Using evaluative frameworks to examine the implementation outcomes of a cognitive behavioral therapy program for autistic students with anxiety within public school settings

Pickard, Katherine; Meyer, Allison; Reyes, Nuri; Tanda, Tanea; Reaven, Judy

doi:10.1177/13623613211065797

Cited by 7 publications

(3 citation statements)

References 51 publications

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“…Particularly within the studied population of autistic students, interactions serve as a common coping strategy for symptoms of comorbid mental health conditions. Concerning the practicality of an emotion-responsive assessment, as indicated by the NEGP, disparate results were noted (27). This comparison highlights that although the combined NEGP and SSRS assessment effectively predicted both autism outcomes with significant effect sizes, the integration of NEGP items did not enhance treatment accuracy for either outcome and even led to a decrease in Emotional force value.…”

Section: Effectiveness Of the Ssrs In Evaluating Emotion-related Trea...mentioning

confidence: 86%

From personification abuse to normal expression: emotional treatment for language disorders in schools

Ke,

Zhou

2024

Front. Psychiatry

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IntroductionThe escalating prevalence of personification abuse in language disorders among students poses a substantial challenge for autistic students in the domain of language disorders. While prior research has mainly focused on the cognitive hurdles faced by autistic students, ongoing debates persist about the onset, severity, and roots of these challenges in their classroom behavior, with limited exploration of how preconceived notions impact personification abuse. This study aims to delve into emotional treatments for language disorders, specifically targeting personification abuse, to facilitate the shift from distorted perceptions to normative expression. It seeks to pinpoint the primary emotional interventions linked to instances of personification abuse and scrutinize the emotional factors influencing therapeutic approaches for language disorders.MethodsThe research encompassed a cohort of 110 autistic students, aged 2 to 5 years, diagnosed with language disorders, all clinically determined to have autism by developmental pediatricians at a prestigious medical facility. Among these children, 95 were attending specialized schools, while 15 were situated in community settings.ResultsThe outcomes disclosed that children across all developmental phases displayed instances of personification abuse in language disorders, showcasing noteworthy enhancements in personification abuse following emotional treatment. Significantly, the discernible disparity in personification abuse performance and emotional treatment can be linked to the simultaneous cognitive advancement of autistic students across four grade levels, with variations noted based on normative expressions.DiscussionThese findings underscore the insufficiency of solely relying on intrinsic trends to comprehend personification abuse within an emotional treatment context. The study accentuates the potential pitfalls associated with emotional treatment for language disorders and stresses the imperative need for additional research and psychiatric intervention strategies.

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Section: Effectiveness Of the Ssrs In Evaluating Emotion-related Trea...mentioning

confidence: 86%

From personification abuse to normal expression: emotional treatment for language disorders in schools

Ke,

Zhou

2024

Front. Psychiatry

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“…An additional direction would be to explore the optimal dosage for delivery of FYF-SB. Although exit interviews from the pilot study indicated that the 40-min 12 weekly sessions were recommended (Pickard et al, 2021), future research could investigate the differential impact of varied intervention dosage on treatment outcome. Examining the relationship between program dosage, adherence and facilitator competence on child outcome will be important.…”

Section: Future Directionsmentioning

confidence: 99%

Implementing school-based cognitive behavior therapy for anxiety in students with autism or suspected autism via a train-the-trainer approach: Results from a clustered randomized trial

Reaven

Pickard

Meyer

et al. 2023

Autism

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Autistic youth frequently experience interfering anxiety, and schools may be an ideal setting to deliver mental health care. A type 1 hybrid-effectiveness, cluster randomized trial was used to examine the effectiveness of school-based Facing Your Fears compared to usual care. Change in provider cognitive behavior therapy knowledge and treatment fidelity (adherence and provider competence) were also examined. Seventy-seven interdisciplinary school providers across 25 elementary/middle schools were trained via a train-the-trainer approach. Eighty-one students, ages 8–14 years, with autism or suspected autism and anxiety participated. Students who received school-based Facing Your Fears displayed significantly greater reductions in anxiety compared to students in usual care according to caregiver and child report (Screen for Anxiety and Related Emotional Disorders). Significant reductions in total anxiety ( p = 0.012), separation ( p = 0.002), and social anxiety ( p = 0.003) subscales occurred, according to parent report. Student self-report indicated significant reductions on the social anxiety subscales ( p = 0.001). Interdisciplinary school providers demonstrated significantly increased cognitive behavior therapy knowledge following training ( p < 0.001). Mean adherence and competence ratings were strong. The positive effectiveness and implementation outcomes are encouraging. Training interdisciplinary school providers to deliver school-based Facing Your Fears has the potential to increase access to care for anxious autistic students. Future directions and limitations are discussed. Lay Abstract Autistic youth frequently experience anxiety that can negatively affect them at home, with friends, and at school. Autistic youth have difficulty accessing mental health care, and this is particularly true for youth from traditionally underserved backgrounds. Providing mental health programs in schools may increase access to care for autistic youth with anxiety. The purpose of the study was to train interdisciplinary school providers to deliver school-based Facing Your Fears, a cognitive behavior therapy program for anxiety in autistic youth. Seventy-seven interdisciplinary school providers across 25 elementary/middle schools were trained by their colleagues and members of the research (train-the-trainer approach). Eighty-one students with autism or suspected autism, ages 8–14 years, were randomly assigned to either school-based Facing Your Fears or usual care. Students in school-based Facing Your Fears showed significant reductions in anxiety compared to students in usual care according to caregiver and student report. Other measures involved examining change in provider cognitive behavior therapy knowledge after training and determining how well interdisciplinary school providers were able to deliver school-based Facing Your Fears. Results indicated that interdisciplinary school providers showed significant improvements in cognitive behavior therapy knowledge after training. Interdisciplinary school providers were able to deliver most of school-based Facing Your Fears activities and with good quality. The positive outcomes in this study are encouraging. Training interdisciplinary school providers to deliver school-based Facing Your Fears may increase access to care for anxious autistic students. Future directions and limitations are discussed.

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“…That is, although both interventions are rooted in CBT principles, ZOR primarily uses psychoeducation and direct teaching of coping strategies to improve selfregulation, while FYF-SB pairs psychoeducation with graded exposure in which students practice facing their fears a little bit at a time to reduce anxiety symptoms. Although graded exposure plays a critical role in anxiety outcomes and is considered a core component of CBT [33,34], previous research has demonstrated that graded exposure is often a novel treatment strategy for school-based providers that may be logistically complicated to implement within schools [35]. Thus, in addition to their distinct intervention targets, comparing ZOR and FYF-SB may provide insight into the feasibility of each intervention's core components when implemented within school settings.…”

Section: Introductionmentioning

confidence: 99%

A Cluster Randomized Controlled Trial Comparing the Effectiveness of Two School-Based Interventions for Autistic Youth with Anxiety

Pickard,

Maddox,

Boles

et al. 2023

Preprint

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Background: Recent systematic reviews have indicated that cognitive behavioral therapy (CBT) is effective in reducing anxiety symptoms for autistic and non-autistic children. However, the vast majority of CBT research for autistic youth has been implemented within university settings and primarily by mental health providers. Schools hold great promise to equitably manage the mental health symptoms of autistic youth. Although preliminary research evaluating CBT within schools has been promising, CBT has not yet been compared to another readily available school mental health program. The goal of this protocol paper is to describe a multi-site study comparing two school-based interventions, Facing Your Fears-School Based (FYF-SB) and Zones of Regulation (ZOR) via a cluster randomized controlled type 1 hybrid effectiveness-implementation trial to determine which of the two interventions will best support autistic youth with anxiety in schools. Methods: Up to 100 elementary and middle schools will be randomized into FYF-SB or ZOR. Once schools are randomized, a minimum of two interdisciplinary school providers at each school will be trained to deliver either FYF-SB or ZOR over the course of 12 weeks to groups of 2-5 autistic students ages 8-14 years. Over the course of two years, a total of 200 autistic students will receive either ZOR or FYF-SB. The primary outcome of this trial is child anxiety, as rated by masked evaluators and via caregiver- and student-report, which will be measured at baseline, post-treatment, and 6-month follow-up. Semi-structured interviews will also be conducted with a purposive sample of students, caregivers, and school providers to understand the acceptability, appropriateness, and feasibility of either ZOR or FYF-SB. Stakeholder engagement is a central component of this project via two stakeholder advisory boards that will directly inform and oversee the project. Discussion. Results of this study will provide evidence about the relative impact of two school-based mental health interventions on outcomes reported as meaningful by caregivers and school providers. The additional focus on evaluating factors that support the implementation of FYF-SB and ZOR will allow future studies to test targeted implementation strategies that support mental health programming uptake and implementation within public schools. Trial Registration: This trial is registered with clinicaltrials.gov (NCT05863520).

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Using evaluative frameworks to examine the implementation outcomes of a cognitive behavioral therapy program for autistic students with anxiety within public school settings

Cited by 7 publications

References 51 publications

From personification abuse to normal expression: emotional treatment for language disorders in schools

From personification abuse to normal expression: emotional treatment for language disorders in schools

Implementing school-based cognitive behavior therapy for anxiety in students with autism or suspected autism via a train-the-trainer approach: Results from a clustered randomized trial

A Cluster Randomized Controlled Trial Comparing the Effectiveness of Two School-Based Interventions for Autistic Youth with Anxiety

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