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The Coping Cat program for children with anxiety and autism spectrum disorder: a pilot randomized controlled trial.1 The Coping Cat program is a cognitive-behavioral therapy intervention that helps children recognize and analyze anxious feelings and develop strategies to cope with anxiety-provoking situations. The program focuses on four related components: (1) recognizing anxious feelings and physical reactions to anxiety; (2) clarifying feelings in anxiety-provoking situations; (3) developing a coping plan (for example, modifying anxious self-talk into coping self-talk, or determining what coping actions might be effective); and (4) evaluating performance and administering self-reinforcement. Incorporating adaptive skills to prevent or reduce feelings of anxiety, the Coping Cat therapist uses a workbook to guide the child through consideration of previous behavior in situations in which the child felt anxious, as well as the development of expectations for future behavior in anxious situations. The Coping Cat workbook is used for children aged 8 to 13 years and the C.A.T. Project workbook is used for children aged 14 to 17 years. The C.A.T. Project differs from Coping Cat only in the use of developmentally appropriate pictures and examples for older ages.Cognitive behavioral therapies are considered the treatment of choice for typically developing children with anxiety disorders; among those having shown evidence of success are the Coping Cat program: children who have participated in the program not only show improvement but maintain these gains. Thus, the aim of this study was to assess whether the program could be modified to treat anxiety in children with ASD. The participants were 22 children, ages 8–14 (average age 11.26, diagnosed with ASD and at least one primary anxiety disorder (separation anxiety disorder, generalized anxiety disorder, or social phobia). Twelve children were randomized to receive the intervention and the remainder of the children was placed on a waiting list. The program consists of 16 sessions, divided into two parts: the first 8 sessions focus on skills training (learning to recognize signs of anxious arousal and learning to implement anxiety management techniques), and the second 8 weeks are devoted to desensitization via exposure to increasingly fear-provoking stimuli. The program was modified slightly to increase its accessibility to children with ASD. Children in the active treatment group showed significantly greater improvement in anxiety than the wait-listed children at the end of the program and after a follow-up period of two months. The authors concluded that program may be feasible and effective in reducing anxiety among children with high-functioning ASD.
Randomized controlled trial for early intervention for autism: a pilot study of the Autism 1-2-3 Project.2 Waiting lists for participation in early intervention programs are often long. Wong and colleagues developed a brief intervention aimed at improving communication and social interaction among children in Hong Kong newly diagnosed with ASD and waiting to be enrolled in therapeutic programs. This very brief intensive intervention, which they called the Autism 1-2-3 project, targeted largely preverbal children up to 36 months of age. The aim was to develop a simple, inexpensive program to improve communication and social interaction. The program, which involved family members, lasted 2 weeks, and was administered 5 days per week delivered in ½-hour sessions. Based on the focus of recent programs such as the social pragmatic approach, the program used favorite toys to foster eye contact, gestures, and vocalizations/words, focused on requests. The pilot was conducted using a single-blind cross-over design. Outcome measures (assessed at baseline and after the two-week intervention) included language and communication, reciprocal social interaction, a symbolic play test, and parental stress. After receiving the intervention, children showed significant improvement in communication skills and parents showed decreased stress. Children with autism improved in blinded assessments of language/ communication, reciprocal social interaction, and symbolic play. Parents perceived significant improvement in their children’s language, social interaction, and their own stress level. The program needs to be tested on larger groups of children with a range of abilities before conclusions regarding efficacy can be made.
Managing repetitive behaviours in young children with autism spectrum disorder (ads): Pilot randomised controlled trial of a new parent group intervention.3This article reports on a feasibility study of a new intervention. Forty-five families were randomized to either a new parent group intervention or wait list. The intervention’s goal was to reduce restricted and repetitive behaviors (RRB) in children under age 8 with autism spectrum disorders (ASD). Examples of common RRB include spinning, arm flapping, and pulling a coat zipper up and down continuously. The Managing Repetitive Behaviors Program (MRB) utilizes parent group learning alongside opportunities for mutual support and sharing of strategies. The group met for 8 weekly two-hour sessions. The aim of the group was to help parents understand triggers of RRB and where and how to intervene to manage these behaviors.The MRB parent-group intervention led to overall improvement in parent-child interaction and parent self-efficacy. Regarding RRB, 30% of children in the intervention group were classified as definitely ‘improved’ at 6 months, while an additional 26% made some improvement; in the wait list group, 75% had no change in behavior. In follow-up focus groups, parents expressed overwhelmingly positive opinions of the intervention program.
Computer-Assisted Face Processing Instruction Improves Emotion Recognition, Mentalizing, and Social Skills in Students with ASD.4FaceSayTM is a computer-based social skills intervention that uses games to teach eye gaze, joint attention, and facial recognition skills. For example, “Amazing Gazing’’ teaches children to attend to eye gaze and respond to joint attention. An avatar is surrounded by objects, numbers, or faces, and the child must look at the avatar’s eyes and identify which object, number, or face the avatar is attending to. In the ‘‘Band Aid Clinic,’’ children must select the appropriate face ‘‘band aid’’ to fit over an obscured portion of an avatar’s face. Band aids include pictures of facial features, such as eyes or a mouth. A recent study randomized 31 children in Southern California to either FaceSayTM or a control group (SuccessMaker program, which aims to help children develop and maintain reading skills). Children attended one session per week for 10 weeks.At the end of 10 weeks, FaceSayTM participants had greater improvements in their ability to recognize basic emotions such as happiness, sadness, neutrality, anger, disgust and fear, compared to control group. In addition, intervention group participants had fewer autism symptoms as assessed by teacher ratings.
1 McNally Keehn RH, Lincoln AJ, Brown MZ, Chavira DA. The Coping Cat program for children with anxiety and autism spectrum disorder: a pilot randomized controlled trial. Journal of autism and developmental disorders. Jan 2013;43(1):57-67.
2 Wong VC, Kwan QK. Randomized controlled trial for early intervention for autism: a pilot study of the Autism 1-2-3 Project. Journal of autism and developmental disorders. Jun 2010;40(6):677-688.
3 Grahame V, Brett D, Dixon L, et al. Managing repetitive behaviours in young children with autism spectrum disorder (ads): Pilot randomised controlled trial of a new parent group intervention. Journal of Autism and Developmental Disorders S2- Journal of Autism & Childhood Schizophrenia. October 2015, Volume 45, Issue 10, pp 3168-3182
4 Rice LM, Wall CA, Fogel A, Shic F. Computer-Assisted Face Processing Instruction Improves Emotion Recognition, Mentalizing, and Social Skills in Students with ASD. Journal of Autism and Developmental Disorders. 2015.
5 Reprinted from Research in Autism Spectrum Disorders 7(6), 631-638. (2013), with permission from Elsevier
6 Reprinted from Clinical Psychology Review, 34(1), 73-86. (2014), with permission from Elsevier