Group cognitive behaviour therapy for children with autism spectrum disorder and comorbid anxiety: Examining factors that impact outcomes

Anxiety is common in children with Autism Spectrum Disorder (ASD; MacNeil, Lopes, & Minnes, 2009; Kim, Szatmari, Bryson, Streiner, & Wilson, 2000; White, Oswald, Ollendick, & Scahill, 2009) and can lead to significant impairment (Farrugia & Hudson, 2006; Kim et al., 2000; van Steensel, Bögels, & Dirksen, 2012). Implementing treatments in real-world environments has been identified as one of the top priorities for researchers in the area of anxiety in youth with ASD (Vasa, Keefer, Reaven, South & White, 2018). The current study examined the effectiveness of a manualized, group-based Cognitive Behaviour Therapy (CBT; Facing Your Fears (FYF); Reaven, Blakeley‐Smith, Culhane‐Shelburne, & Hepburn, 2012; Reaven, Blakeley-Smith, Nichols, & Hepburn, 2011) with children with ASD without intellectual disability (IQ>70) and their parents at BC Children’s Hospital. The primary goals of this research were to a) measure the effectiveness of the treatment protocol in a community setting with a complex population, and b) examine a selection of possible predictors of treatment outcomes (e.g., amount of homework completion, level of clinician-provided parent support during in vivo exposure practice, parent-child relationship variables, and parent personality variables), and thus contribute to the sparse literature in this regard. Significant decreases in child anxiety were observed from pre- to post-treatment at the levels of a) parent questionnaire ratings (ηp2 = .36), b) clinician severity ratings based on parent interview (d=.98), and c) parent ratings on primary individual exposure targets (last 7 weeks of group; d=1.50). After controlling for baseline child anxiety, variables that were found to significantly predict parent ratings of child anxiety symptoms at post-treatment were a) level of clinician support provided during in vivo exposure practice, b) parent-child communication, and c) self-reported parent trait anxiety. Overall, results from the current study are consistent with previous research demonstrating the effectiveness of the FYF treatment program for children with ASD.