The Effectiveness of an Attention-based Intervention for School Aged Autistic Children With Anger Regulating Problems

Study Overview
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Brief Summary
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Children on the autism spectrum often show aggressive behavior. Treatment can train children to be more aware of their emotions. Investigators studied the effectiveness of an attention-based intervention tailored on aggressive behavior problems and the use of anger coping strategies of school aged autistic children with anger regulation problems.

Detailed Description
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Investigators studied the effectiveness of an attention-based intervention tailored on aggressive behavior problems and the use of anger coping strategies of school aged autistic children with anger regulation problems. Using a randomized controlled trial (RCT), children were allocated to the attention-based treatment in combination with a psycho-educational parent-training (treatment group) or to the parent-training only (active control group).

Official Title
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The Effectiveness of an Attention-based Intervention for School Aged Autistic Children With Anger Regulating Problems: a Randomized Controlled Trial

Conditions
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Autism Spectrum Disorder

Intervention / Treatment
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* Behavioral: Anger can go!
* Behavioral: Parent psycho-education


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Primary diagnosis of autism spectrum disorder age 8 - 13 seeking treatment for aggressive behaviour problems Exclusion Criteria: psychotropic medication still being set

Ages Eligible for Study
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Minimum Age: 8 Years
Maximum Age: 13 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Treatment
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Intervention condition<br>Participants received both parent training and child-focussed treatment | Behavioral: Anger can go!<br>* The intervention Anger Can Go! was designed to treat anger regulation problems in autistic children aged 8 to 13 years old. The intervention consists of nine sessions of 60 minutes and is divided in four phases. Phase 1: psycho-education, affect-education and measuring anger with an anger-thermometer. This is a self-report scale presented as the drawing of a thermometer, that allows the child to indicate his level of anger, as linked to specific bodily and behavioral representations on a scale from 0 to 3. Phase 2: making a functional behavior assessment (FBA) and taking a time-out at a low anger-level (between 1 and 2 on the scale 0 to 3) to prevent aggressive outbursts. Phase 3: taking a time-out at a low anger-level (between 1 and 2 on the scale 0 to 3) to prevent aggressive outbursts, shifting attention away from aversive stimuli, to cope with the stress of the anger provoking situation. Phase 4: creating solutions to cope with an anger provoking situation.<br>Behavioral: Parent psycho-education<br>* Three psycho-educational parent group sessions (take place before the children's sessions in intervention group). Parents meet with other parents and a therapist to learn about the nature of their Expressed Emotion (EE) and how it relates to the child's aggressive behavior.<br>|
| Active Comparator: Control condition<br>Participants received only parent training | Behavioral: Parent psycho-education<br>* Three psycho-educational parent group sessions (take place before the children's sessions in intervention group). Parents meet with other parents and a therapist to learn about the nature of their Expressed Emotion (EE) and how it relates to the child's aggressive behavior.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Aggressive behavior problems: Arguing, Temper tantrums, Destroying things and Physical violence | Questionnaire Social Behavior (QSB) measuring behavioral and emotion regulation problems typical for autistic children. | At week 0, before the intervention group received treatment | 
| Aggressive behavior problems: Arguing, Temper tantrums, Destroying things and Physical violence | Questionnaire Social Behavior (QSB) measuring behavioral and emotion regulation problems typical for autistic children. | 9 weeks later after treatment | 
| Aggressive behavior problems: aggression as reported by parent | The aggression sub scale from the Child Behavior Checklist (CBCL). Minimum value: 0, maximum value: 36. A higher score means more aggression. | At week 0, before the intervention group received treatment | 
| Aggressive behavior problems: aggression as reported by parent | The aggression sub scale from the Child Behavior Checklist (CBCL). Minimum value: 0, maximum value: 36. A higher score means more aggression. | 9 weeks later after treatment | 
| Aggressive behavior problems: aggression as reported by teacher | The aggression sub scale from the Teacher Rating Form (TRF). Minimum value: 0, maximum value: 36. A higher score means more aggression. | At week 0, before the intervention group received treatment | 
| Aggressive behavior problems: aggression as reported by teacher | The aggression sub scale from the Teacher Rating Form (TRF). Minimum value: 0, maximum value: 36. A higher score means more aggression. | 9 weeks later after treatment | 
| Anger coping strategies | The Behavioral Anger Response Questionnaire for children (BARQ-C) | At week 0, before the intervention group received treatment | 
| Anger coping strategies | The Behavioral Anger Response Questionnaire for children (BARQ-C) | 9 weeks later after treatment | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Quality of life of the child | Pediatric Quality of life inventory (Peds ql): Physical Functioning, Emotional Functioning, Social Functioning and School Functioning. | At week 0, before the intervention group received treatment | 
| Quality of life of the child | Pediatric Quality of life inventory (Peds ql): Physical Functioning, Emotional Functioning, Social Functioning and School Functioning. | 9 weeks later after treatment | 
| Social impairment due to autism symptoms | Social Responsiveness Scale (SRS). Minimum value: 0, maximum value: 195. A higher score means more impairments. | At week 0, before the intervention group received treatment | 
| Social impairment due to autism symptoms | Social Responsiveness Scale (SRS). Minimum value: 0, maximum value: 195. A higher score means more impairments. | 9 weeks later after treatment | 
| Parental stress | Nijmeegse Ouderlijke Stress Index (NOSI). Minimum value: 6, maximum value: 66. A higher score means more stress | At week 0, before the intervention group received treatment | 
| Parental stress | Nijmeegse Ouderlijke Stress Index (NOSI). Minimum value: 6, maximum value: 66. A higher score means more stress | 9 weeks later after treatment | 
| Parental well-being | Symptom Checklist-90 (SCL-90). Minimum value: 0, maximum value: 360. A higher score indicates a worse well-being. | At week 0, before the intervention group received treatment | 
| Parental well-being | Symptom Checklist-90 (SCL-90). Minimum value: 0, maximum value: 360. A higher score indicates a worse well-being. | 9 weeks later after treatment | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Autism spectrum disorder, Anger, Randomized controlled trial