical teams frequently ask us how they can use this programme to treat the anxiety problems faced by the many autistic children referred to them; we do not yet know the answer. Working together: This project will involve researchers, autistic adults, parents of autistic children, and clinicians working together. Autistic children with anxiety problems and their parents will be asked about how the programme needs to change to fit their needs. An Expert Reference Group, including parents of autistic children, autistic adults with lived experience of anxiety, clinicians, and researchers will meet regularly to review the information collected and adapt the programme. Next steps: We will apply for funding to test how well the adapted programme works. Sharing findings: Findings will be shared through social media and parent support groups. We will write two academic papers co-authored by public contributors.

Research activity codes: 5.6 PSYCHOLOGICAL AND BEHAVIOURAL
Health categories: MENTAL HEALTH