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Parent experiences of a specialist intervention service for mental health difficulties in children with autism spectrum disorder
Child and Adolescent Mental Health
Abstract
Mental health problems are increasingly being recognised as a significant health need for people with autism spectrum disorder, but few specialist services are available. This study explored parents’ experiences of a specialist autism spectrum psychological intervention service located within a broader Neurodevelopmental and Social Communication Disorders Team.
Forty-nine parents completed a telephone based survey designed to assess experiences of a specialist intervention service.
High levels of satisfaction were reported. Parents reported aspects of the service that they found most useful.
Most parents reported satisfaction with the service and suggested improvements were used to guide service development.
... 10,11 Other core symptoms involve the lack of or poor language skills and repetitive speech. 9 ASD has no cure and is lifelong; 12 thus, currently available treatments are not directed for cure but are aimed at improving the overall functioning of the child with autism. 13 ...
... Although this belief may act as a buffer for parents to cope, it is important to note that there is no cure for autism. 12 These beliefs should not be left alone as it may lead to false hopes or a continuous denial of the diagnosis, possibly leading to maladaptation to the disorder and impairment in the family's quality of life. Thus relevant health care professionals such as counselors need to ensure that parents are aware of this fact and help them overcome the psychological impact of the diagnosis while guiding them toward acceptance. ...
Background
The lifelong nature of autism in a child has deep implications on parents as they are faced with a range of challenges and emotional consequences in raising the child. The aim of this meta-synthesis was to explore the perspectives of parents in raising a child with autism in the childhood period to gain an insight of the adaptations and beliefs of parents toward autism, their family and social experiences, as well as their perceptions toward health and educational services.
Methods
A systematic search of six databases (PubMed, EMBASE, PsychInfo, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, and Database of Abstracts of Reviews of Effects [DARE]) was conducted from inception up to September 30, 2014. Full-text English articles of qualitative studies describing parents’ perceptions relating to the care of children younger than 12 years of age and diagnosed with a sole disorder of autism were included.
Results
A total of 50 eligible articles were appraised and analyzed, identifying four core themes encompassing all thoughts, emotions, and experiences commonly expressed by parents: 1) The Parent, 2) Impact on the Family, 3) Social Impact, and 4) Health and Educational Services. Findings revealed that parents who have a child with autism experienced multiple challenges in different aspects of care, impacting on parents’ stress and adaptation.
Conclusion
Health care provision should be family centered, addressing and supporting the needs of the whole family and not just the affected child, to ensure the family’s well-being and quality of life in the face of a diagnosis of autism.
... When psychological interventions are delivered by clinicians with expertise in neurodevelopmental difficulties the feedback is positive (Kingston et al., 2013), however, the challenge appears to be that access to these skills is limited. Gillberg (2010), in his discussion of ESSENCE difficulties, notes the need for children to be seen and assessed by a sufficient range of professionals with the appropriate skills and competencies, but raises concerns about how often this happens in practice. ...
Besani, C., Kavanagh, M. (2013). An evaluation of the relationship of dependency and ward
atmosphere in a Adolescent Inpatient Mental Health Service, Clinical Psychology Forum
... The importance of an assessment of neurodevelopmental difficulties to enable such interventions to be effective is clear. When psychological interventions are delivered by clinicians with expertise in neurodevelopmental difficulties the feedback is positive (Kingston et al., 2013), however, the challenge appears to be that access to these skills is limited. Gillberg (2010), in his discussion of ESSENCE difficulties, notes the need for children to be seen and assessed by a sufficient range of professionals with the appropriate skills and competencies, but raises concerns about how often this happens in practice. ...
this is a collection of papers setting out the context and best practice in delivering psychological services to children young people and their families
Childhood is the time of the greatest psychological
development in any person’s life; the things that a child
experiences during the early years of their lives will have
a major and lasting impact on them and the people
around them. As they grow up, these experiences will
affect how they bring up their own children and, in
turn, this will affect the emotional lives of their
children’s children. Before reaching adulthood, all
children and young people will experience many
episodes of psychological distress – from a bruised knee,
through the loss of a favourite toy, to falling-out with a
friend. The psychological impact of these events will
depend largely on the environment in which the child
lives, and the quality of care they receive from the
people around them. For most children the distress they
encounter will be mild and relatively short lived particularly
for those protected by good social support from
family and friends, and in environments that provide
physical and economic security. In these environments
the minor emotional upsets, although distressing, can
help a person become more resilient and help them
learn to manage bigger upsets later in life.
For some children the magnitude or frequency of
distress will be so great that it has the potential to have
a negative impact on the rest of their lives, unless they
get the right help and support. It is not just the size of
the event that matters, but also the number of negative
events a young person experiences that impacts on
their psychological wellbeing. Many children growing
up in adverse social circumstances including poverty,
domestic violence, or parental substance misuse, will
experience a number of the factors which are known to
be harmful to good psychological development, more
likely resulting in complex patterns of difficulties.
Family educational involvement and parent–teacher relationships are important for supporting student outcomes and have unique implications for families of children with autism spectrum disorder (ASD). However, little research has examined child and family characteristics among families of children with ASD as predictors of family involvement and parent–teacher relationships. The present study examined child and family variables that may affect family involvement and parent–teacher relationships for families of children with ASD. Findings suggested (a) parents of children with higher developmental risk reported less family involvement and poorer relationships with their child’s teacher and (b) family histories accessing services predicted family involvement and parent–teacher relationships. Limitations of the current study and implications for science and practice are discussed.
Five hundred and fifty four school children, 8 to 12 years of age, completed the Spanish version of the Spence Children's Anxiety Scale (SCAS), the ITA-UNAM, which measures anxiety in children, and the CES-D measuring depression. The study investigated the structural model of the SCAS found by Spence. Two models were tested using confirmatory factor analysis: one 38-item and a second 32-item model, both involving 6 related first-order factors loading in a higher-order factor. The 38-item model provided a reasonably good ft, confirming the one reported by Spence. However, the second model provided the best ft of the data. Both models coincide with the most common anxiety disorders classified by the DSM-IV-TR. Further psychometric analyses reinforced construct validity of the SCAS and showed acceptable internal consistency.
Demonstrations of high-quality services have surpassed cost control as the primary task of health care. In this study we evaluated the relationship between several traditionally accepted standards of quality of children's mental health care and client mental health outcomes. Three customary performance guidelines (therapeutic relationship, satisfaction, and parent involvement) that are believed to be indicators of quality care were tested for their ability to account for improvement of mental health outcomes among adolescent clients. In addition, we examined service utilization to determine whether it represents an intermediate outcome of the treatment process.The results showed statistically significant, yet weak and inconsistent, relationships between these commonly accepted measures of quality and client outcomes among adolescents receiving outpatient treatment. We did not find service utilization to be a mediator. Limitations of the study and implications of the results are discussed.
Parents of children with autism spectrum disorders (ASD) try many and varied interventions and therapies in the hopes of improving their children's outcomes; however, empirical evidence supporting (or opposing) the vast majority of treatments is limited or nonexistent. This study examined caregiver efficacy ratings for a wide range of biological and educational/behavioral treatments commonly used for children with ASD. A web-based questionnaire regarding the development of children with ASD was distributed nationally and internationally through more than 200 autism-support organizations; results were analyzed from 479 parents (91% mothers) who reported on their children with autism, Asperger's syndrome, or PDD-NOS (M age=8.3 years, 80.2% male). Improvement – whether small or dramatic – was rated for 50–80% of children in each of 9 drug categories, while ratings of “child became worse” were reported for 15–20.3%. Approximately half of children were said to improve while on a special diet; 51% of those on a gluten-free and/or casein-free (GF/CF) diet were reportedly improved, while no observable effects of the GF/CF diet were indicated for about one quarter of participating children. For 10 of the 16 educational/behavioral therapies, parents reported improvement for approximately 70% of children. The most common rating was “child improved somewhat” followed by “child improved dramatically.” Results are discussed relative to the meaning of “improvement” in ASD and in light of both placebo effects and cost of treatments/therapies.
There is considerable evidence that children and adolescents with autistic spectrum disorders (ASD) are at increased risk of anxiety and anxiety disorders. However, it is less clear which of the specific DSM-IV anxiety disorders occur most in this population. The present study used meta-analytic techniques to help clarify this issue. A systematic review of the literature identified 31 studies involving 2,121 young people (aged <18 years) with ASD, and where the presence of anxiety disorder was assessed using standardized questionnaires or diagnostic interviews. Across studies, 39.6% of young people with ASD had at least one comorbid DSM-IV anxiety disorder, the most frequent being specific phobia (29.8%) followed by OCD (17.4%) and social anxiety disorder (16.6%). Associations were found between the specific anxiety disorders and ASD subtype, age, IQ, and assessment method (questionnaire versus interview). Implications for the identification and treatment of anxiety in young people with ASD are discussed.
Autism spectrum disorders are now recognized to occur in up to 1% of the population and to be a major public health concern because of their early onset, lifelong persistence, and high levels of associated impairment. Little is known about the associated psychiatric disorders that may contribute to impairment. We identify the rates and type of psychiatric comorbidity associated with ASDs and explore the associations with variables identified as risk factors for child psychiatric disorders.
A subgroup of 112 ten- to 14-year old children from a population-derived cohort was assessed for other child psychiatric disorders (3 months' prevalence) through parent interview using the Child and Adolescent Psychiatric Assessment. DSM-IV diagnoses for childhood anxiety disorders, depressive disorders, oppositional defiant and conduct disorders, attention-deficit/hyperactivity disorder, tic disorders, trichotillomania, enuresis, and encopresis were identified.
Seventy percent of participants had at least one comorbid disorder and 41% had two or more. The most common diagnoses were social anxiety disorder (29.2%, 95% confidence interval [CI)] 13.2-45.1), attention-deficit/hyperactivity disorder (28.2%, 95% CI 13.3-43.0), and oppositional defiant disorder (28.1%, 95% CI 13.9-42.2). Of those with attention-deficit/hyperactivity disorder, 84% received a second comorbid diagnosis. There were few associations between putative risk factors and psychiatric disorder.
Psychiatric disorders are common and frequently multiple in children with autism spectrum disorders. They may provide targets for intervention and should be routinely evaluated in the clinical assessment of this group.
This longitudinal community study assessed the prevalence and development of psychiatric disorders from age 9 through 16 years and examined homotypic and heterotypic continuity.
A representative population sample of 1420 children aged 9 to 13 years at intake were assessed annually for DSM-IV disorders until age 16 years.
Although 3-month prevalence of any disorder averaged 13.3% (95% confidence interval [CI], 11.7%-15.0%), during the study period 36.7% of participants (31% of girls and 42% of boys) had at least 1 psychiatric disorder. Some disorders (social anxiety, panic, depression, and substance abuse) increased in prevalence, whereas others, including separation anxiety disorder and attention-deficit/hyperactivity disorder (ADHD), decreased. Lagged analyses showed that children with a history of psychiatric disorder were 3 times more likely than those with no previous disorder to have a diagnosis at any subsequent wave (odds ratio, 3.7; 95% CI, 2.9-4.9; P<.001). Risk from a previous diagnosis was high among both girls and boys, but it was significantly higher among girls. Continuity of the same disorder (homotypic) was significant for all disorders except specific phobias. Continuity from one diagnosis to another (heterotypic) was significant from depression to anxiety and anxiety to depression, from ADHD to oppositional defiant disorder, and from anxiety and conduct disorder to substance abuse. Almost all the heterotypic continuity was seen in girls.
The risk of having at least 1 psychiatric disorder by age 16 years is much higher than point estimates would suggest. Concurrent comorbidity and homotypic and heterotypic continuity are more marked in girls than in boys.
The Kiddie Schedule for Affective Disorders and Schizophrenia was modified for use in children and adolescents with autism by developing additional screening questions and coding options that reflect the presentation of psychiatric disorders in autism spectrum disorders. The modified instrument, the Autism Comorbidity Interview-Present and Lifetime Version (ACI-PL), was piloted and frequently diagnosed disorders, depression, ADHD, and OCD, were tested for reliability and validity. The ACI-PL provides reliable DSM diagnoses that are valid based on clinical psychiatric diagnosis and treatment history. The sample demonstrated a high prevalence of specific phobia, obsessive compulsive disorder, and ADHD. The rates of psychiatric disorder in autism are high and are associated with functional impairment.
Best practice for assessment of anxiety symptoms in children suggests that child self-report is an important element to consider. Yet, it is not known if it is a reliable assessment method for children with high-functioning autism spectrum disorders (ASDs). The present study examines the extent to which verbally fluent children with ASD and their parents agree on the child's symptoms of anxiety. Sixty-three children with ASD and their parents independently completed the Screen for Child Anxiety Related Emotional Disorders (SCARED). Intraclass correlations indicated moderate-to-strong agreement on several domains. Associations among child factors (e.g., verbal IQ, metacognitive ability) and parent–child agreement were explored. More advanced verbal ability was associated with better agreement on Separation, School Avoidance, and Total Anxiety; higher metacognitive skills were associated with better agreement on Social Anxiety. Implications for the use of child self-report are discussed.
The objective of this study was to report on the prevalence and correlates of anxiety and mood problems among 9- to 14- year-old children with Asperger syndrome (AS) and high-functioning autism. Children who received a diagnosis of autism (n 40) or AS (n 19) on a diagnostic interview when they were 4 to 6 years of age were administered a battery of cognitive and behavioural measures. Families were contacted roughly 6 years later (at mean age of 12 years) and assessed for evidence of psychiatric problems including mood and anxiety disorders. Compared with a sample of 1751 community children, AS and autistic children demonstrated a greater rate of anxiety and depression problems. These problems had a significant impact on their overall adaptation. There were, however, no differences in the number of anxiety and mood problems between the AS and autistic children within this high-functioning cohort. The number of psychiatric problems was not correlated with early autistic symptoms but was predicted to a small extent by early verbal/non-verbal IQ discrepancy scores. These data indicate that high-functioning PDD children are at greater risk for mood and anxiety problems than the general population but the correlates and risk factors for these comorbid problems remain unclear.
This study investigated the utility of self-report measures to screen for psychiatric comorbidities in autism spectrum disorders (ASDs). Thirty-eight 10–17 year olds with an ASD and without mental retardation completed: the Children's Depression Inventory-Short version (CDI-S), Revised Children's Manifest Anxiety Scale (RCMAS), Conners-Wells Adolescent Self-report Scale-Short edition (CASS-S), and Short Leyton Obsessional Inventory-Child Version (SLOI-CV). Their parents were interviewed with the Autism Comorbidity Interview-Present and Lifetime (ACI-PL) to establish psychiatric diagnoses. Sensitivity, specificity, positive and negative predictive values, and reliability coefficients were calculated for each self-report and compared to values from literature. The CDI-S and CASS-S yielded a high number of false negatives, with lower sensitivities and specificities in the sample than the literature. There was a nearly significant difference in total mean RCMAS scores between participants with and without anxiety, though again the means for both groups were below the threshold of concern. The SLOI-CV yielded a high false positive rate. All four instruments had reliability coefficients comparable to literature values. Results must be considered preliminary due to sample size. However, the findings suggest that although self-report instruments may provide useful information in the diagnosis of psychiatric comorbidities in ASD, caution must be exercised in their interpretation.
Background: This study was undertaken to explore parental perceptions of the role and value of a specialist service for children and families. This service offers assessment and diagnosis of children with neurodevelopmental disorders of the kind that are not evident at birth.
Method: Information was collected from 37 families on expectations and experience of clinic attendance, user satisfaction and outcome through interviews and questionnaires, once before and twice after clinic attendance.
Results: 87% of parents found clinic attendance worthwhile, with most expecting to be provided with a diagnosis and advice on education. Parents perceived that the clinic was best able to meet their diagnostic needs and they reported that they were more able to obtain a diagnosis and a specialist opinion at a regional centre than at local clinics. Parent satisfaction with the parent-child relationship improved following clinic attendance and parents’ self-identified concerns about their child decreased.
Symptoms of psychiatric disorders have been found to co-occur at high rates in those diagnosed with Autistic Disorder (AD). However, to date, no study has yet examined the developmental trajectory of comorbid psychiatric symptoms across the lifespan within the AD population. Therefore, the purpose of this study was to conduct a cross-sectional investigation of symptoms of anxiety across the lifespan, using a sample of individuals diagnosed with AD. This study utilizes a sample with an age range from infancy to adulthood. Endorsement rates of overlapping anxiety symptoms from measures that have been found reliable and valid for the specific purpose of examining psychiatric symptoms within the AD population are utilized for this study. Results indicate that there is a significant difference between different age cohorts on symptom endorsements of anxiety. Additionally, a cubic trend was found when examining the pattern of anxiety symptoms across the lifespan in those diagnosed with AD. That is, anxiety rises from toddlerhood to childhood, decreases from childhood to young adulthood, but again increases from young adulthood into older adulthood. Implications of these findings, limitations of this study, and future directions for research are discussed.
Anxiety disorders have been found to be highly comorbid with autism spectrum disorders (ASDs). Even so, the identification and dissemination of empirically supported treatments for anxiety in adults or children who have ASD has lagged behind the larger evidence-based trend. This review examines the efficacy of cognitive-behavioral therapy as a treatment for anxiety in children who have an ASD and delineates and summarizes the trends in modifying efficacious cognitive-behavioral therapies for anxiety for use with those having an ASD. Limitations and recommendations for future research toward a standardized treatment model for anxiety in children are discussed.
Children with high-functioning autism spectrum disorders (ASD) are at high risk for developing significant anxiety. Anxiety can adversely impact functioning across school, home and community environments. Cognitive behavioral therapies (CBT) are frequently used with success for children with anxiety symptoms. Modified CBT interventions for anxiety in children with ASD have also yielded promising results.
Fifty children with high-functioning ASD and anxiety were randomizedto group CBT or treatment-as-usual (TAU) for 12 weeks. Independent clinical evaluators, blind to condition, completed structured interviews (Anxiety Disorders Interview Schedule – Parent Version;ADIS-P) pre- and post-intervention condition.
Forty-seven children completed either the CBT or TAU condition. Results indicated markedly better outcomes for the CBT group. Significant differences by group were noted in Clinician Severity Ratings, diagnostic status, and clinician ratings of global improvement. In the intent-to-treat sample, 10 of 20 children (50%) in the CBT group had a clinically meaningful positive treatment response, compared to 2 of 23 children (8.7%) in the TAU group.
Initial results from this randomized, designed treatment study suggest that agroup CBT intervention specifically developed for children with ASD may be effective in decreasing anxiety. Limitations of this study include small sample size, lack of an attention control group, and use of outcome measures normed with typically developing children
Accessible summary
This review paper contributes to better understanding of child and adolescent perception of quality of psychiatric care and should therefore be of interests for those who are concerned with the development and improvement of psychiatric care.
The review shows that the concept of patient satisfaction in child and adolescent psychiatric care is still underdeveloped and that few valid instruments have been developed to measure the concept.
The review helps to clarify the concept of adolescent satisfaction with psychiatric care by indentifying the universal components of the concept.
The paper concludes that children's perception of quality of care differs from their parents' and that quality assessment of children and adolescents needs to be heeded.
Abstract
Users' perspectives ought to be a determining factor for assessing the quality of psychiatric care and hence their perspectives need to be thoroughly understood. There is a lack of comprehensive knowledge of how children and adolescents perceive the quality of their psychiatric care. Therefore, the purpose of this paper is to critically review and synthesize findings from research on youth experience and satisfaction with psychiatric care. The review finds that knowledge about youth perception of quality of care is scattered and that few researchers consider previous findings. There are few valid instruments to measure child and adolescent patient satisfaction and few studies have considered these users' perceptions. These few studies indicate that adolescents' satisfaction has three universal components: satisfaction with environment and the organization of services; with user–caregiver relationship; and with treatment outcome. However, instruments that only use these factors lack sensitivity, while instruments that measure specific components of services capture differences in satisfaction between user groups. The review shows that parents and children have different mental care needs, and that the assessments by children and adolescents of their psychiatric care should be heeded.
Anxiety and poor stress management are common concerns in clinical samples of children with autism spectrum disorders (ASD). Anxiety may worsen during adolescence, as young people face an increasingly complex social milieu and often become more aware of their differences and interpersonal difficulties. This review summarizes the state of research on the prevalence, phenomenology, and treatment of anxiety in youth with autism and related conditions such as Asperger's Disorder. Using search words autism, asperger(s), or pervasive developmental disorder and anxiety or anxious to find reports published between 1990 and 2008, this review identified 40 papers. The results of the review suggest that anxiety, whether measured categorically or dimensionally, is indeed common in children and adolescents with autism spectrum disorders and may be a source of additional morbidity. The assessment of anxiety disorders in ASD should be conducted using multiple informants and modalities, as children with ASD often do not display age-typical symptoms of anxiety. To date, relatively few controlled intervention studies using well-characterized samples have been conducted despite preliminary evidence for efficacy of select pharmacological and psychosocial approaches. Recommendations for future applied research are presented and clinical implications are explored.
To evaluate the reliability and validity of a semistructured measure of obsessive-compulsive symptom severity in children and adolescents with obsessive-compulsive disorder (OCD).
Sixty-five children with OCD (25 girls and 40 boys, aged 8 to 17 years) were assessed with the Children's Yale-Brown Obsessive Compulsive Scale (CY-BOCS). Interrater agreement was assessed by four raters in a subsample (n = 24). Discriminant and convergent validity were assessed by comparing CY-BOCS scores to self-ratings of depression, anxiety, and obsessive-compulsive symptoms.
Internal consistency was high, measuring .87 for the 10 items. The intraclass correlations for the CY-BOCS Total, Obsession, and Compulsion scores were .84, .91, and .68, suggesting good to excellent interrater agreement for subscale and total scores. The CY-BOCS Total score showed a significantly higher correlation with a self-report of obsessive-compulsive symptoms (r = .62 for the Leyton survey) compared with the Children's Depression Inventory (r = .34) and the Children's Manifest Anxiety Scale (r = .37) (p = .02 and .05, respectively).
The CY-BOCS yields reliable and valid subscale and total scores for obsessive-compulsive symptom severity in children and adolescents with OCD. Reliability and validity appear to be influenced by age of the child and the hazards associated with integrating data from parental and patient sources.
The Spence Children's Anxiety Scale (SCAS) is a child self-report measure designed to evaluate symptoms relating to separation anxiety, social phobia, obsessive-compulsive disorder, panic-agoraphobia, generalized anxiety and fears of physical injury. The results of confirmatory and exploratory factor analyses supported six factors consistent with the hypothesized diagnostic categories. There was support also for a model in which the 1st-order factors loaded significantly on a single 2nd-order factor of anxiety in general. The internal consistency of the total score and subscales was high and 6 month test-retest reliability was acceptable. The SCAS correlated strongly with a frequently used child self-report measure of anxiety. Comparisons between clinically anxious and control children showed significant differences in total SCAS scores, with subscale scores reflecting the type of presenting anxiety disorder of the clinical samples.
The aim of the study was to evaluate the effectiveness of a brief CBT intervention for anxiety with children diagnosed with Asperger syndrome (AS). A second interest was to evaluate whether more intensive parent involvement would increase the child's ability to manage anxiety outside of the clinic setting.
Seventy-one children aged ten to twelve years were recruited to participate in the anxiety programme. All children were diagnosed with AS and the presence of anxiety symptoms was accepted on parent report via brief interview. Children were randomly assigned to one of three conditions: intervention for child only, intervention for child and parent, wait-list control.
The two intervention groups demonstrated significant decreases in parent-reported anxiety symptoms at follow-up and a significant increase in the child's ability to generate positive strategies in an anxiety-provoking situation. There were a number of significant differences between the two interventions to suggest parent involvement as beneficial.
The sample of children with AS in this study presented with a profile of anxiety similar to a sample of clinically diagnosed anxious children. The intervention was endorsed by parents as a useful programme for children diagnosed with Asperger syndrome and exhibiting anxiety symptoms, and active parent involvement enhanced the usefulness of the programme. Limitations of the study and future research are discussed.
Consumer satisfaction with health care is one of the goals of health care delivery. Information on what affects satisfaction helps health care providers to deliver patient-centred care. The aim of this study was to explore the relationship between young persons' symptoms and satisfaction with Child and Adolescent Mental Health Services (CAMHS). It also examined differences in satisfaction of the parent/carer and their child. Self-report questionnaires were used to gather information from respondents. High levels of satisfaction were reported, although children and adolescents were less satisfied than parents/carers. Young people with self-reported conduct problems were least satisfied with CAMHS, as were those who rated their problems as having a significant impact on their lives. There was no relationship between carer-reported 'caseness' and carer satisfaction with services. Further exploration of the needs and expectations of young people who have behavioural difficulties is necessary so that their needs are better understood and expectations met.
The purpose of the study described was to evaluate the effectiveness of a cognitive behavioural intervention for anger management with children diagnosed with Asperger syndrome. Forty-five children and their parents were randomly assigned to either intervention or wait-list control conditions. Children in the intervention participated in six 2-h weekly sessions while parents participated in a larger parent group. Parent reports indicated a significant decrease in episodes of anger following intervention and a significant increase in their own confidence in managing anger in their child. Qualitative information gathered from parents and teachers indicated some generalization of strategies learned in the clinic setting to both home and school settings. Limitations of the study and suggestions for future research are also discussed.
A family-based, cognitive behavioural treatment for anxiety in 47 children with comorbid anxiety disorders and High Functioning Autism Spectrum Disorder (HFA) was evaluated. Treatment involved 12 weekly group sessions and was compared with a waiting list condition. Changes between pre- and post-treatment were examined using clinical interviews as well as child-, parent- and teacher-report measures. Following treatment, 71.4% of the treated participants no longer fulfilled diagnostic criteria for an anxiety disorder. Comparisons between the two conditions indicated significant reductions in anxiety symptoms as measured by self-report, parent report and teacher report. Discussion focuses on the implications for the use of cognitive behaviour therapy with HFA children, for theory of mind research and for further research on the treatment components.
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