Increasing Access and Reach: Implementing School-Based CBT for Anxiety in Students with ASD or Suspected ASD

ABSTRACT

Youth with Autism Spectrum Disorder (ASD) are at high risk for experiencing clinical anxiety, interfering with friendships, family functioning, and school performance. Many children with ASD and anxiety have difficulty accessing appropriate mental health care and schools are often the ideal location to receive services. The implementation of evidence-based practices to manage anxiety in students with ASD in schools is just beginning. The primary purpose of the current study was to train interdisciplinary school providers to effectively deliver a 13 session evidence-based, group cognitive behavioral therapy (CBT) program adapted for schools [Facing Your Fears – School-Based program (FYF-SB)], to students with anxiety and ASD, or suspected ASD, using a quasi-experimental design. Provider CBT knowledge, feasibility, and effectiveness of FYF-SB were examined. Twenty-five interdisciplinary school providers, from nine elementary/middle urban public schools were trained to deliver FYF-SB. Twenty-nine students (aged 8–14), with clinically significant anxietyASD, or ASD characteristics, participated. Provider CBT knowledge significantly improved following FYF-SB training. Six of 9 school teams exceeded the minimum standard for acceptable treatment adherence (80%) and 8 of the 9 participating teams delivered adequate intervention dosage for student sessions, although parent attendance was more variable. School providers indicated that FYF-SB was feasible, acceptable, and appropriate for participating students. Parents and students reported significant reductions in student anxiety following program participation. Implementation and treatment outcomes are encouraging and suggest that traditionally underserved students with ASD or ASD characteristics may be able to access much needed mental health interventions in their own communities.

Acknowledgments

The authors extend a special thanks to the administrators from the participating school districts and the many school providers, students, and parents who participated in this study.

Disclosure statement

Drs. Reaven, Blakeley-Smith, and Hepburn receive royalties from Paul Brookes Publishing for the publication of the original Facing Your Fears manual.

Notes

¹ The intent of the current study was to recruit students with ASD; however, low-income and/or traditionally underserved students are often under diagnosed or misdiagnosed. If eligibility was limited to only those students with medical diagnoses of ASD or an educational identification of ASD, students who could benefit from the program may have been missed. There were no significant demographic differences between children with or without an ASD diagnosis at baseline.

² Examples of how the RE-AIM Framework informed the selection of instruments for both school providers and students are included in measurement descriptions.

Additional information

Funding

The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: This research is supported by Health Resources and Services Administration (HRSA) [PI: Reaven—1 R41 MC31075-01-00]. Judy Reaven is supported in part, by the Health Resources and Services Administration (HRSA) under the Leadership Education in Neurodevelopmental Disabilities (LEND) [Grant T73MC11044] and by the Administration on Intellectual and Developmental Disabilities (AIDD) under the University Center of Excellence in Developmental Disabilities (UCDEDD) [Grant 90DD0632] of the U.S. Department of Health and Human Services (HHS). This information or content and conclusions are those of the authors and should not be construed as the official position or policy of, nor should any endorsements be inferred by HRSA, HHS, or the U.S. Government. There are no other disclosures for the other authors.