Background: Adolescents with ASD and intellectual disability (ID) are a complex and
under-served population. Anxiety occurs at higher rates in individuals with ASD/ID (53%)
than in ID alone (17%) and may result in physical distress, avoidance of stressful
situations, and problem behavior. Further, it frequently contributes to caregivers
"taking over" tasks for youth with ID and limiting independence. Parents voice concern
about treatment options as the limited available supports often focus on prevention and
accommodation of anxiety, rather than on building coping skills. Thus, teens often finish
high school with limited coping abilities and consequently experience heightened anxiety
in the workplace and poor job retention. Yet, when coping skills are taught early in
adolescence, there is an opportunity to practice coping prior to transition, leading to
better employment rates, decreased clinical service use, and increased long-term wages.
Addressing anxiety and building coping skills for teens with ASD/ID is of critical
importance as these are per-requisite skills for successful transition to adulthood.
Intervention: A significant treatment barrier for teens with ASD/ID is the lack of
evidence based, manualized interventions for this population. This is due, in part,
because youth with ASD/ID have typically been excluded from intervention research trials
examining the effectiveness of best practice treatments such as cognitive behavioral
therapy (CBT). Recent research adapting CBT to meet the cognitive, social, and behavioral
needs of this population have yielded promising results and challenge the paradigm that
individuals with ID are not able to access cognitive and emotion regulation strategies.
The research team for the present study adapted a CBT manualized intervention, Facing
Your Fears, for adolescents with ASD/ID (FYF:ASD/ID) and completed a pilot study with 23
teens. Preliminary outcome measures indicated significant improvements in anxiety and
mood symptoms.
Objective: The current study seeks to test whether FYF:ASD/ID, an adapted CBT
intervention for teens with ASD/ID, is more effective in reducing anxiety than
treatment-as-usual (TAU).
Study Design: The investigators will use a Randomized Control Trial (RCT) with 36
adolescents with ASD/ID (12-18 years) randomized to FYF: ASD/ID and 36 adolescents
randomized to TAU for 14 weeks. The 36 teens randomized to TAU will then cross-over and
complete FYF:ASD/ID. Evaluations will take place at Baseline, Post-Intervention, and
6-month follow-up. Teens in the TAU will have two baseline assessments prior to crossing
over to FYF:ASD/ID; both groups will complete a 6-month follow-up assessment after
finishing FYF:ASD/ID.
Specific Aims: Three aims are proposed: (1) examine the efficacy of FYF: ASD/ID relative
to TAU in improving anxiety as measured by parent report and determine if gains are
maintained at 6-month follow-up; (2) examine secondary outcomes of anxiety such as how
emotion regulation and problem behavior are affected by participation in FYF:ASD/ID; and
(3) examine whether adolescents' independent use of CBT skills (as assessed by goal
attainment ratings of prompting level required to use strategies) to manage anxiety are
increased following participation in FYF:ASD/ID.
Impact: The present study would represent the first RCT of a CBT intervention for
adolescents with ASD/ID, a critical step toward establishing an evidence base for anxiety
treatment for this underserved and vulnerable population.
Translatability: It is necessary to close the gap in the availability of anxiety
interventions and ensure effective mental health care for all individuals on the
spectrum. Completing a well-designed RCT that incorporates random assignment, a control
group, and careful measurement of anxiety is a critical next step in evaluating the
effectiveness of this CBT treatment and supporting the study of interventions that can
contribute to positive coping skills that allow teens to access time limited transition
services and optimize outcome.