1 - (SYM 128) Development and Testing of Internet-based, Parent-led Cognitive Behavioral Therapy for Anxiety Among Autistic Youth

Introduction: Anxiety disorders are highly common among autistic youth. Internet-based, parent-led cognitive behavioral therapy (iCBT) has been shown to be a low-cost, effective treatment for childhood anxiety disorders but has been rarely tested in this population. Including the perspective of autistic youth, their parents, and community clinicians in the development of therapies like iCBT has the potential to reduce harm, enhance engagement, and boost efficacy. The goal of this presentation is to describe the iterative development and testing of an iCBT program that incorporated youth, parent, and clinician feedback.

Methods: PHASE 1: iCBT materials were shared with autistic youth (n = 3), parents (n = 3) and mental health clinicians (n = 4). Focused interviews and survey feedback was gathered. PHASE 2: iCBT was pilot tested with eight families. Qualitative feedback was gathered and integrated into a subsequent revision. PHASE 3: A randomized controlled trial testing two versions of the iCBT program was tested, one that included email support (iCBT-Email) and one that also included biweekly telehealth coaching calls (iCBT-Video), with further feedback gathered posttreatment. Qualitative data were analyzed with thematic analyses using an inductive approach.

Results: PHASE 1: Parents, youth, and clinicians perceived material to be acceptable, high quality, and informative. Themes that were identified to lead to incremental improvements included those related to: Content Acceptability, Language Clarification, Enhancing Engagement, and Usability. PHASE 2: Feedback gathered after the pilot trial led to additional changes, including making adolescent content more developmentally appropriate, changing module frequency, and updating language to reflect a neurodiversity framework. PHASE 3: Response and remission rates did not differ across conditions (overall rates of 70% and 37%, respectively). Satisfaction measures did not differ across groups though several parents in the iCBT-Email condition expressed a preference for more live therapist interaction. Parents and youth expressed an interest in more cartoons covering a wider range of topics.

Conclusions: We developed an effective iCBT program for autistic youth with anxiety disorders that was iteratively improved through several stages of development. Children, parents, and therapists all contributed unique information that led to incremental modifications through deliberate, built-in stages of the project that incorporated their perspectives.