Community Implementation of Facing Your Fears: A Cognitive Behavioural Therapy Program for Anxiety in Children with ASD

Poster Presentation
Friday, May 3, 2019: 5:30 PM-7:00 PM
Room: 710 (Palais des congres de Montreal)
B. Drouillard, A. Solish, N. Klemencic, A. Ritzema, V. Nolan, M. Pilkington, E. Anagnostou and J. A. Brian, Holland Bloorview Kids Rehabilitation Hospital, Toronto, ON, Canada
Background: Comorbid anxiety disorders are common among youth with high functioning Autism Spectrum Disorder (ASD; White, Oswald, Ollendick, & Scahill, 2009); however, there are few interventions demonstrated to be effective with this population. Facing Your Fears (FYF) is a manualized cognitive-behavioural therapy (CBT) program for anxiety, designed specifically for youth with high functioning ASD (Reaven, Blakely-Smith, Nichols, & Hepburn, 2011). Although FYF has demonstrated efficacy in research/hospital settings (Reaven, Blakely-Smith, Culhane-Shelburne, & Hepburn, 2012), its effectiveness when implemented in community settings is not well established.

Objectives: To evaluate the effectiveness of the FYF program implemented in community versus hospital-based settings.

Methods: Participants were 105 parent-child dyads (51 from the hospital setting and 54 from community settings). Children (76 boys, 29 girls; age range = 6.92 – 15.30 years; Mage = 10.47 years; SD = 1.75) had a diagnosis of ASD, broadly average cognitive functioning, and significant anxiety symptoms. Participants completed the Screen for Child Anxiety-Related Emotional Disorders (SCARED, Child and Parent; Birmaher, Brent, Chiappetta, Bridge, Monga, & Baugher, 1997) and the Spence Children’s Anxiety Scale (SCAS, Child and Parent; Spence, 1998) pre- and post-intervention. Examination of baseline participant characteristics, using one-way ANOVAs, revealed that the only pre-treatment characteristic differing significantly across settings was child age, with children in the hospital setting being significantly younger (M = 10.08 years, SD = 1.71) than children in the community (M = 10.87 years, SD = 1.72; F(1, 103) = 5.60, p = .02). One-way ANCOVAs controlling for child age were therefore used to demonstrate pre-intervention equivalence between hospital-based and community-based participants on measures of anxiety and other behavioural difficulties.

Results: Within hospital-based groups, paired samples t-tests revealed significant reductions in anxiety from pre- to post-intervention on the SCAS- Parent Report, t(50) = 4.75, p < .001; SCAS-Child Report, t(52) = 4.23, p < .001; SCARED- Parent Report, t(50) = 6.38, p < .001; and SCARED- Child Report, t(50) = 3.62, p = .001. Similarly, within community-based groups, paired samples t-tests revealed significant reductions in anxiety from pre- to post-intervention on the SCAS- Parent Report, t(48) = 3.97, p < .001; SCARED- Parent Report, t(46) = 5.05, p < .001; and SCARED- Child Report, t(45) = 2.58, p < .05. Reductions in anxiety noted on the SCAS- Child Report in the community-based sample failed to reach significance, t(49) = 1.62, p = .11. ANCOVAs controlling for age revealed no significant differences in pre-post intervention change scores between participants in hospital and community-based FYF groups on the SCAS- Parent Report, F(1, 97) = .189, ns; SCAS- Child Report, F(1, 100) = 1.124, ns; SCARED- Parent Report, F(1, 95) = .072, ns; and SCARED- Child Report, F(1, 94) = 2.139, ns.

Conclusions: Findings provide support for the effectiveness of the FYF program when implemented in community settings. Given the similar reductions in anxiety symptoms observed among participants in hospital- and community-based groups, community implementation of FYF is a feasible and effective means of improving access to evidence-based anxiety intervention for children with high functioning ASD.