(PS3-D79) Coaching Children with Anxiety and Autism Through Telehealth: A Case Study

Background: Autism spectrum disorder (ASD) is a prevalent neurodevelopmental disorder. Anxiety is the most common co-occurring condition in ASD and significantly impacts quality of life, social and adaptive skills, and parental stress and anxiety. Evidence-based treatments for anxiety in young children with ASD are limited. Preliminary support has emerged for CALM (Coaching Approach behavior and Leading by Modeling) for anxiety disorders in typically developing children ages 3-8 years. CALM is an adaptation of Parent-Child Interaction Therapy, and has been piloted over telehealth. CALM has yet to be assessed in children with ASD and no study has examined change in physiological indicators of anxiety or assessed caregiver factors that may affect treatment outcomes.

Objectives: The present case is drawn from an ongoing pilot study of tele-CALM for children ages 4-8 years with ASD and anxiety. The study aims to evaluate 1) the feasibility and acceptability of implementing CALM for children with ASD via telehealth, and the impact of CALM on 2) child anxiety symptoms and cardiac regulation and 3) parental accommodation, stress, and anxiety.

Method: The child described is an 8-year-old girl with ASD and anxiety (WISC-V FSIQ = 121) and her mother. Child anxiety symptoms were assessed weekly via the Parent-Rated Anxiety Scale for Youth with ASD (PRAS-ASD). Caregiver anxiety symptoms, parenting stress, and accommodation were assessed pre and post treatment via the General Anxiety Disorder-7 (GAD-7), Parenting Stress Index-Short Form (PSI-SF), and Family Accommodation Scale-Anxiety (FAS-A). Cardiac data were collected pre and post treatment during a parent-child interaction.

Results: At baseline, the PRAS-ASD was clinically elevated. Parent anxiety was in the moderate range. A fear hierarchy was constructed, where situations that the participant feared were rated on a scale of 0 (no fear) to 10 (very intense fear). Participant’s top fear was getting her head wet in the shower. Through treatment, the therapist coached the parent through a parent-led exposure protocol (DADS: Describe, Approach, Direct Command, Selective Attention). By the end of treatment (12 sessions), the participant successfully completed exposures at the top of her hierarchy. At post-treatment, the PRAS-ASD score was below average, the PSI decreased from 107 to 102, and the GAD was in the average range (Figure 1). The child’s time between heart beats (inter-beat interval) increased from 622ms pre-treatment to 699ms post-treatment (Figure 2). Data collection will be complete by Fall 2023.

Conclusions: Preliminary results suggest that tele-CALM for children with ASD is feasible and impactful. In this case study, the family reported high satisfaction with telehealth and the intervention. The child independently engaged in core adaptive skills after treatment, her anxiety levels were below clinical cut-off, and her heartrate decreased from pre to post treatment. The parent also self-reported lower anxiety symptoms and lower stress. This case study highlights the potential behavioral and physiological impacts of tele-CALM for children with ASD and anxiety for both child and caregiver.

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