(PS4-36) Effectiveness of Treating Specific Phobias and Separation Anxiety in Autistic Youth with Co-occurring Intellectual Disabilities via Teletherapy

Fear and anxiety are among the most common presenting problems for youth with autism spectrum disorder (White et al., 2009), with as many as 69% of autistic children experiencing clinically significant anxiety (Kerns et al., 2020). Further, approximately 35% of autistic children with a co-occurring intellectual disability (ID) display elevated anxiety symptoms (Kerns et al., 2021). Although cognitive behavior therapy (CBT) has been shown to be efficacious in treating anxiety in autistic youth, these treatments are time- and resource-intensive, often inaccessible, and have largely excluded those with ID. To date, there has been limited research on telehealth interventions for anxiety in autistic youth (e.g. Conaughton et al., 2017; Hepburn et al., 2016), and only two studies have adapted CBT to treat anxiety in autistic youth with ID (Blakeley-Smith et al., 2021; Moskowitz et al., 2017). Thus, accessible, virtually-delivered interventions are urgently needed to treat fear and anxiety in autistic youth with ID.

Using a multiple baseline design across participants, this study examined the feasibility and effectiveness of an existing multicomponent intervention package, incorporating individualized strategies from Positive Behavior Support (PBS) and CBT (Moskowitz et al., 2017), delivered in a brief, parent-mediated format via telehealth to address anxiety in autistic youth with ID. Participants included 3 autistic children with co-occurring ID (Mage = 5, IQ < 70) and a specific phobia or separation anxiety. Independent observers assessed the degree of phobic avoidance using the percent of steps completed on a Behavioral Approach Test (BAT; Muskett et al., 2020), and appearance of anxiety on a Likert-type rating scale that includes behavioral indicators of anxiety (Moskowitz et al., 2017). Data collection is complete for the first two participants and is currently in progress for the third participant.

Both participants demonstrated a substantial decrease in anxiety once the intervention was implemented. Results showed that when compared to baseline BATs (Participant 1: M = 0%, SD = 0, Participant 2: M = 0%, SD = 0), participants engaged a higher percentage of approach steps in the BAT during the intervention (Participant 1: M = 40.8%, SD = 22.7; Participant 2: M = 100%, SD = 0). Further, appearance of anxiety decreased for both participants from baseline to intervention. 

Altogether, these results offer initial support for the efficacy of a brief, parent-mediated, virtually-delivered adaptation of CBT with PBS to treat anxiety in autistic youth with ID. This is especially pertinent given the increased stress, caregiving burden, and limited access to quality care parents of autistic youth with ID often face. Thus, telehealth may present as a promising modality to help mitigate these barriers in underserved communities.