The Effectiveness of an Attention-based Intervention for School Aged Autistic Children With Anger Regulating Problems

Autism Spectrum Disorder Clinical Trial

Official title:

The Effectiveness of an Attention-based Intervention for School Aged Autistic Children With Anger Regulating Problems: a Randomized Controlled Trial

Clinical Trial Details — Status: Completed

Administrative data

• NCT number: NCT05221515
• Other study ID #: BOBpaper2021
• Status: Completed
• Phase: N/A
• Start date: January 1, 2011
• Est. completion date: October 30, 2018

Study information

• Verified date: February 2022
• Source: VU University of Amsterdam
• Contact: n/a
• Is FDA regulated: No
• Study type: Interventional

Clinical Trial Summary

Children on the autism spectrum often show aggressive behavior. Treatment can train children to be more aware of their emotions. Investigators studied the effectiveness of an attention-based intervention tailored on aggressive behavior problems and the use of anger coping strategies of school aged autistic children with anger regulation problems.

Description:

Investigators studied the effectiveness of an attention-based intervention tailored on aggressive behavior problems and the use of anger coping strategies of school aged autistic children with anger regulation problems. Using a randomized controlled trial (RCT), children were allocated to the attention-based treatment in combination with a psycho-educational parent-training (treatment group) or to the parent-training only (active control group).

Recruitment information / eligibility

• Status: Completed
• Enrollment: 51
• Est. completion date: October 30, 2018
• Est. primary completion date: October 30, 2018
• Accepts healthy volunteers: No
• Gender: All
• Age group: 8 Years to 13 Years

Eligibility

Inclusion Criteria:

• Primary diagnosis of autism spectrum disorder

• age 8 - 13

• seeking treatment for aggressive behaviour problems

Exclusion Criteria:

• psychotropic medication still being set

Related Conditions & MeSH terms

• Autism Spectrum Disorder

Intervention

Behavioral:
• Anger can go!
The intervention "Anger Can Go!" was designed to treat anger regulation problems in autistic children aged 8 to 13 years old. The intervention consists of nine sessions of 60 minutes and is divided in four phases. Phase 1: psycho-education, affect-education and measuring anger with an anger-thermometer. This is a self-report scale presented as the drawing of a thermometer, that allows the child to indicate his level of anger, as linked to specific bodily and behavioral representations on a scale from 0 to 3. Phase 2: making a functional behavior assessment (FBA) and taking a time-out at a low anger-level (between 1 and 2 on the scale 0 to 3) to prevent aggressive outbursts. Phase 3: taking a time-out at a low anger-level (between 1 and 2 on the scale 0 to 3) to prevent aggressive outbursts, shifting attention away from aversive stimuli, to cope with the stress of the anger provoking situation. Phase 4: creating solutions to cope with an anger provoking situation.
• Parent psycho-education
Three psycho-educational parent group sessions (take place before the children's sessions in intervention group). Parents meet with other parents and a therapist to learn about the nature of their Expressed Emotion (EE) and how it relates to the child's aggressive behavior.

Locations

Country	Name	City	State
Netherlands	De Bascule	Amsterdam	Noord-Holland
Netherlands	Wei43	Amsterdam

Sponsors (1)

Lead Sponsor	Collaborator
VU University of Amsterdam

Country where clinical trial is conducted

Netherlands, 

References & Publications (35)

Bos MGN, Diamantopoulou S, Stockmann L, Begeer S, Rieffe C. Emotion Control Predicts Internalizing and Externalizing Behavior Problems in Boys With and Without an Autism Spectrum Disorder. J Autism Dev Disord. 2018 Aug;48(8):2727-2739. doi: 10.1007/s10803 — View Citation

Carr, E. G., & Horner, R. H. (2007). The expanding vision of positive behavior support: Research perspectives on happiness, helpfulness, hopefulness. Journal of positive behavior interventions, 9(1), 3-14.

Chalfant AM, Rapee R, Carroll L. Treating anxiety disorders in children with high functioning autism spectrum disorders: a controlled trial. J Autism Dev Disord. 2007 Nov;37(10):1842-57. Epub 2006 Dec 15. — View Citation

Dempsey AG, Llorens A, Brewton C, Mulchandani S, Goin-Kochel RP. Emotional and behavioral adjustment in typically developing siblings of children with autism spectrum disorders. J Autism Dev Disord. 2012 Jul;42(7):1393-402. doi: 10.1007/s10803-011-1368-9. — View Citation

Fernandez-Alcántara M, García-Caro MP, Pérez-Marfil MN, Hueso-Montoro C, Laynez-Rubio C, Cruz-Quintana F. Feelings of loss and grief in parents of children diagnosed with autism spectrum disorder (ASD). Res Dev Disabil. 2016 Aug;55:312-21. doi: 10.1016/j. — View Citation

Fung LK, Mahajan R, Nozzolillo A, Bernal P, Krasner A, Jo B, Coury D, Whitaker A, Veenstra-Vanderweele J, Hardan AY. Pharmacologic Treatment of Severe Irritability and Problem Behaviors in Autism: A Systematic Review and Meta-analysis. Pediatrics. 2016 Feb;137 Suppl 2:S124-35. doi: 10.1542/peds.2015-2851K. Review. — View Citation

Goel R, Hong JS, Findling RL, Ji NY. An update on pharmacotherapy of autism spectrum disorder in children and adolescents. Int Rev Psychiatry. 2018 Feb;30(1):78-95. doi: 10.1080/09540261.2018.1458706. Epub 2018 Apr 25. Review. — View Citation

Gross, J. J. (2015). Emotion regulation: Current status and future prospects. Psychological inquiry, 26(1), 1-26.

Hartmann K, Urbano MR, Raffaele CT, Kreiser NL, Williams TV, Qualls LR, Elkins DE. Outcomes of an emotion regulation intervention group in young adults with autism spectrum disorder. Bull Menninger Clin. 2019 Summer;83(3):259-277. doi: 10.1521/bumc.2019.83.3.259. — View Citation

Hill AP, Zuckerman KE, Hagen AD, Kriz DJ, Duvall SW, van Santen J, Nigg J, Fair D, Fombonne E. Aggressive Behavior Problems in Children with Autism Spectrum Disorders: Prevalence and Correlates in a Large Clinical Sample. Res Autism Spectr Disord. 2014 Sep 1;8(9):1121-1133. — View Citation

Ibrahim K, Kalvin C, Marsh CL, Anzano A, Gorynova L, Cimino K, Sukhodolsky DG. Anger Rumination is Associated with Restricted and Repetitive Behaviors in Children with Autism Spectrum Disorder. J Autism Dev Disord. 2019 Sep;49(9):3656-3668. doi: 10.1007/s10803-019-04085-y. — View Citation

Kanne SM, Mazurek MO. Aggression in children and adolescents with ASD: prevalence and risk factors. J Autism Dev Disord. 2011 Jul;41(7):926-37. doi: 10.1007/s10803-010-1118-4. — View Citation

Linehan, M. (2014). DBT? Skills training manual. Guilford Publications.

Luiselli, J. K. (Ed.). (2014). Children and youth with autism spectrum disorder (ASD): recent advances and innovations in assessment, education, and intervention.

Mascha, K., & Boucher, J. (2006). Preliminary investigation of a qualitative method of examining siblings' experiences of living with a child with ASD. The British Journal of Development Disabilities, 52(102), 19-28.

Mazefsky CA, Kao J, Oswald DP. Preliminary evidence suggesting caution in the use of psychiatric self-report measures with adolescents with high-functioning autism spectrum disorders. Res Autism Spectr Disord. 2011 Jan;5(1):164-174. — View Citation

Mazurek, M. O., Kanne, S. M., & Wodka, E. L. (2013). Physical aggression in children and adolescents with autism spectrum disorders. Research in Autism Spectrum Disorders, 7(3), 455-465.

McStay RL, Dissanayake C, Scheeren A, Koot HM, Begeer S. Parenting stress and autism: the role of age, autism severity, quality of life and problem behaviour of children and adolescents with autism. Autism. 2014 Jul;18(5):502-10. doi: 10.1177/1362361313485163. Epub 2013 Oct 8. — View Citation

Patel S, Day TN, Jones N, Mazefsky CA. Association between anger rumination and autism symptom severity, depression symptoms, aggression, and general dysregulation in adolescents with autism spectrum disorder. Autism. 2017 Feb;21(2):181-189. doi: 10.1177/1362361316633566. Epub 2016 Jul 9. — View Citation

Reese RM, Richman DM, Belmont JM, Morse P. Functional characteristics of disruptive behavior in developmentally disabled children with and without autism. J Autism Dev Disord. 2005 Aug;35(4):419-28. — View Citation

Ridderinkhof A, de Bruin EI, Blom R, Bögels SM. Mindfulness-Based Program for Children with Autism Spectrum Disorder and Their Parents: Direct and Long-Term Improvements. Mindfulness (N Y). 2018;9(3):773-791. doi: 10.1007/s12671-017-0815-x. Epub 2017 Oct — View Citation

Samson AC, Phillips JM, Parker KJ, Shah S, Gross JJ, Hardan AY. Emotion dysregulation and the core features of autism spectrum disorder. J Autism Dev Disord. 2014 Jul;44(7):1766-72. doi: 10.1007/s10803-013-2022-5. — View Citation

Samson AC, Wells WM, Phillips JM, Hardan AY, Gross JJ. Emotion regulation in autism spectrum disorder: evidence from parent interviews and children's daily diaries. J Child Psychol Psychiatry. 2015 Aug;56(8):903-13. doi: 10.1111/jcpp.12370. Epub 2014 Dec 1. — View Citation

Segal, Z. V., Williams, J. M. G., & Teasdale, J. D. (2013). Mindfulness-based cognitive therapy for depression. Guilford Publications.

Seymour M, Wood C, Giallo R, Jellett R. Fatigue, stress and coping in mothers of children with an autism spectrum disorder. J Autism Dev Disord. 2013 Jul;43(7):1547-54. doi: 10.1007/s10803-012-1701-y. — View Citation

Shivers CM, Jackson JB, McGregor CM. Functioning Among Typically Developing Siblings of Individuals with Autism Spectrum Disorder: A Meta-Analysis. Clin Child Fam Psychol Rev. 2019 Jun;22(2):172-196. doi: 10.1007/s10567-018-0269-2. Review. — View Citation

Singh, N. N., Lancioni, G. E., Manikam, R., Winton, A. S., Singh, A. N., Singh, J., & Singh, A. D. (2011). A mindfulness-based strategy for self-management of aggressive behavior in adolescents with autism. Research in Autism Spectrum Disorders, 5(3), 115

Sofronoff K, Attwood T, Hinton S, Levin I. A randomized controlled trial of a cognitive behavioural intervention for anger management in children diagnosed with Asperger syndrome. J Autism Dev Disord. 2007 Aug;37(7):1203-14. — View Citation

Spek AA, van Ham NC, Nyklícek I. Mindfulness-based therapy in adults with an autism spectrum disorder: a randomized controlled trial. Res Dev Disabil. 2013 Jan;34(1):246-53. doi: 10.1016/j.ridd.2012.08.009. Epub 2012 Sep 8. — View Citation

Tanksale R, Sofronoff K, Sheffield J, Gilmour J. Evaluating the effects of a yoga-based program integrated with third-wave cognitive behavioral therapy components on self-regulation in children on the autism spectrum: A pilot randomized controlled trial. — View Citation

White SW, Albano AM, Johnson CR, Kasari C, Ollendick T, Klin A, Oswald D, Scahill L. Development of a cognitive-behavioral intervention program to treat anxiety and social deficits in teens with high-functioning autism. Clin Child Fam Psychol Rev. 2010 Mar;13(1):77-90. doi: 10.1007/s10567-009-0062-3. — View Citation

White SW, Ollendick T, Scahill L, Oswald D, Albano AM. Preliminary efficacy of a cognitive-behavioral treatment program for anxious youth with autism spectrum disorders. J Autism Dev Disord. 2009 Dec;39(12):1652-62. doi: 10.1007/s10803-009-0801-9. Epub 2009 Jun 30. — View Citation

Wong C, Odom SL, Hume KA, Cox AW, Fettig A, Kucharczyk S, Brock ME, Plavnick JB, Fleury VP, Schultz TR. Evidence-Based Practices for Children, Youth, and Young Adults with Autism Spectrum Disorder: A Comprehensive Review. J Autism Dev Disord. 2015 Jul;45(7):1951-66. doi: 10.1007/s10803-014-2351-z. Review. — View Citation

Wood JJ, Drahota A, Sze K, Har K, Chiu A, Langer DA. Cognitive behavioral therapy for anxiety in children with autism spectrum disorders: a randomized, controlled trial. J Child Psychol Psychiatry. 2009 Mar;50(3):224-34. doi: 10.1111/j.1469-7610.2008.01948.x. — View Citation

Zaidman-Zait A, Mirenda P, Duku E, Vaillancourt T, Smith IM, Szatmari P, Bryson S, Fombonne E, Volden J, Waddell C, Zwaigenbaum L, Georgiades S, Bennett T, Elsabaggh M, Thompson A. Impact of personal and social resources on parenting stress in mothers of — View Citation

* Note: There are 35 references in all — Click here to view all references

Outcome

Type	Measure	Description	Time frame	Safety issue
Primary	Aggressive behavior problems: Arguing, Temper tantrums, Destroying things and Physical violence	Questionnaire Social Behavior (QSB) measuring behavioral and emotion regulation problems typical for autistic children.	At week 0, before the intervention group received treatment
Primary	Aggressive behavior problems: Arguing, Temper tantrums, Destroying things and Physical violence	Questionnaire Social Behavior (QSB) measuring behavioral and emotion regulation problems typical for autistic children.	9 weeks later after treatment
Primary	Aggressive behavior problems: aggression as reported by parent	The aggression sub scale from the Child Behavior Checklist (CBCL). Minimum value: 0, maximum value: 36. A higher score means more aggression.	At week 0, before the intervention group received treatment
Primary	Aggressive behavior problems: aggression as reported by parent	The aggression sub scale from the Child Behavior Checklist (CBCL). Minimum value: 0, maximum value: 36. A higher score means more aggression.	9 weeks later after treatment
Primary	Aggressive behavior problems: aggression as reported by teacher	The aggression sub scale from the Teacher Rating Form (TRF). Minimum value: 0, maximum value: 36. A higher score means more aggression.	At week 0, before the intervention group received treatment
Primary	Aggressive behavior problems: aggression as reported by teacher	The aggression sub scale from the Teacher Rating Form (TRF). Minimum value: 0, maximum value: 36. A higher score means more aggression.	9 weeks later after treatment
Primary	Anger coping strategies	The Behavioral Anger Response Questionnaire for children (BARQ-C)	At week 0, before the intervention group received treatment
Primary	Anger coping strategies	The Behavioral Anger Response Questionnaire for children (BARQ-C)	9 weeks later after treatment
Secondary	Quality of life of the child	Pediatric Quality of life inventory (Peds ql): Physical Functioning, Emotional Functioning, Social Functioning and School Functioning.	At week 0, before the intervention group received treatment
Secondary	Quality of life of the child	Pediatric Quality of life inventory (Peds ql): Physical Functioning, Emotional Functioning, Social Functioning and School Functioning.	9 weeks later after treatment
Secondary	Social impairment due to autism symptoms	Social Responsiveness Scale (SRS). Minimum value: 0, maximum value: 195. A higher score means more impairments.	At week 0, before the intervention group received treatment
Secondary	Social impairment due to autism symptoms	Social Responsiveness Scale (SRS). Minimum value: 0, maximum value: 195. A higher score means more impairments.	9 weeks later after treatment
Secondary	Parental stress	Nijmeegse Ouderlijke Stress Index (NOSI). Minimum value: 6, maximum value: 66. A higher score means more stress	At week 0, before the intervention group received treatment
Secondary	Parental stress	Nijmeegse Ouderlijke Stress Index (NOSI). Minimum value: 6, maximum value: 66. A higher score means more stress	9 weeks later after treatment
Secondary	Parental well-being	Symptom Checklist-90 (SCL-90). Minimum value: 0, maximum value: 360. A higher score indicates a worse well-being.	At week 0, before the intervention group received treatment
Secondary	Parental well-being	Symptom Checklist-90 (SCL-90). Minimum value: 0, maximum value: 360. A higher score indicates a worse well-being.	9 weeks later after treatment