Training Outpatient Clinicians to Deliver Cognitive Behavior Therapy to Children with High- Functioning Autism Spectrum Disorders and Anxiety: A Comparison of Three Methods of Learning Children with high-functioning autism spectrum disorders (ASD) are at greater risk for developing psychiatric symptoms, particularly anxiety symptoms, compared to typically developing children and children with other developmental disabilities. Anxiety problems can be especially "debilitating" to individuals with ASD by adversely impacting school performance, peer relationships, family functioning, and further exacerbating the core-deficits of ASD. Cognitive behavioral treatments (CBT) are frequently used in the general pediatric population with good success to reduce anxiety symptoms. Recently published studies, have demonstrated significant reductions in anxiety symptoms for children with ASD following the delivery of modified CBT interventions. Because these treatment studies have occurred exclusively in lab settings, generalizability to other clinical settings may be limited. To enhance the portability and generalizability of novel interventions, it is important to introduce the interventions into real world settings to inform protocol development, increase acceptability of the intervention and subsequently maximize the success for clinical practice. To further enhance acceptability, it is also important to identify the instruction methods necessary for the intervention to be delivered to fidelity. There are two main goals for this proposal. First, to train outpatient clinicians (professionals in psychology) to fidelity on an original, manualized group CBT (Face Your Fears - FYF) intervention for 8-14 year old children with high-functioning ASD and clinical anxiety. Second, to develop an optimal training model for clinicians delivering the FYF intervention by comparing three different instruction methods for learning the FYF intervention. In Phase 1, eight clinicians will be recruited from one site, to deliver the FYF intervention to four sequential treatment groups (four children and their families). Clinicians will work in teams of three. Training materials will be developed, and the outpatient cohort of clinicians will be trained to fidelity on the FYF intervention. In Phase 2, 36 total clinicians will be recruited from three sites to deliver the FYF intervention to three sequential treatment groups. Clinicians will be randomized to one of three instruction methods.--1) manual only (Manual), 2) manual plus three-day workshop (Workshop), and 3) manual plus three-day workshop, plus bi-weekly supervised consultation (Workshop-Plus). The efficacy of the different instruction methods will be evaluated by examining a) the increases in the clinicians'acquisition of the intervention techniques, and b) the reductions in anxiety symptoms for children with ASD.
Children with autism spectrum disorders (ASD) are at high risk for developing co- occurring anxiety symptoms, which can interfere significantly with the child's ability to participate in home, school and community activities. Thus, the careful and systematic development of feasible and efficacious treatments for children with ASD and serious psychiatric co-morbidity, clearly meets a strong public health need. Anxiety symptom reduction may result in a greater sense of mastery, less social isolation and more opportunities to participate in community activities.
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