Preliminary Effectiveness of the Autism Life Care Model (ALCM) in Improving Comorbid Internalizing and Externalizing Symptoms in Adolescents with ASD

Background:  Successful transitions for individuals with ASD to adulthood are critically dependent upon the collaboration across care networks, as well as the inclusion of the individual in decision making. This has been difficult to accomplish for adolescents with ASD who have been poorly served through isolated treatment silos leading to inefficient use of resources and confusion about treatment needs. A PA Statewide Needs Assessment found that close to half of all caregivers of adolescents reported an unmet need for transition services, as well as related unwanted outcomes (e.g., inpatient hospitalization) as they age. The existing system promotes disjointed and narrowly focused care which leads to poor outcomes for adults with ASD. Frustration about this lack of synchrony and patient-centeredness led to the development of the Autism Life Care Model (ALCM) which targets transition-aged youth with ASD. This model provides a consistent, frequent assessment of strengths and needs, patient-centeredness in the establishment and monitoring of treatment goals, as well as collaboration and reinforcement of interventions across disciplines and environments. 

Objectives:  This study sought to examine the effectiveness of the ALCM pilot program at six months following enrollment in the program. Given the short duration of follow-up, it was expected that individuals enrolled in the program would demonstrate improvements in co-morbid internalizing and externalizing symptoms as a result of increase coordination of care related to treatment goals.

Methods:  Twenty-one families participated in the ALCM pilot along with one ALCM Coordinator. Sessions were conducted in an outpatient psychiatry clinic specializing in treating individuals with ASD. Out of the 21 clients (M = 15.90; SD = 2.90) enrolled in ALCM,  eight individuals and their parents completed the Child Behavior Checklist (CBCL), the Youth Self Report (YSR), and the Intolerance of Uncertainty Scale(IUS)/Intolerance of Uncertainty Scale for Children (IUSC) at an initial intake session, as well as at a six month follow-up session.     

Results:  Repeated-measures ANOVAs were completed to assess for significant changes in variables of interest. At the time of the follow-up, caregivers reported on average that their child’s number of somatic complaints significantly decreased while their child’s ODD problems and intolerance of uncertainty showed a trend toward significantly decreasing. At a six month follow-up session, the individuals with ASD reported a significant decrease in anxious/depressed symptoms, aggressive behavior, somatic problems, antisocial/conduct problems, internalizing problems, and externalizing problems. Additionally, the total amount of reported problems showed a trend toward significantly decreasing. The group means for the majority of these scales fell from the borderline clinically significant range to the normal range of symptomatology on the CBCL and YSR.

Conclusions:  Results from the pilot of the ALCM program supported the hypotheses that following engagement in the program, individuals demonstrated decreased self- and caregiver-reported symptoms of comorbid internalizing and externalizing symptoms. Although further research needs to be done to rule-out alternative explanations for these results, the recorded improvements in behavior are promising in regards to the effectiveness of improved coordination of treatment efforts across individual’s care networks.