Cognitive Behaviour Therapy for Anxiety in Children with Autism Spectrum Disorder: Predictors of NON-Response to Treatment

Background: Internalizing mental health issues, such as anxiety and depression, are common, often debilitating conditions for children and youth with autism spectrum disorder (ASD; Simonoff et al., 2008). The complex, pervasive, and heterogeneous clinical symptoms of youth with ASD and co-occurring psychiatric disorders makes treatment of mental health issues challenging (Wood et al., 2006). Facing Your Fears (FYF) is a well-established, evidence-based modified cognitive behaviour therapy (CBT) group that has been developed for children and youth with ASD (Reaven et al., 2009). Findings from randomized controlled trails have shown that anxiety symptoms, social difficulties, and emotion dysregulation improve in children and youth with ASD who participate in FYF, with these improvements maintained 12 months post-intervention (Reaven et al. 2012). While the majority of FYF participants show reductions in anxiety symptoms and less interference in daily life, a small subset of FYF participants (approximately 20% of children and adolescents) are not responsive to the treatment (Reaven et al., 2009). To date it is unknown why some individuals with ASD are responsive to FYF and others are not.

Objectives: The present study aims to examine the demographic and clinical predictors of responsiveness to FYF. Consistent with previous research in pediatric anxiety, it is expected that sex, type of anxiety disorder, severity of anxiety symptoms at pre-assessment, and presence of parental psychopathology will be associated with poorer outcomes after FYF.

Methods: 51 children and youth between 8 and 13 years of age participated in FYF groups over a 5-year period. Children/youth and their caregivers completed a variety of measures before (pre) and after (post) participating in FYF. Specifically, anxiety type, symptoms, and severity (Spence Children’s Anxiety Scale and the Anxiety Disorder Interview Scale [ADIS]), presence of other psychiatric disorders (ADIS, Behaviour Assessment System for Children -2, Child Depression Inventory), parent psychopathology (State Trait Anxiety Inventory), and ASD symptom severity (Social Communication Questionnaire) were assessed. Demographic variables (age, sex) and other clinical variables (IQ) were obtained prior to starting the group.

Results: Data have been collected and analyses will be completed in Winter 2019. Using pairwise correlations and hierarchical logistic regression analyses we will identify which demographic and clinical factors are associated with non-response to FYF.

Conclusions: FYF has shown to be effective in reducing anxiety symptoms for most children and youth with ASD (Reaven et al., 2012). Determining what factors are associated with treatment non-response will be valuable in providing appropriate, effective, targeted treatment for youth with ASD and co-occurring mental health issues, ultimately improving the care, outcomes, and quality of life of youth with ASD.