(PS5-11) A Mixed Methods Examination of Caregiver Satisfaction with Anxiety Treatment Among Youth with Autism Spectrum Disorder

Background: For Cognitive Behavioral Therapy (CBT) to best meet the specific needs of youth with co-occurring anxiety and Autism Spectrum Disorder (ASD) and continue to grow as a sustainable treatment option, it will be important for researchers to consider caregiver perspectives and feedback. To this end, we conducted a systematic inductive thematic analysis to identify what caregivers of children with co-occurring anxiety and ASD like most and least about their anxiety treatment. 

Methods: The current project used data from a multi-site randomized controlled trial (RCT) that included 148 caregivers of youth ages 7-13 (M= 9.89, SD= 1.79; 23.0% female) with a primary anxiety disorder and ASD. 77.7% of the sample identified as White, 7.4% Other, 5.4% Black or African American, 6.1% Asian, 2.0% American Indian or Alaskan Native (1.4% missing); 18.2% Hispanic/Latino. Families were randomly assigned to (1) standard CBT (Coping Cat), (2) CBT tailored for youth with ASD and co-occurring anxiety, or (3) treatment as usual. Following treatment, caregivers (89.93% mothers) completed the Consumer Satisfaction Questionnaire (CSQ), which included quantitative measures of caregiver satisfaction with treatment and open ended text responses. Researchers applied a systematic inductive thematic analysis to open-ended responses on the CSQ to identify common themes of caregiver responses to most- and least-liked treatment features. A team of five coders developed a code book, and two coders independently coded each CSQ response and resolved discrepancies recursively via consensus coding. 

Results: Satisfaction with treatment was high (M= 64.98, SD= 5.48). Among most-liked treatment features, the following themes emerged: (1) caregiver involvement in treatment [i.e., use of parent coaching; positive impact on parenting practices (42.45% of caregivers endorsed)], (2) learning coping skills and techniques (36.79%), (3) therapist factors [i.e., interpersonal qualities of therapist; rapport (25.47%), (4) personalized treatment [i.e., ability to offer treatment tailored to individual child’s needs (9.43%), and (5) symptom reduction/improvement in global functioning that resulted from treatment (8.49%). Among least liked treatment features, themes included: (1) aspects of commuting to the clinic [traffic; parking; distance (43.14%), (2) nothing [i.e., caregivers reported liking all aspects of treatment 11.76%)], (3) limited number of sessions (10.78%), (4) commitment required [i.e., time commitment; homework (8.82%), (5) burdensome questionnaire battery (7.84%), (6) scheduling difficulties (5.88%), (7) needing more focus on ASD concerns (3.92%), and (8) wanting more exposures (1.96%). Theme frequencies will be presented separately for the two active treatment conditions in the trial and by treatment responder status. 

Conclusions: Results from this study reflect the benefit of asking caregivers for their perspectives, and incorporating their feedback into anxiety treatment.