Stepped-Care Cognitive-Behavioral Treatment for Youth With ASD and Anxiety
Condition: Cognitive Behavioral Therapy; Autism Spectrum Disorder; Anxiety Disorders; Obsessive-Compulsive Disorder; Social Anxiety Disorder; Generalized Anxiety Disorder; Specific Phobia
MeSH terms: Anxiety Disorders; Autism Spectrum Disorder; Obsessive-Compulsive Disorder; Phobia, Social
Study type: Interventional

Summary: 
      This study implements a parent-led, flexible, individually-tailored cognitive-behavioral
      intervention for children with ASD and anxiety.
    

Detailed description: 
      Autism spectrum disorder (ASD) affects as many as 1 out of 59 individuals, with many
      higher-functioning youth not diagnosed until school-age or later. This equates to ~102,000
      children under the age of 14 years in the state of Texas alone. Significant impairment in
      social and adaptive functioning are common, as are comorbid behavioral health disorders, with
      anxiety disorders affecting between 50-80% of youth with ASD. Given the relative frequency of
      anxiety disorders among children with ASD, the associated impairment, and worsening
      trajectory over time without intervention, there is a great need for treatment that
      specifically addresses anxiety-related symptoms in ASD. Cognitive-behavioral therapy (CBT)
      has been established as a first-line treatment for anxiety disorders among youth with and
      without ASD. A particular form of CBT, Behavioral Intervention for Anxiety in Children with
      ASD (BIACA), has demonstrated efficacy in a number of studies. However, treatment is
      delivered by therapists as "full-packages" (i.e., 12-16 clinic sessions), which can be
      therapist-intensive, costly, impractical for families, and not responsive to parental
      preferences. Alternatives approaches, such as parent-led, stepped-care models that improve
      accessibility, are efficient, provide personalized care, and lower mental health treatment
      cost, are greatly needed. Stepped-care models provide a lower-intensity first step (e.g.,
      parent-led, less costly, and more convenient for parents) as the initial treatment with the
      assumption that a proportion of individuals will respond to the first step and others will
      need to step up to more intensive treatment. Matching treatment to families' needs and
      tailoring subsequent treatment may be an efficient and effective approach, as well as
      consistent with parents' desire to help their child. Given this, together with the
      substantial impairment associated with clinical anxiety in individuals with ASD across the
      age span, this study implements a parent-led, flexible, individually-tailored
      cognitive-behavioral intervention for children with ASD and anxiety.
    

Intervention name(s): Stepped Care CBT
Intervention type(s): Behavioral
Intervention description(s): Stepped Care CBT is a multi-method, parent-led approach, consisting of two main steps. Step one involves a "low-intensity" delivery of CBT, consisting of more flexible, parent-led, at-home treatment. Participants who do not show improvement in symptom severity at the end of Step One, are then "stepped up" to receive Step Two. Step two involves a "high intensity" delivery of CBT, consisting of therapist-led, parent-assisted weekly treatment sessions.
Intervention model: Single Group Assignment
Intervention model description: Single group observational.
Masking: None (Open Label)
Primary purpose: Treatment