“Cool for School”: Can a parent-group help to reduce anxiety in children with autism?

The intervention is an adaptation of Cool Little Kids (CLK); a six-session, parent-led program that has demonstrated excellent outcomes in the reduction of anxiety among preschool-aged children. The core treatment strategy in this program is in vivo exposure, which primarily works via extinction to shift expectations of threat. To better tailor this intervention to children on the autism spectrum, the pre-existing CLK program has been modified to also include processes to help reduce "Intolerance of Uncertainty" which is a construct shown to have a key role in the expression of anxiety among children with autism. The modified CLK program also incorporates examples which describe children on the spectrum to make it more relevant to parents of children on the spectrum. This modified CLK program is a six-session intervention, delivered face-to-face by a trained member of the research team. The program includes a clinician manual and parent workbook. These documents clearly map out the intervention sessions, providing information on the topics to be discussed and the associated activities. Parents are required to attend all sessions; if they are unable to make a session (due to parent or child illness) they are invited to attend a different session that week, or if they are still unwell all week, are offered a make-up session prior to the next session. Both parents are encouraged to attend if possible. Adherence to the intervention is monitored through checking of attendance and of homework completion. The content of the sessions, each of which lasts 1.75-2 hours with a maximum of 8 parents per session, is as follows: - Week 1: Welcome to the program; presentation of anxiety in children and how this may differ for children with autism; the different forms of anxiety; discussion of how anxiety presents in the children of the participants; consideration of the factors which contribute to their children’s anxiety; goal setting (what each parent would like their child to be able to do) - Week 2: How parents can/do deal with anxiety in their children; strategies for reducing anxiety and building bravery - Week 3: Further strategies for reducing anxiety and how these can be tailored to specific children’s anxiety - Week 4: Discussion of parents’ experiences of implementing strategies to reduce anxiety; troubleshooting any difficulties they may experience; consideration of the role intolerance of uncertainty plays in maintaining anxiety; - Week 5: Strategies to increase children’s ability to cope with uncertainty; how to think about parents’ own concerns regarding their child’s anxiety - Week 6: Considering their child’s progress over the previous 5-weeks; identification of areas that may need further work During the sessions, parents are encouraged (but not required) to share and reflect on their own experiences of their child’s anxiety and share their homework achievements. Parents will be asked to identify the anxious behaviours or their child, consider how the strategies discussed during the sessions could minimise these behaviours, and practice these techniques at home. They are encouraged to practice the strategies as much as possible, as opportunities arise. We are piloting this modified program with 4 parents who have provided positive feedback during the sessions. This study aims to further this pilot research by running a larger scale trial of the modified intervention with 64 parents of children with autism: 32 will be allocated to the invention group (thus will complete all four stages of the study; initial assessment, intervention program, short-term follow-up and one-year follow-up) and 32 will be in the control group (therefore only completing the initial, short-term follow-up and one-year follow-up assessments). This method allows for the comparison of anxiety levels between those children whose parents completed the program, and those who did not, thus providing data regarding the efficacy of the program.