Youth with Autism Spectrum Disorders (ASD) are underserved in several aspects of health care, including mental health services (Mandell et al, 2005). Reports of psychiatric comorbidity are high and symptoms are significantly impairing (de Bruin, Ferdinand, Meester, de Nijs, & Verheij, 2007). Finding innovative ways to provide evidence-based interventions to families who live far from specialty medical centers is an important goal for translational research.
Objectives:
This is a phase-II, quasi-experimental study of the clinical viability of delivering cognitive-behavioral intervention through videoconferencing to youth with ASD and clinically significant anxiety symptoms. The purpose of the current study was to examine the 1) acceptability, 2) feasibility and 3) preliminary efficacy of an evidence-based, family-focused intervention (i.e., Facing Your Fears(FYF; Reaven et al, 2011) to psychiatrically complex youth in rural Colorado through OoVoo, a commercially available videoconferencing application.
Methods: Twenty parent/child pairs from rural Colorado met inclusion criteria for the study (e.g., confirmed diagnosis of autism and clinically significant symptoms of anxiety) and participated in 10 sessions of "Facing Your Fears" delivered through the internet in either 1-family, 2-family, or 4-family groups. Acceptability was measured through parent and youth report on a satisfaction questionnaire. Feasibilitywas assessed through a multi-method strategy, including monitoring intervention completion, session attendance, technical difficulties, and adherence to the key elements of FYF. Preliminary estimates of efficacy were obtained through youth and parent report of anxiety symptoms (SCARED; Birmaher et al, 2002), fears (Fears Survey Schedule for Children- II; Gullone & King, 1992) and parent report of family functioning (Family Impact Questionnaire, Donenberg & Baker, 1993) at pre-treatment, post-treatment and 3-month follow-up.
Results: Acceptability. Satisfaction was rated as "very high" for 95% of parents, 72% of school-aged children, and 50% of teens. Feasibility. Eighteen of 20 families completed the intervention and all 18 families completing the treatment attended 85% of sessions or more. There was a 70% chance of technical difficulties in the first 3 sessions and a 30% chance in subsequent sessions. Fidelity of telehealth delivery to the key elements of the FYF intervention was strong for the psychoeducational component, but less robust for sessions focused on graded exposure activities. Efficacy. Pre- vs. post-treatment data are available for analysis, with follow-up data to be provided. Effect sizes for youth and parent report of anxiety symptoms were .39 and .04, respectively; with greater impact noted on youth and parent report of specific fears (effect sizes of .82 and .24, respectively). Parents reported a significant improvement in the youth's impact on the family's overall functioning (Cohen's d = 1.28).
Conclusions: Telehealth delivery of the manualized mental health intervention was feasible and acceptable to families, but challenging for therapists. With modifications, telehealth platforms may improve access to potentially therapeutic, direct intervention with clinicians. More work is needed to improve delivery of some program components. Results must be interpreted with caution, due to the quasi-experimental design (no comparison group) and reliance on non-independent observers. The next step is to conduct more rigorous efficacy studies of telehealth delivery.
See more of: Treatment Trials: Behavioral Interventions
See more of: Prevalence, Risk factors & Intervention