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School based cognitive behavioural therapy targeting anxiety in children with autistic spectrum disorder: a quasi-experimental randomised controlled trail incorporating a mixed methods approach

Abstract

Children with a diagnosis of autism are more likely to experience anxiety than their typically developing peers. Research suggests that Cognitive Behavioural Therapy (CBT) could offer a way to help children with autism manage their anxiety but most evidence is based on clinical trials. This study investigated a school-based CBT programme using a quasi-experimental design incorporating the child and parent versions of the Spence Children’s Anxiety Scale (Spence, J Abnorm Psy 106(2):280–297, 1997) and the Coping Scale for Children and Youth (Brodzinsky et al., J Appl Dev Psychol 13:195–214, 1992). Interview data was incorporated to help understand the process of change further. Children in the experimental condition had lower levels of anxiety, maintained at follow-up and changes were found in coping behaviours such as lower behavioural avoidance strategies but increased problem solving strategies at follow-up. Limitations of the research together with future directions are also discussed.

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Fig. 1

Notes

  1. Although the American Psychiatric Association released the Diagnostic and Statistical Manual of Mental Disorders 5th Edition (DSM-V: American Psychiatric Association 2013) which changed the definition of ASD this research and the cited references were all conducted prior to its release so the DSM-IV definition has been retained.

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Author Contributions

CC conceived the study and participated in the design and coordination of the study and performed the measurement, statistical analysis and drafted the manuscript. VH supported the conception and design of the study and analysis of qualitative data. TC supported the design and analysis. All authors contributed to the final manuscript.

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Correspondence to Chris Clarke.

Appendix 1: Semi-structured Interview used with Children and Parent at Post-intervention

Appendix 1: Semi-structured Interview used with Children and Parent at Post-intervention

General Introduction

Introductions (me, my role and why I am speaking to them)

  • The right to withdraw at anytime

  • This is being recorded, do you consent/are you happy to proceed?

  • What we will do with the interview data

    • Transcribed

    • Analysed

    • Used in doctoral thesis

    • Securely stored

  • Check for understanding (Ask them, if necessary, to repeat back key points of what I have said; Based on what I have told you are you happy to proceed?)

Child

  • Talk to the child about different emotions they have had recently (try to get the child to talk about ‘good’ or ‘happy’ experiences as well)

  • Reflect on an experience they found difficult recently (what was different to the happy/good experiences?)

    • Physiological (sweating, pounding heart) reaction to the event

    • Thoughts about the event (What were they thinking? Did they think about any other options?)

    • What emotions were they experiencing?

      • What was the outcome? (What did they do? What options did they consider? Why did they choose this outcome?)

  • If this happened again, would they do anything differently?

  • Talk to the child about the classroom (where do you sit? who do you work with? what are your favourite subjects (why do you like them? What about subject?)) Develop this to find probing questions about their thoughts, feelings and emotions in the classroom and what strategies they use.

Parent

  • What is their understanding of ASD

    • Communication (sharing experiences, mannerisms)

    • Social interaction (friendships, social rules/etiquette)

    • Rigid behaviours (interests, other interests, taking part in other peoples’ games, rules)

  • Using their understanding, how does this impact on their child’s behaviours.

  • What sort of feelings/emotions do you see in your child.

    • How does he cope with these behaviours and feelings?

    • What does anxiety look like to the parent?

    • Physiological?

  • When has he done something which they thought would be difficult, but he was okay with (what was different? why was it surprising about it?)

    • What coping behaviours did they use (avoidance, etc.)

  • What is your understanding of his behaviours in school/classroom (what have you heard from teacher’s, your child’s friends, etc.)

  • Have you noticed any changes in child’s name recently?

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Clarke, C., Hill, V. & Charman, T. School based cognitive behavioural therapy targeting anxiety in children with autistic spectrum disorder: a quasi-experimental randomised controlled trail incorporating a mixed methods approach. J Autism Dev Disord 47, 3883–3895 (2017). https://doi.org/10.1007/s10803-016-2801-x

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  • DOI: https://doi.org/10.1007/s10803-016-2801-x

Keywords

  • Autism
  • Cognitive behavioural therapy
  • Schools based interventions
  • Coping behaviours
  • Mixed methods