Facing your fears in schools: using the ADIS/ASA to characterize anxiety and intervention outcomes in students with autism or suspected autism

TL;DR

A school-based CBT program called FYF-S reduces anxiety in autistic students, as measured by a specialized interview tool.

Contribution

First school-based study using the ADIS/ASA to assess anxiety and intervention outcomes in autistic youth.

Findings

Students in FYF-S had significant reductions in anxiety compared to usual care.

Participants showed fewer anxiety diagnoses and improved total anxiety scores post-intervention.

Abstract

Autistic youth are at higher risk of developing anxiety compared to their peers, with as many as 40% experiencing clinical anxiety. Emerging research suggests that these rates are an underestimate as distinct presentations of anxiety (e.g., fear of change, idiosyncratic fears) are often not recognized. CBT is a well-established approach for managing anxiety in autistic youth, but many have difficulty accessing these interventions. School-based CBT programs, like Facing Your Fears in Schools (FYF-S), have shown effectiveness in reducing anxiety in autistic students and may increase access to care. The Anxiety and Related Disorders Interview Schedule for DSM-5 with Autism Spectrum Addendum is a semi-structured interview that captures both DSM-5 and distinct presentations of anxiety. This study aimed to: 1) characterize a subsample of students with autism or suspected autism and anxiety and 2) examine effectiveness of FYF-S using the ADIS/ASA.

This study utilized a subsample of students (N=37; ages 7-14) from a larger Type 1 hybrid-effectiveness trial who had either autism or suspected autism. Students were randomized to either FYF-S or Usual Care (UC). Caregivers completed the ADIS/ASA at baseline and post-intervention. The ADIS/ASA was administered by clinicians rigorously trained to reliability and masked to condition.

Students had both DSM-5 and distinct anxiety diagnoses at Time 1. Further, students in FYF-S demonstrated significant reductions in anxiety compared to UC, as evidenced by fewer anxiety diagnoses overall and significant improvement in total anxiety.

This is the first school-based study using the ADIS/ASA to characterize anxiety and measure outcomes in autistic students. Overall, results indicate that FYF-S may be a promising school-based intervention for autistic youth.

https://clinicaltrials.gov/study/NCT03685474, identifier NCT03685474.

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