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Feasibility, Acceptability and Preliminary Treatment Outcomes in a School-Based CBT Intervention Program for Adolescents with ASD and Anxiety in Singapore

Abstract

Adolescents with autism spectrum disorder (ASD) are at high risk for anxiety difficulties and disorders. Clinic-based cognitive behavioral therapy (CBT) is effective; however, few published school-based CBT programs for youth with ASD exist. In this study, the Facing Your Fears CBT protocol was adapted for delivery and piloted within a school setting by non-clinicians, with culturally appropriate adaptations. 44 13–15 aged youth with ASD from 22 mainstream schools in Singapore participated. Feasibility, acceptability and preliminary treatment outcomes were examined. Decreases in youth and parent reported anxiety symptoms were reported. Staff and parents found the program useful. Stakeholder support was important for implementation. Initial findings reflect the importance of carefully bridging research-to-practice for youth with ASD and anxiety.

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Notes

  1. In Singapore, diagnoses are mostly made during preschool years at government subsided public hospitals, or by school psychologists (for school-aged students). Diagnoses are made using the ADOS and ADI, consistent with Clinical Practice Guidelines on ASD published by Singapore’s Academy of Medicine and Ministry of Health in 2010 https://www.moh.gov.sg/content/dam/moh_web/HPP/Doctors/cpg_medical/current/2010/ASD%20book%20Apr%2010.pdf.

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Acknowledgments

JR is supported in part, by the Health Resources and Services Administration (HRSA) under the Leadership Education in Neurodevelopmental Disabilities (LEND) GrantT73MC11044 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). JR was also supported in part by the National Institutes of Health (NIH) Grant R33MH089291-03. 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 NIH, HRSA, HHS, or the US Government. JR receives royalties from the publication of the original Facing Your Fears: Group Therapy for Managing Anxiety in Children with High-Functioning Autism Spectrum Disorders (FYF; Reaven et al. 2011). The authors extend a special thanks to the Ministry of Education in Singapore, as well as the AEDs/LBS, psychologists, educators, students and parents who participated in this study. A special thanks to Julianne Wen-Li Tan and Phyllis Peck Lee Lim for their hard work organizing and executing the project.

Author Contributions

ID participated in the design and implementation of the study, training of participants, interpretation of the data, and drafted the manuscript. MA participated in the design and implementation of the study, coordination of the study, collection, analysis and interpretation of the data, and critically reviewed the manuscript. JR conceived of the study, participated in its design and implementation, training of participants, coordination, analysis and interpretation of the data, drafted part of the manuscript and critically reviewed the manuscript. All authors read and approved the final manuscript.

Funding

This study was funded 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), and by the National Institutes of Health (NIH) Grant R33MH089291-03.

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Correspondence to Irene E. Drmic or Judy Reaven.

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Drmic, I.E., Aljunied, M. & Reaven, J. Feasibility, Acceptability and Preliminary Treatment Outcomes in a School-Based CBT Intervention Program for Adolescents with ASD and Anxiety in Singapore. J Autism Dev Disord 47, 3909–3929 (2017). https://doi.org/10.1007/s10803-016-3007-y

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Keywords

  • Cognitive behavior therapy (CBT)
  • Autism spectrum disorder (ASD)
  • Adolescents
  • Anxiety
  • Facing your fears
  • Schools