Facing Your Fears in Schools: Implementing a CBT Program for Students With ASD or Other Special Learning Needs
试验速览
- 阶段
- 不适用
- 状态
- 已完成
- 入组人数
- 389
- 试验地点
- 1
- 主要终点
- Reduction in symptoms of anxiety of participants as measured by scores from the parent-completed questionnaire, Parent-Rated Anxiety Scale for ASD (PRAS-ASD).
研究概览
简要总结
The overall goal of the project is to develop a feasible, effective and sustainable school-based program to manage anxiety in elementary and middle school students with Autism Spectrum Disorder (ASD) and other special learning needs. There are two phases to this Department of Health and Human Services/Health Resources and Services Administration-funded research. In the first phase, there will be engagement of community partners in the process of developing the adapted intervention for implementation in schools. The first phase is ongoing until approximately fall of 2018.
This project is the second phase of this program of research and is focused on piloting and implementing the school-based intervention within 3 local school districts in a systematic and sustainable way - through a "train-the-trainer" model. Primary aims are:
- to prepare cross-disciplinary teams of School - Based Trainers to conduct three pilot student groups of Facing Your Fears - School Based (FYF-SB) within their own district, with the goal of later training others in their districts to deliver FYF-SB.
- at the start of the following academic year (2019-2020), within each of the three participating districts, 10 schools will be randomized to one of two conditions for the fall semester: a) FYF-SB or b) Usual Care; and assess implementation and treatment outcomes.
详细描述
Children with Autism Spectrum Disorder (ASD) are at high risk for developing clinically significant anxiety. Anxiety markedly interferes with peer relationships, family functioning and participation in academic programming. Youth with ASD demonstrate significant reductions in anxiety following participation in treatments rooted in evidence-based practice (EBP) such as cognitive behavior therapy (CBT). The treatment program, Facing Your Fears (FYF), is one such EBP. However, substantial disparities in access to psychiatric services exist, particularly for youth from minority and/or low income families. Schools may be the ideal location to access these services because they represent one of the only consistent resources available to many low resourced families.
The current proposal is innovative for several reasons: (1) There are very few published studies examining the effectiveness of treatments for children with ASD and anxiety in schools, and none that have focused on under-resourced communities; (2) There are no known studies that have identified students for an intervention program according to special education eligibility criteria, combined with other inclusion criteria, an approach which will likely serve more students, and in turn, potentially increase the feasibility of FYF-SB; (3) a "train the trainer" model will result in increased capacity for low resourced schools to serve underserved youth; and (4) Finally, the current study is one of the first to examine organizational constructs that are potentially associated with adoption of FYF-SB, the results of which would help determine critical next steps in implementation research.
Overview of Facing Your Fears (FYF): The clinical version of FYF is a 14-week, family-focused CBT group intervention (1 ½ hours each session) aimed toward managing anxiety in children ages 8-14 with high-functioning ASD. FYF is composed of three books (e.g., facilitators, parents and children) and a digital versatile disc (DVD). The 14 weeks are divided into two, seven-session intervention blocks: (1) an introduction to anxiety symptoms with an emphasis on the individual expression of anxiety symptoms, as well as an introduction to common CBT strategies, and (2) a focus on using specific tools and strategies (i.e. deep breathing, positive coping statements and graded exposure--facing fears a little at a time) to improve emotion regulation and manage anxiety symptoms. Although FYF was originally developed for youth with ASD, there is no mention of ASD in the curriculum, as the focus is exclusively on management of anxiety. Importantly, careful attention was paid to the delivery of core concepts, given the social, communicative and cognitive challenges of youth with ASD (Moree & Davis, 2010). The use of written worksheets, multiple choice lists, emphasis on creative and varied outlets for expression, use of video modeling and a focus on strengths and talents make FYF ideal for students with special learning needs.
Facing Your Fears: School-Based (FYF-SB): FYF-SB will be very similar to FYF, but will be modified for delivery in school settings. Phase 1 study, currently in completion, will enable input to be obtained from school personnel, district leaders and parents as a way to determine the best ways to adapt the intervention for schools. Thus the logistical details of how the intervention will be offered to students within each participating school district has been discussed in detail with each of the 3 participating districts' leaders and key personnel.
Research Methods:
研究设计
- 研究类型
- Interventional
- 分配方式
- Randomized
- 干预模型
- Crossover
- 主要目的
- Treatment
- 盲法
- None
入排标准
- 年龄范围
- 8 Years 至 14 Years（Child）
- 性别
- All
- 接受健康志愿者
- 是
入选标准
- •Estimated Verbal intelligence quotient (IQ) of 80 or above as determined by the Weschler Abbreviated Scales of Intelligence (WASI), or an equivalent measure administered within the past three years; or presents with achievement scores in school records that suggest average-low average-borderline intellectual functioning
- •Clinically significant anxiety symptoms as defined by significant elevations on either the SCARED, or PRAS-ASD, according to either student, parent, or teacher report
- •Currently staffed into special education with an individualized education plan (IEP) or 504 with one of the following eligibility categories: autism, other health impairment, emotional disturbance, specific learning disabilities, multiple disabilities or other speech/language impairment; OR currently identified as at risk and in need of Response to Intervention (RTI) consultation and not yet found to be eligible for special education services OR currently in the process of completing the educational eligibility evaluation
- •Significant deficits in reciprocal social behavior as defined by a Total T Score on the Social Responsive Scale Version 2 (SRS-2) of 60 or above
- •Lives with parent/guardian who can provide consent for participation.
排除标准
- •(1) Presentation of psychosis, severe aggressive behavior, or other severe clinical symptoms that require more intensive treatment such as day treatment or hospitalization
研究组 & 干预措施
Facing Your Fears-School Based (FYF-SB)
This group will receive the Facing Your Fears - School Based intervention during the fall semester
干预措施: Facing Your Fears - School Based (Behavioral)
Usual Care (UC)
This group will receive usual care of anxiety treatment during the fall semester, but will be in the FYF-SB arm the following spring semester.
干预措施: Usual Care (Behavioral)
结局指标
主要结局
Reduction in symptoms of anxiety of participants as measured by scores from the parent-completed questionnaire, Parent-Rated Anxiety Scale for ASD (PRAS-ASD).
时间窗: 13 weeks
The Parent - Rated Anxiety Scale for ASD (Scahill et al.) is a 25 item, parent report measure created to assess anxiety in youth with ASD. This measure has good test - retest reliability of 0.88 and 0.86, and strong convergent validity with other anxiety measures (0.83). This measure will be completed by parents before and after study treatment.
Classroom attendance
时间窗: 13 weeks
Teachers will track participants' daily attendance, including late arrivals and amount of time spent outside of classroom. Progression will be tracked for any trends before, during, and after study participation.
Reduction in symptoms of anxiety of the participant as measured by scores from the teacher - completed questionnaire, The School Anxiety Scale (SAS).
时间窗: 13 weeks
The School Anxiety Scale (Lyneham et al. 2008) is a 16 item teacher-reported measure of anxiety designed to assess the behavior of children at school from 5 to 12 years of age. Items are answered on a four-point scale. This measure provides a total score for anxiety, with scores ranging from 0 - 48. Two subscales are also calculated, reflecting social anxiety and generalized anxiety. This measure will be completed by teachers before and after study treatment.
Reduction in symptoms of anxiety of participants as measured by scores from parent - completed questionnaire, The Social Responsiveness Scale, Second Edition (SRS-2).
时间窗: 13 weeks
The Social Responsiveness Scale (Constantino \& Gruber, 2012) is a parent - reported 65 - item questionnaire that uses a 4 - point Likert scale to assess behaviors associated with ASD. It included five subscales: awareness, cognition, communication, motivation, and autistic mannerisms. Higher scores suggest greater impairment. The SRS is commonly used in autism research, has good reliability, and is valid across cultures (Bolte et al., 2008). This measure will be completed by parents before and after study treatment.
Reduction in symptoms of anxiety of participants as measured by scores from parent -, and teacher - completed questionnaire, Emotion Regulation Checklist (ERC).
时间窗: 13 weeks
The Emotion Regulation Checklist (Shields \& Cicchetti, 1997) is a 24 - item parent/teacher report measure that provides information regarding a child's typical responses to emotionally intense experiences. The instrument has good reliability and validity across adult informants and provides indices regarding the child's ability to modulate and express affect in a manner that is context - appropriate. The ERC has been shown to be sensitive to change in effectiveness studies of CBT protocols with anxious youth (Suveg, Kendall, Comer, \& Robin, 2006). This measure will be completed by teachers and parents before and after study treatment.
Reduction in symptoms of anxiety of participant as measured by scores from parent -, and self - completed questionnaire, Screening for Childhood Anxiety and Related Emotional Disorders (SCARED).
时间窗: 13 weeks
Screening for Childhood Anxiety and Related Emotional Disorders (Birmaher et al, 1999) if a 40 - item inventory of statements that assess five types of anxiety experienced by children and adolescents, to be completed separately by parents and students. A total score, as well as cutoffs for specific domains on anxiety (e.g., social, generalized) are obtained. A total score of 25 or higher is considered to be clinically significant. Youth who obtain a score above the clinical cutoff for the total score or for 1 or more domains are eligible. This measure will be completed by parents and students before and after study treatment.
次要结局
- Emotion Dysregulation Inventory Scores: Reactivity(Baseline, 13 Weeks)
- Teacher Concern Inventory: Work Stressors(Baseline, 13 Weeks)
- Teacher Concern Inventory: Time Management Subscale(Baseline, 13 Weeks)
- Protocol adherence as measured by fidelity checklist.(13 weeks)
- Emotion Dysregulation Inventory Scores: Dysphoria(Baseline, 13 Weeks)
- Teacher Concern Inventory: Professional Distress(Baseline, 13 Weeks)
- Teacher Concern Inventory: Discipline and Motivation(Baseline, 13 Weeks)
- Teacher Concern Inventory: Professional Investment(Baseline, 13 Weeks)