Expert Provider Use of Empirically-Evaluated Treatment Elements for Anxiety in Youth with ASD

Background:  The research-to-practice gap is a well-established phenomenon and extends to treatments for youth with autism spectrum disorders (ASD; e.g., Brookman-Frazee, et al., 2010). ASD, relative to typically-developing youth, are at increased risk for anxiety (van Steensel et al., 2011). There has been a growing interest in the study of efficacious anxiety treatments for individuals with ASD (Danial & Wood, 2013); however, dissemination of these treatments has been limited (Reaven et al., 2014). In order to identify the size and scope of the research-to-practice gap for the treatment of anxiety in ASD, use of empirically-evaluated treatment elements by expert community providers must be examined.

Objectives:  The primary purpose of this study was to examine the extent to which expert, community providers are using the most and least empirically-examined treatment elements to treat anxiety in ASD youth.

Methods:  We conducted a comprehensive literature search, and reliably coded articles (N= 48) for anxiety (excluding OCD) treatment elements (ICC(2,5)=.792). Fifty elements were identified from included articles. For analytical purposes, elements were then sorted into 8 categories ranging from the least (group 8) to most (group 1) frequently used treatment elements (see Figure 1). Groups were divided to provide closest match possible to the frequency distribution in the literature while balancing statistical power. Next, 53 expert providers (primarily treating ASD youth for ≥5 years, and ≥50 ASD youth over the last 5 years) participated in a national, multi-site survey, rating these 50 treatment elements in terms of their frequency of use to target anxiety

Results:  A one-way ANOVA revealed significant differences in provider ratings of frequency of use of element groups, F (1,7) = 3.42,  p = .006. Pairwise comparisons between element groups revealed that providers reported using elements in group 1 more often than those in groups 6, 7, and 8 (p’s ≤ .005). Next, a repeated-measures ANOVA was conducted to identify differences among strategies within the top and bottom groups. Within group 1, graduated exposure and visual supports were used significantly more by providers than self-management and didactic teaching (p’s < .05; see Figure 2A); while within group 8, providers used peer-monitoring significantly less than all other strategies (p’s < .05; see Figure 2B).

Conclusions:  Expert providers in usual care settings are largely using empirically-examined treatment elements to treat anxiety in youth with ASD. Thus, their expertise may be important for identifying clinical variables relevant to treatment elements that have not yet received empirical examination. Toward this end, a “two-way bridge” initiative (Goldfried et al., 2014), which promotes dissemination of clinical experiences to researchers and vice versa, rather than solely relying on the researchers, may be useful for narrowing the research-to-practice gap. In this context, observational studies of treatment elements in usual care settings would augment provider-reported element use. Moreover, whether these frequently used elements are efficacious remains to be seen. Thus, future “two-way” bridge initiatives could focus on evaluating outcomes associated with implementation of these treatment elements in usual care settings, which would pave the way for targeted dissemination efforts.