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

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; M_age = 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.