The Development of a Psychoeducational Tool to Manage Anxiety in People With Autism Spectrum Disorders
Condition: Autism Spectrum Disorders; Anxiety
MeSH terms: Anxiety Disorders; Autistic Disorder; Autism Spectrum Disorder; Child Development Disorders, Pervasive
Study type: Interventional

Summary: 
      The purpose of this pilot intervention trial is to assess the efficacy of newly developed
      psychoeducation guides designed to manage anxiety in Autism Spectrum Disorder (ASD) by
      recruiting 30 participants with ASD and high levels of anxiety along with their
      parent/caregivers who both receive a version of the psychoeducation guide.
    

Detailed description: 
      ASDs have a devastating impact on adaptive function; current UK lifetime costs of supporting
      a person with an ASD, along with the opportunity costs of lost productivity, are estimated at
      £0.8-1.2 million per year (Knapp, Romeo, & Beecham, 2009). The impact of having an anxiety
      disorder has also been shown to affect an individual's quality of life and functioning over
      and above physical illness, major depression and socioeconomic factors (Stein et al., 2010).
      Around 40% of individuals with ASD will also have anxiety symptoms, and treatment for
      additional mental health problems is also costly. Early work using clinical therapies with
      individuals with ASD such as modified CBT indicate that the anxious symptoms which co-occur
      with ASD can be modified and improvements to the anxiety recorded although further work is
      needed. Therefore, focussing on interventions for individuals with ASD and anxiety may be
      very beneficial. However, not all individuals with ASD that also present with anxiety will
      require face to face therapy, therefore, psychoeducation could provide an effective and
      cost-effective way of improving mental health in ASD through self-help strategies. This could
      lead to improved outcomes for individuals and less burden on the clinical services supporting
      these families.

      The intervention is focused on psychoeducation. Four psychoeducation guides will be
      available: parent/caregiver, adult with ASD, adolescent with ASD, and child with ASD.
      Participants and their parents/caregivers will be give guides to read in their own time over
      a 4 week period. The guides will be designed to improve participant's and their
      parent/caregiver's knowledge of anxiety in ASD. The guides introduce the concept of anxiety
      and how it presents in individuals with ASD, different anxiety triggers, strategies that can
      be used to manage anxiety, and an introduction to specific anxiety disorders. Level of
      detail, language and presentation of content will vary across the guides to be appropriate
      for the functioning level of the readers.

      The aim of this study is to recruit 30 participants with autism spectrum disorder (ASD) and
      high levels of anxiety (aged 8-25 years) and their parent/caregiver into a pilot trial of a
      psychoeducation intervention. Participants will be recruited through clinical services in
      South London and the Maudsley (SLaM) and Guy's and St Thomas' (GSTT) NHS trusts through the
      patient consent to contact register (C4C) in SLaM and via referral from clinical care
      co-ordinators in the clinics in each trust. Additional participants may be recruited from
      non-clinical sources such as research recruitment lists held by autism charities or
      advertisements, including local newsletters, social media sites, emails or letters.

      This is a pilot efficacy trial of newly developed psychoeducation guides employing a
      randomized, parallel-arm, intention to treat design with a 4 week intervention. Participant
      families will be randomly allocated (1:1) to either an immediate or a delayed start group to
      allow measurement of anxiety symptoms over a one month period with and without the
      psychoeducation guide. This design helps to control for the effects of attention (anxiety may
      show a large placebo response) while allowing all participants access to the intervention.

      The aim is to improve participants' and their parent/caregivers' knowledge of the
      presentation of anxiety in ASD and their confidence in using simple strategies in its
      management. The primary outcome is improvement of participant and parent/caregiver
      understanding of the presentation and simple management strategies for anxiety in ASD.
      Secondary outcomes include improvement in anxiety symptoms and confidence in managing
      anxiety, feedback on acceptability, usefulness and appropriateness of the guide.

      The trial analyses will be intention-to treat. Missing data will be imputed. The primary
      analysis will compare the groups randomized to immediate vs delayed treatment 4 weeks post
      randomisation when the immediate start group will have had the guide for 4 weeks and the
      delayed start group will have been on a "waiting list" for 4 weeks, this controls for
      attention and spontaneous improvement. The investigators will then check the two groups for
      comparability at pre-intervention time point (Time 1). If the two groups show similar
      baselines levels and magnitude of change in knowledge and symptom severity post intervention,
      they will be combined to gain a further estimate of the treatment effect. Both the
      knowledge/confidence measure and measure of anxiety symptoms, will be treated as continuous
      variables. Linear regression models will include baseline severity and randomisation group as
      predictors. The primary focus will be on parent-carer response but if sample sizes are
      sufficient, separate, parallel analyses will use data from individuals with ASD.
    

Intervention name(s): Psychoeducation
Intervention type(s): Other
Intervention description(s): The intervention is focused on psychoeducation. Four psychoeducation guides will be available: parent/caregiver, adult with ASD, adolescent with ASD, and child with ASD. The guides introduce the concept of anxiety and how it presents in individuals with ASD, different anxiety triggers, strategies that can be used to manage anxiety, and an introduction to specific anxiety disorders. Level of detail, language and presentation of content will vary across the guides to be appropriate for the functioning level of the readers.
Other intervention name(s): Self-help guide
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: None (Open Label)
Primary purpose: Treatment
Keywords: Psychoeducation; Self-help