Effectiveness of a Computer-Assisted Cognitive-Behavioral Therapy Program in Treating Youth with Anxiety and Co-Occurring Autism Spectrum Disorder: Camp Cope-a-Lot

Background: It has been reported that nearly 40% of children and adolescents with a diagnosis of ASD meet clinical criteria for at least one co-morbid anxiety disorder (van Steensel, Bögels, & Perrin, 2011) and those with high functioning autism (HFA) experience more anxiety than those with low functioning ASD and accompanying intellectual impairment (White, Oswald, Ollendick, & Scahill, 2009). Cognitive behavioral therapy (CBT) is most often used for treating anxiety ASD youth. Across the limited amount of studies, positive outcomes have been reported, providing preliminary evidence for CBT as an effective treatment modality for anxiety in individuals with HFA or AS (Lang, Regester, Lauderdale, Ashbaugh, & Haring, 2010; McNally Keehn, Lincoln, Brown, & Chavira, 2013; Sofronoff, Attwood, & Hinton, 2005; Wood et al., 2009). In 2008 Kendell and Khanna introduced Camp Cope-A-Lot: The Coping Cat CD Rom (Kendall & Khanna, 2008a), which is a computer-assisted CBT intervention for anxiety in youth based off of the Coping Cat program framework. No studies to date have evaluated the effectiveness of this treatment package for reducing anxious symptoms in children with ASD.

Objectives: The aims of this study was to examine the effectiveness of an empirically supported, computer-assisted CBT intervention for reducing anxiety symptoms in youth with ASD.

Methods: Participants included twenty-seven 8 – 15 year-old children with a diagnosis of ASD and clinically significant anxiety symptoms consistent with Separation Anxiety Disorder, Generalized Anxiety Disorder, Specific Phobia, or Social Phobia. Anxiety disorder classifications were confirmed using the Anxiety Disorders Interview Schedule – Parent Version (ADIS-P). All participants scored ≥ 70 on measures of intellectual and language abilities. Participants were randomly assigned to either 12 sessions of computer-assisted CBT, CCAL (n=15) or a 12-session computer assisted program aimed to improve social skills rather than improve anxious symptoms, The Social Express (TSE) (n=12). Kendell and Khanna’s (2008a) twelve-session CCAL CD Rom for anxious children was employed as the primary intervention. Anxiety outcome measures included ADIS-P Parent Severity Ratings (PSR) as well as parent and child ratings on the Multidimensional Anxiety Scale for Children (MASC) and Spence Children’s Anxiety Scale (SCAS). Social skills outcome measures were used and the primary outcome measure included the Social Skills Improvement System Parent Form (SSIS-P) total scores as well as total scores on the Social Responsiveness Scale (SRS) and self-report Friendship Quality Scale (FQS) total scores.

Results: Preliminary findings suggest that some children who completed a 12-session CBT computer assisted program evidenced clinically significant reductions in anxiety symptoms as measured by the primary and secondary outcome measures. Comparative outcomes for participants in the CCAL and TSE interventions groups will be presented.

Conclusions: Preliminary evidence suggests that the Camp Cope-A-Lot CD Rom for anxious children may be an effective treatment for reducing anxiety symptoms in children with ASD and co-occurring anxiety. Furthermore, preliminary evidence suggests that the alternate computer assisted intervention; The Social Express may be an effective program in improving social skills acquisition as evidenced by social skills outcome measures.