Acceptability and caregiver‐reported outcomes for young children with autism spectrum disorder whose parents attended a preventative population‐based intervention for anxiety: A pilot study
Abstract
This pilot study explored acceptability to parents and outcomes for children of a preventive intervention for anxiety problems in pre‐schoolers with autism spectrum disorder (ASD) who were an identified sub‐group within a population‐based randomised trial of the Cool Little Kids parenting group programme. The population trial included 545 temperamentally inhibited pre‐schoolers recruited across eight economically diverse areas of Melbourne, Australia. Within this sample, 26 parents reported that their child had received an ASD diagnosis. Trial measures included baseline inhibited temperament and developmental problems, post‐intervention feedback on the programme, and caregiver‐reported child mental health outcomes (anxiety diagnoses and internalising symptoms) at 1‐ and 2‐year follow‐up. Sample retention for the children with ASD over 2 years was strong (92%). At follow‐up, fewer intervention than control children with ASD had anxiety disorders after 1 year (% (n): 25 (3) vs. 77 (10), P = .028) and separation anxiety symptoms after 2 years (M (SD): 4.22 (2.68) vs. 9.38 (5.91), P = .017). Similar effects favouring the intervention group were apparent across other child emotional outcome measures but without statistical significance in this small sample. Parents of the children with ASD reported that Cool Little Kids was “quite useful” in relation to their child's anxiety but also gave feedback that they would appreciate some tailoring of programme content to the context of ASD. These pilot findings suggest Cool Little Kids may be helpful for reducing comorbid anxiety in pre‐schoolers with ASD. Further research is warranted to develop an ASD‐specific adaptation which can be trialled with a larger sample of children with confirmed ASD diagnosis. Trial registration ISRCTN30996662 http://www.isrctn.com/ISRCTN30996662. Autism Res 2018, 11: 1166–1174. © 2018 International Society for Autism Research, Wiley Periodicals, Inc. Lay Summary: Many children with autism spectrum disorder (ASD) also have anxiety. This pilot study explored acceptability to parents and outcomes for pre‐schoolers with ASD of a parenting group programme to prevent anxiety problems. Among the sample of 26 pre‐schoolers with ASD, we found reduced anxiety disorders and separation symptoms when their parents had received the intervention, as reported by caregivers in checklists and clinical interviews. Parents gave feedback that the programme was useful but suggested content be adapted to the context of ASD.
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Only four anxiety treatment studies have been conducted in children under 6 years old.
“Only four anxiety treatment studies have been conducted in children under 6 years old”
From DINOSAUR: an integrated cognitive-behavioral treatment for anxiety in young children with ASD (2021) · cites this paper as [3]
Of the four anxiety treatment studies in children under 6 years old, three utilized CBT approaches.
“of which three utilized CBT approaches [3, 8, 9, 26].”
From DINOSAUR: an integrated cognitive-behavioral treatment for anxiety in young children with ASD (2021) · cites this paper as [3]
A third study focuses on the prevention of anxiety using the Cool Little Kids CBT protocol in children with behavioral inhibition.
“A third study focuses on the prevention of anxiety using the Cool Little Kids CBT protocol in children with behavioral inhibition [3].”
From DINOSAUR: an integrated cognitive-behavioral treatment for anxiety in young children with ASD (2021) · cites this paper as [3]
All three of these treatments include adaptations that account for the developmental level of the young child.
“All three of these treatments include adaptations that account for the developmental level of the young child [3, 8, 9]”
From DINOSAUR: an integrated cognitive-behavioral treatment for anxiety in young children with ASD (2021) · cites this paper as [3]
Preliminary findings from anxiety treatment studies in children under 6 years old suggest that CBT may be effective for this age range.
“Preliminary findings from these studies suggest that CBT may be effective for this age range; however, further study is needed.”
From DINOSAUR: an integrated cognitive-behavioral treatment for anxiety in young children with ASD (2021) · cites this paper as [3]
Two years later, children in the active anxiety prevention treatment group had a significantly lower rate of separation anxiety symptoms compared to a treatment-as-usual control group.
“and, 2 years later, a significantly lower rate of separation anxiety symptoms compared to a treatment-as-usual control group [3].”
From DINOSAUR: an integrated cognitive-behavioral treatment for anxiety in young children with ASD (2021) · cites this paper as [3]
One year after treatment, children in the active anxiety prevention treatment group had significantly lower rates of anxiety disorders compared to a treatment-as-usual control group.
“One year after treatment, children in the active treatment group had significantly lower rates of anxiety disorders”
From DINOSAUR: an integrated cognitive-behavioral treatment for anxiety in young children with ASD (2021) · cites this paper as [3]
The anxiety prevention treatment was developed for young neurotypical children and delivered without modifications for ASD.
“The anxiety prevention treatment was developed for young neurotypical children and delivered without modifications for ASD [3, 35].”
From DINOSAUR: an integrated cognitive-behavioral treatment for anxiety in young children with ASD (2021) · cites this paper as [3]
One major piece of feedback from parents was that the treatment needed to be more customized to address the unique features of young children with ASD.
“One major piece of feedback from the parents was that the treatment needed to be more customized to address the unique features of young children with ASD [3].”
From DINOSAUR: an integrated cognitive-behavioral treatment for anxiety in young children with ASD (2021) · cites this paper as [3]
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“While prior studies of young autistic children have utilized the PAS-R (Bischof et al., 2018; Charman et al., 2021; Palmer et al., 2023; Thurman & Dimachkie Nunnally, 2022), its psychometric properties in this population remain unknown, particularly for those with ID. Autism-specific anxiety…”
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- Authors
- Bischof, N. L., Rapee, R. M., Hudry, K., & Bayer, J. K.
- Affiliations
- La Trobe University (AU)
- Macquarie University (AU)
- The University of Melbourne (AU)
- Corresponding author
- Bayer, Jordana K.
- Venue
- Autism Research
- Publisher
- Wiley
- Published
- 2018-05-15
- Volume
- 11
- Issue
- 8
- Pages
- 1166-1174
- ISSN
- 1939-3792 (ISSN-L)
- 1939-3806
- OpenAlex
- W2803197676
- Cited by
- 23
- References
- 24
- Citations by year
- 2026: 1 · 2025: 4 · 2024: 3 · 2023: 3 · 2022: 1 · 2021: 7 · 2020: 3 · 2019: 1
- FWCI
- 1.64
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Autism Research (publishedVersion)
- PubMed (publishedVersion)
- Minerva Access (University of Melbourne) (submittedVersion)
- Funders
- National Health and Medical Research Council (607302)
- Topics
- Life Sciences › Neuroscience › Cognitive Neuroscience › Autism Spectrum Disorder Research
- Social Sciences › Psychology › Clinical Psychology › Child and Adolescent Psychosocial and Emotional Development
- Social Sciences › Psychology › Clinical Psychology › Family and Disability Support Research
- Keywords
- autism spectrum disorder, childhood anxiety, separation anxiety, preventive interventions, preschool children, inhibited temperament, internalizing problems, treatment acceptability, parent-reported outcomes, anxiety comorbidity, child mental health, child social problems, child emotional problems, child sleep problems, child feeding problems
- MeSH terms
- Autism Spectrum Disorder, Anxiety Disorders, Australia, Child, Child, Preschool, Female, Humans, Male, Parents, Pilot Projects, Program Evaluation, Parenting, Treatment Outcome, Caregivers, Patient Satisfaction
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