Maintenance of Intervention Effects of a Family-Focused Cognitive-Behavioral Treatment for Anxiety in Youth with ASD

Background:  Empirical support for the efficacy of modified cognitive-behavioral interventions targeting anxiety symptoms in youth with ASD is building; however, there are few reports of maintenance of treatment gains beyond a 3-month follow-up period in the autism literature.  

Objectives:  To conduct a 1-year follow-up study of anxiety symptoms in 50 youth with ASD who participated in a randomized controlled trial of Facing Your Fears, initially reported in Reaven et al., 2012.   

Methods: In the original study, 26 youth were randomly assigned to Treatment as Usual (TAU) and 24 to Active Treatment (Facing Your Fears, Reaven et al., 2010).   Youth in the TAU condition were offered the opportunity to complete the intervention following completion of their post-TAU measures.  Forty-seven youth, ages 7-11 with a confirmed diagnosis of ASD, completed the intervention and 35 families provided parent report of anxiety symptom severity in the youth 1-2 years after completing the 12-week intervention.   

Results:  Preliminary Analyses. Examination of differences between those families who provided follow-up data and those who did not yielded no significant differences in anxiety symptom severity (at baseline or at post-treatment), autism symptom severity, intellectual functioning, socioeconomic status (income and mother’s level of education) or gender. There were also no differences in session attendance or parent/youth satisfaction ratings with the intervention. Anxiety symptoms were measured with the SCARED- Parent Version (Birmharer et al., 1999) at pre-treatment, post-treatment and at 1-year follow-up. The SCARED Total Score was used in this study, where scores of 25 or higher indicate greater risk of a clinically significant anxiety disorder. The mean number of days between post-treatment assessment and follow-up assessment was 378.06 (sd = 62.17).

Anxiety Outcomes 1 year post-treatment. Overall, parent report of anxiety symptom severity on the SCARED suggests that symptoms continue to maintain or decrease approximately one year after completing the Facing Your Fears Intervention. Mean SCARED scores were: Pre-treatment mean: 31.93 (sd = 11.85); Post-treatment mean: 27.36 (sd = 12.11); 1-year follow-up mean: 19.06 (sd = 10.34). At pre-treatment, 98% of youth obtained a clinically significant Total score on the SCARED (i.e, >25); at post-treatment, 51.4% obtained a score in the clinically significant range, and at 1-year follow-up, 17.1% obtained a score in the clinically significant range. Paired t-tests show statistically significant improvements at 1-year follow-up, relative to scores obtained immediately after completing the intervention (t (1,34) = 4.64, p = .000). Examination of responder characteristics and other intervening variables are underway.

Conclusions:  These data are amongst the first reports of maintenance of intervention effects over a 1-2 year period for a cognitive-behavioral treatment for anxiety in youth with ASD.  These findings add to the growing body of evidence supporting the potential impact of family-focused, cognitive-behavioral approaches to anxiety in ASD. Limitations include reliance on parent report of youth anxiety.  Further research, utilizing more robust outcome measures, is warranted.