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Addressing the Needs of Diverse Youth with ASD and Anxiety in Public Schools: Stakeholder Input on Adaptations of Clinic-Based Facing Your Fears

  • Judy ReavenEmail author
  • Nuri Reyes
  • Katherine Pickard
  • Tanea Tanda
  • Megan A. Morris
Original Paper
  • 14 Downloads

Abstract

Anxiety disorders are among the most common co-occurring psychiatric conditions for youth with ASD (van Steensel et al. in Clin Child Fam Psychol Rev 14:302–317, 2011). Although modified cognitive behavioral therapies (CBT) have yielded significant reductions in anxiety, substantial disparities in access to mental health services exist for youth from diverse and low-income families. Schools represent a consistent resource for underserved communities; thus, there is a critical need to adapt and implement CBT programs in school settings. Engaging stakeholders in the initial phase of adaptation is essential to support adoption and sustainability of best practice interventions in schools. The primary purpose of the study was to adapt group CBT (Facing Your Fears (FYF); Reaven et al. in Facing your fears: group therapy for managing anxiety in children with high-functioning autism spectrum disorders, Paul Brookes Publishing, Baltimore, 2011) via iterative processes with key stakeholders to create a feasible, effective, and sustainable school-based program to manage anxiety in underserved students with ASD. Two rounds of parent and professional focus groups were conducted across three school districts (total 14 groups), using qualitative content analysis methodology. Details regarding the delivery of FYF, selection of students, training considerations for staff, and identifying meaningful outcomes were obtained in anticipation of an implementation trial of FYF.

Keywords

Autism spectrum disorder Anxiety Cognitive Behavioral Therapy School mental health 

Notes

Acknowledgements

The authors extend a special thanks to the administrators from the participating school districts, professionals, and parents who participated in this study, as well as other clinicians who helped to facilitate the focus groups: Audrey Blakeley-Smith, Susan Hepburn, and Allison Meyer. We also wish to thank Aubyn Stahmer, Ph.D., for her invaluable consultation

Funding

The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: This research is supported by Health Resources and Services Administration (HRSA) (PI: Reaven—1 R41 MC31075-01-00). Judy Reaven receives royalties from the publication of Facing your fears: group therapy for managing anxiety in children with high-functioning autism spectrum disorders (FYF; Reaven et al., 2011). Judy Reaven is supported in part, by the Health Resources and Services Administration (HRSA) under the Leadership Education in Neurodevelopmental Disabilities (LEND) Grant T73MC11044 and by the Administration on Intellectual and Developmental Disabilities (AIDD) under the University Center of Excellence in Developmental Disabilities (UCDEDD) Grant 90DD0632 of the U.S. Department of Health and Human Services (HHS). This information or content and conclusions are those of the authors and should not be construed as the official position or policy of, nor should any endorsements be inferred by HRSA, HHS, or the U.S. Government. There are no other disclosures for the other authors.

Compliance with Ethical Standards

Ethical Approval

All procedures performed in this study were in accordance with the ethical standards of the Institutional Review Board at the University of Colorado Anschutz Medical Campus, Protocol #17-1656 and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. Informed consent was obtained for all individual participants.

References

  1. Aarons, G., Glisson, C., Green, P., Hoagwood, K., Kelleher, K., & Landsverk, J. (2012). The organizational social context of mental health services and clinician attitudes toward evidence-based practice: A United States national study. Implementation Science,7, 1–15.CrossRefGoogle Scholar
  2. Adams, D., Simpson, K., & Keen, D. (2018). School-related anxiety symptomatology in a community sample of primary school aged children on the autism spectrum. Journal of School Psychology,70, 64–73.PubMedCrossRefGoogle Scholar
  3. Attwood, T. (2004). Exploring feelings: Cognitive behaviour therapy to manage anxiety. Arlington, TX: Future Horizons.Google Scholar
  4. Birmaher, B., Brent, D. A., Chiappetta, L., Bridge, J., Monga, S., & Baugher, M. (1999). Psychometric properties of the Screen for Child Anxiety Related Emotional Disorders (SCARED): A replication study. Journal of the American Academy of Child and Adolescent Psychiatry,38(10), 1230–1236.  https://doi.org/10.1097/00004583-199910000-00011.CrossRefPubMedGoogle Scholar
  5. Bromley, J., Hare, D. J., Davison, K., & Emerson, E. (2004). Mothers supporting children with autistic spectrum disorders: Social support, mental health status and satisfaction with services. Autism,8, 409–423.PubMedCrossRefGoogle Scholar
  6. Chiu, A., Langer, D., McLeod, B., Har, K., Drahota, A., Galla, B., et al. (2013). Effectiveness of modular CBT for child anxiety in elementary schools. School Psychology Quarterly,28, 141–153.PubMedPubMedCentralCrossRefGoogle Scholar
  7. Clarke, C., Hill, V., & Charman, T. (2017). School based cognitive behavioural therapy targeting anxiety in children with autistic spectrum disorder: A quasi-experimental randomized controlled trail incorporating a mixed methods approach. Journal of Autism and Developmental Disorders,47, 3883–3895.PubMedCrossRefGoogle Scholar
  8. Creswell, J. W. (1998). Qualitative inquiry and research design: Choosing among five traditions. Thousand Oaks, CA: Sage Publications Inc.Google Scholar
  9. Damschroder, L. J., Aron, D. C., Keith, R. E., Kirsh, S. R., Alexander, J. A., & Lowery, J. C. (2009). Fostering implementation of health services research findings into practice: A consolidated framework for advancing implementation science. Implementation Science,4, 50.PubMedCrossRefGoogle Scholar
  10. Drahota, A., Chlebowski, C., Stadnick, N., Baker-Ericzén, M., & Brookman-Frazee, L. (2017). Dissemination and implementation of behavioral treatments for anxiety in ASD. In C. M. Kerns, P. Reno, E. A. Storch, P. C. Kendall, & J. J. Wood (Eds.), Anxiety in children and adolescents with autism spectrum disorder (pp. 231–249). London: Academic Press.CrossRefGoogle Scholar
  11. Drmic, I., Aljunied, M., & Reaven, J. (2017). Feasibility, acceptability and preliminary treatment outcomes in a school-based CBT intervention program for adolescents with ASD and anxiety in Singapore. Journal of Autism and Developmental Disorders,47, 3909–3929.PubMedCrossRefGoogle Scholar
  12. Eiraldi, R., Power, T. J., Schwartz, B. S., Keiffer, J. N., McCurdy, B. L., Mathen, M., et al. (2016). Examining effectiveness of group cognitive-behavioral therapy for externalizing and internalizing disorders in urban schools. Behavior Modification,40, 611–639.PubMedPubMedCentralCrossRefGoogle Scholar
  13. Elkins, R. M., McHugh, R. K., Santucci, L. C., & Barlow, D. H. (2011). Improving the transportability of CBT for internalizing disorders in children. Clinical Child and Family Psychology Review,14, 161–173.PubMedCrossRefGoogle Scholar
  14. Flouri, E., Midouhas, E., Charman, T., & Sarmadi, A. (2015). Poverty and the growth of emotional and conduct problems in children with autism with and without Comorbid ADHD. Journal of Autism and Developmental Disorders,45, 2928–2938.PubMedCrossRefGoogle Scholar
  15. Ginsburg, G., Becker, K., Drazdowski, T., & Tein, J. (2012). Treating anxiety disorders in inner city schools: Results from a pilot randomized controlled trial comparing CBT and usual care. Child & Youth Care Forum,41, 1–19.CrossRefGoogle Scholar
  16. Glaser, B. G., & Strauss, A. L. (1967). The constant comparative method of qualitative analysis. The Discovery of Grounded Theory: Strategies for Qualitative Research,101, 158–168.Google Scholar
  17. Herzig-Anderson, K., Colognori, D., Fox, J. K., Stewart, C. E., & Warner, C. M. (2012). School based anxiety treatments for children and adolescents. Child and Adolescent Psychiatric Clinics,21, 655–668.CrossRefGoogle Scholar
  18. Hsieh, H. F., & Shannon, S. E. (2005). Three approaches to qualitative content analysis. Qualitative Health Research,15, 1277–1288.PubMedCrossRefGoogle Scholar
  19. Kasari, C., & Smith, T. (2013). Interventions in schools for children with autism spectrum disorder: Methods and recommendations. Autism,17, 254–267.PubMedCrossRefGoogle Scholar
  20. Kester, K. R., & Lucyshyn, J. M. (2019). Co-creating a school-based Facing Your Fears anxiety treatment for children with autism spectrum disorder: A model for school psychology. Psychology in Schools,56, 1–16.CrossRefGoogle Scholar
  21. Leigh, J. P., Grosse, S. D., Cassady, D., Melnikow, J., & Hertz-Picciotto, I. (2016). Spending by California’s Department of Developmental Services for persons with autism across demographic and expenditure categories. PLoS ONE,11, 1–23.CrossRefGoogle Scholar
  22. Lopata, C., Donnelly, J., & Thomeer, M. (2017). Anxiety and ASD in schools: School-related issues and individualized education programs. In C. M. Kerns, P. Reno, E. A. Storch, P. C. Kendall, & J. J. Wood (Eds.), Anxiety in children and adolescents with autism spectrum disorder (pp. 211–230). London: Academic Press.CrossRefGoogle Scholar
  23. Luxford, S., Hadwin, J. A., & Kovshoff, H. (2017). Evaluating the effectiveness of a school based cognitive behavioural therapy intervention for anxiety in adolescents diagnosed with autism spectrum disorder. Journal of Autism and Developmental Disorders,47(896), 3908.Google Scholar
  24. Lyneham, H. J., Street, A. K., Abbott, M. J., & Rapee, R. M. (2008). Psychometric properties of the school anxiety scale—Teacher reported (SAS-TR). Journal of Anxiety Disorders,22, 292–300.  https://doi.org/10.1016/j.janxdis.2007.02.001.CrossRefPubMedGoogle Scholar
  25. Lyon, A. R., & Bruns, E. J. (2019). From evidence to impact: Joining our best school mental health practices with our best implementation strategies. School Mental Health,11, 106–114.PubMedCrossRefGoogle Scholar
  26. Mackintosh, V. H., Myers, B. J., & Goin-Kochel, R. P. (2005). Sources of information and support used by parents of children with autism spectrum disorders. Journal on Developmental Disabilities,12, 41–51.Google Scholar
  27. Magaña, S., Lopez, K., Aguinaga, A., & Morton, H. (2013). Access to diagnosis and treatment services among Latino children with autism spectrum disorders. Intellectual and Developmental Disabilities,51, 141–153.PubMedCrossRefGoogle Scholar
  28. Mandell, D. S., & Novak, M. (2005). The role of culture in families’ treatment decisions for children with autism spectrum disorders. Mental Retardation and Developmental Disabilities Research Review,11, 110–115.CrossRefGoogle Scholar
  29. Merikangas, K. R., He, J. P., Brody, D., Fisher, P. W., Bourdon, K., & Koretz, D. S. (2010). Prevalence and treatment of mental disorders among US children in the 2001–2004 NHANES. Pediatrics,125, 75–81.PubMedCrossRefGoogle Scholar
  30. Mifsud, C., & Rapee, R. M. (2005). Early intervention for childhood anxiety in a school setting: Outcomes for an economically disadvantaged population. Journal of the American Academy of Child and Adolescent Psychiatry,44, 996–1004.PubMedCrossRefGoogle Scholar
  31. Montes, G., Halterman, J. S., & Magyar, C. I. (2009). Access to and satisfaction with school and community health services for US children with ASD. Pediatrics,124(Supplement 4), S407–S413.PubMedCrossRefGoogle Scholar
  32. Moree, B. N., & Davis, T. E., III. (2010). Cognitive-behavioral therapy for anxiety in children diagnosed with autism spectrum disorders: Modification trends. Research in Autism Spectrum Disorders,4, 346–354.CrossRefGoogle Scholar
  33. Mychailyszyn, M. P., Brodman, D. M., Read, K. L., & Kendall, P. C. (2012). Cognitive behavioral school-based interventions for anxious and depressed youth: A meta-analysis of outcomes. Clinical Psychology: Science and Practice,19, 129–153.Google Scholar
  34. Mychailyszyn, M. P., Méndez, J. L., & Kendall, P. C. (2010). School functioning in youth with and without anxiety disorders: Comparisons by diagnosis and comorbidity. School Psychology Review,39, 106–122.Google Scholar
  35. Olatunji, B. O., Cisler, J. M., & Deacon, B. J. (2010). Efficacy of cognitive behavioral therapy for anxiety disorders: A review of meta-analytic findings. Psychiatric Clinics,33(557), 577.Google Scholar
  36. Olfson, M., Blanco, C., Wang, S., Laje, G., & Correll, C. U. (2014). National trends in the mental health care of children, adolescents, and adults by office-based physicians. JAMA Psychiatry,71(1), 81–90.PubMedCrossRefGoogle Scholar
  37. Parsons, S., Charman, T., Faulkner, R., Ragan, J., Wallace, S., & Wittemeyer, K. (2013). Commentary–bridging the research and practice gap in autism: The importance of creating research partnerships with schools. Autism,17, 268–280.PubMedCrossRefPubMedCentralGoogle Scholar
  38. Pickard, K., Reyes, N., & Reaven, J. (2019). Short report: Examining the inclusion of diverse participants in CBT research for youth with ASD and anxiety. Autism International Journal of Research and Practice,23, 1057–1064.Google Scholar
  39. Reaven, J., Blakeley-Smith, A., Culhane-Shelburne, K., & Hepburn, S. (2012a). Group cognitive behavior therapy for children with high-functioning autism spectrum disorders and anxiety: A randomized trial. Journal of Child Psychology and Psychiatry, and Allied Disciplines,53, 410–419.  https://doi.org/10.1111/j.1469-7610.2011.02486.x.CrossRefPubMedPubMedCentralGoogle Scholar
  40. Reaven, J., Blakeley-Smith, A., Leuthe, E., Moody, E., & Hepburn, S. (2012b). Facing your fears in adolescence: Cognitive-behavioral therapy for high-functioning autism spectrum disorders and anxiety. Autism Research and Treatment,2012, 1–13.CrossRefGoogle Scholar
  41. Reaven, J., Blakeley-Smith, A., Nichols, S., & Hepburn, S. (2011). Facing your fears: Group therapy for managing anxiety in children with high-functioning autism spectrum disorders. Baltimore, MD: Paul Brookes Publishing.Google Scholar
  42. Reaven, J., Moody, E. J., Grofer Klinger, L., Keefer, A., Duncan, A., O’Kelley, S., et al. (2018). Training clinicians to deliver group CBT to manage anxiety in youth with ASD: Results of a multisite trial. Journal of Consulting and Clinical Psychology,86, 205–217.PubMedPubMedCentralCrossRefGoogle Scholar
  43. Reaven, J. A., Blakeley-Smith, A., Nichols, S., Dasari, M., Flanigan, E., & Hepburn, S. (2009). Cognitive-behavioral group treatment for anxiety symptoms in children with high- functioning autism spectrum disorders: A pilot study. Focus on Autism and Other Developmental Disabilities,24, 27–37.CrossRefGoogle Scholar
  44. Reiss, F. (2013). Socioeconomic inequalities and mental health problems in children and adolescents: A systematic review. Social Science and Medicine,90, 24–31.PubMedCrossRefGoogle Scholar
  45. Siller, M., Reyes, N., Hotez, E., Hutman, T., & Sigman, M. (2014). Longitudinal change in the use of services in autism spectrum disorder: Understanding the role of child characteristics, family demographics, and parent cognitions. Autism,18, 433–446.PubMedCrossRefGoogle Scholar
  46. Smith, T., Iadarola, S., Mandell, D. S., Harwood, R., & Kasari, C. (2017). Community-partnered research with urban school districts that serve children with autism spectrum disorder. Academic Pediatrics,17, 614–619.PubMedCrossRefGoogle Scholar
  47. Spence, S. H. (1997). Structure of anxiety symptoms among children: A confirmatory factor-analytic study. Journal of Abnormal Psychology,106, 280–297.PubMedCrossRefGoogle Scholar
  48. Stahmer, A. C., Suhrheinrich, J., Reed, S., & Schreibman, L. (2012). What works for you? Using teacher feedback to inform adaptations of pivotal response training for classroom use. Autism Research and Treatment,2012, 1–11.CrossRefGoogle Scholar
  49. Storch, E. A., Lewin, A. B., Collier, A. B., Arnold, E., De Nadai, A. S., Dane, B. F., et al. (2015). A randomized controlled trial of cognitive-behavioral therapy versus treatment as usual for adolescents with autism spectrum disorders and comorbid anxiety. Depression and Anxiety,32, 174–181.PubMedCrossRefGoogle Scholar
  50. Syriopoulou-Delli, C., Polychronopoulou, S., Kolaitis, G., & Antoniou, A. (2018). Views of teachers on anxiety symptoms in students with autism spectrum disorder. Journal of Autism and Developmental Disorders,49, 704–720.CrossRefGoogle Scholar
  51. Thomas, K. C., Ellis, A. R., McLaurin, C., Daniels, J., & Morrissey, J. P. (2007). Access to care for autism-related services. Journal of Autism and Developmental Disorders,37, 1902–1912.CrossRefGoogle Scholar
  52. Ung, D., Selles, R., Small, B. J., & Storch, E. A. (2015). A systematic review and meta-analysis of cognitive-behavioral therapy for anxiety in youth with high-functioning autism spectrum disorders. Child Psychiatry and Human Development,46, 533–547.PubMedCrossRefGoogle Scholar
  53. van Steensel, F. J., Bogels, S. M., & Perrin, S. (2011). Anxiety disorders in children and adolescents with autistic spectrum disorders: A meta-analysis. Clinical Child and Family Psychology Review,14, 302–317.PubMedPubMedCentralCrossRefGoogle Scholar
  54. Weissman, A. S., Antinoro, D., & Chu, B. C. (2009). Cognitive-behavioral therapy for anxious youth in school settings: Advances and challenges. In M. Mayer, R. Van Acker, J. E. Lochman, & F. M. Gresham (Eds.), Cognitive-behavioral interventions for emotional and behavioral disorders (pp. 173–203). London: The Guilford Press.Google Scholar
  55. Weston, L., Hodgekins, J., & Langdon, P. E. (2016). Effectiveness of cognitive behavioural therapy with people who have autistic spectrum disorders: A systematic review and meta analysis. Clinical Psychology Review,49, 41–54.PubMedCrossRefGoogle Scholar
  56. White, S. W., Ollendick, T., Albano, A. M., Oswald, D., Johnson, C., Southam-Gerow, M. A., et al. (2013). Randomized controlled trial: Multimodal anxiety and social skill intervention for adolescents with autism spectrum disorder. Journal of Autism and Developmental Disorders,43, 382–394.PubMedPubMedCentralCrossRefGoogle Scholar
  57. Wood, J. (2006). Effect of anxiety reduction in children’s performance and social adjustment. Developmental Psychology,42, 345–349.PubMedCrossRefGoogle Scholar
  58. Wood, J. J., Drahota, A., Sze, K., Har, K., Chiu, A., & Langer, D. A. (2009). Cognitive behavioral therapy for anxiety in children with autism spectrum disorders: A randomized, controlled trial. Journal of Child Psychology and Psychiatry,50, 224–234.PubMedCrossRefGoogle Scholar
  59. Zuckerman, K. E., Lindly, O. J., Reyes, N. M., Chavez, A. E., Macias, K., Smith, K. N., et al. (2017). Disparities in diagnosis and treatment of autism in Latino and non-Latino white families. Pediatrics,139, 1–10.CrossRefGoogle Scholar

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© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Department of Psychiatry, JFK PartnersUniversity of Colorado Anschutz Medical CampusAuroraUSA
  2. 2.Children’s Hospital ColoradoAuroraUSA
  3. 3.Adult and Child Consortium for Health Outcomes and Delivery ScienceUniversity of Colorado Anschutz Medical CampusAuroraUSA

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