Young people with ASD are prone to anxiety; studies indicate around 50% of those with ASD meet criteria for at least one anxiety disorder (Simonoff et.al., 2008).
Graduated exposure and participant modelling are identified as evidence-based treatment for anxieties and phobias (Ollendick & King 2004). The characteristics of ASD, including difficulties with imagination, may necessitate adaptation of traditional methods to make them more accessible to young people with ASD. One such adaptation is the use of a virtual reality environment (VRE) to reproduce the anxiety-provoking situation. This removes the need to use imagination, and provides a way to gradually increase exposure to the target stimulus.
Objectives:
In this feasibility study, we are: 1. Exploring the use of VRE as a therapeutic tool for young people with ASD with situation specific anxiety. 2. Testing the feasibility and acceptability of the methodology, and investigating the most appropriate outcome measures.
Methods:
Up to 15 verbally fluent young people with ASD aged 8-14 years, who have situation specific anxiety, are being recruited. Each participant receives two home visits, followed by four 30 minute sessions in the VRE with a tailor-made scene specific to their anxiety provoking stimulus. During each session they receive coaching in relaxation techniques and coping self-statements. The VRE we are using is a state of the art technology known as the Blue Room (http://blueroomisv.com/).
During each session the child and parent rate the child’s anxiety using a visual six point scale. Baseline and end point overall anxiety is measured using the Spence Children’s Anxiety Scale (SCAS, Child & Parent version). We are piloting the use of galvanic skin response indices, allowing physiological measurement of arousal to be correlated with scales. Within 6 weeks of participation, interviews are carried out with the child and parent(s) to examine views of acceptability of the methods, and any changes regarding anxiety in real life situations.
Results:
Three children have participated to date. For two children anxiety reduced markedly following VRE sessions, and was associated with excellent functional improvements in anxiety in the real life situations. One child made less progress, but thought that he needed more sessions.
One child (with anxiety related to shopping) had a confidence rating related to this situation of 2 at baseline (on a scale of 0-6, low to high confidence). After 4 VRE sessions this had improved to 6, with corresponding parent ratings changing from 0 at baseline to 4 at end of therapy. Parent and Child SCAS scores on the panic and agoraphobia subscales also decreased by more than one standard deviation. Data for all children who have completed the pilot phase will be available by the end of May 2013.
Conclusions:
Our small pilot study indicates that children are engaged with the VRE, and that four 20-30 minute sessions are effective for some children. The Blue Room VRE shows initial promise as a therapeutic tool for young people with ASD and situation specific anxiety.