DINOSAUR: an integrated cognitive-behavioral treatment for anxiety in young children with ASD

Abstract

Background Anxiety disorders are highly prevalent in children and adolescents with autism spectrum disorder and often emerge before the age of 6 years. Yet, only a few studies have examined anxiety treatment for this group. Preliminary evidence from these studies suggests that utilizing cognitive behavioral therapy (CBT) as well as strategies to target intolerance of uncertainty (IU) and parental accommodation, known mechanistic and maintaining factors of anxiety may improve anxiety and optimize outcomes in this age group. Main body To meet this need, we developed an integrated treatment called DINO Strategies for Anxiety and intolerance of Uncertainty Reduction (DINOSAUR), a 12-week group telehealth treatment for 4- to 6-year-old children with ASD. DINOSAUR works with young children and their parents to deliver CBT along with interventions targeting IU and parental accommodation. In this paper, we first discuss the rationale for developing this treatment and then describe a pilot study of its feasibility and preliminary efficacy. Conclusions There is a great need to develop anxiety treatments for young children with ASD. We proposed a novel integrated treatment approach that aims to alter the way young children and parents respond to fear, which could potentially improve short- and long-term mental health outcomes for this age group. Trial registration ClinicalTrials.govNCT04432077 on June 03, 2020

A case series evaluation of the Fearless Me! © program for children with intellectual disabilities and anxiety

“…Similarly, the lead researcher or child's parents reading the assessment questions to the child participant may have impacted how the children responded. Finally, the role of parental anxiety is important to consider in future research (Keefer & Vasa, 2021), as parental anxiety is known to play a key role in the development and maintenance of a child's anxiety. In addition, parental accommodation of a child's anxiety would benefit from additional focus in the Fearless Me!…”

Anxiety in autistic preschool children: Phenomenology and a network analysis of correlates

“…Second, targeting IU, as well as addressing sensory and somatic symptoms in this age group, could mitigate anxiety. Indeed, several research groups are currently testing IU‐focused treatments such as DINO Strategies for Anxiety and IU Reduction (DINOSAUR; Keefer & Vasa, 2021) and Coping with Uncertainty in Everyday Situations (CUES; Rodgers et al, 2018; Ong et al, 2023) in autistic preschool children with promising results.…”

“…Future randomized trials are needed to test preventive interventions in this age group. Second, during the anxiety assessment, asking questions that tease apart overlapping symptoms, differentiate clinical versus normative anxiety, and assess for both DSM-5 and distinct anxiety can enhance diagnostic accuracy (Vasa et al, 2016) Strategies for Anxiety and IU Reduction (DINOSAUR; Keefer & Vasa, 2021) and Coping with Uncertainty in Everyday Situations (CUES; Rodgers et al, 2018;Ong et al, 2023) in autistic preschool children with promising results.…”