Anxiety Clinical Trial
Official title:
The Development of a Psychoeducation Tool to Manage Anxiety in People With Autism Spectrum Disorders: the Managing Anxiety iN Autism GuidE (MANAGE)
The purpose of this pilot intervention trial is to assess the efficacy of newly developed psychoeducation guides designed to manage anxiety in Autism Spectrum Disorder (ASD) by recruiting 30 participants with ASD and high levels of anxiety along with their parent/caregivers who both receive a version of the psychoeducation guide.
ASDs have a devastating impact on adaptive functionÍž current UK lifetime costs of supporting
a person with an ASD, along with the opportunity costs of lost productivity, are estimated at
£0.8-1.2 million per year (Knapp, Romeo, & Beecham, 2009). The impact of having an anxiety
disorder has also been shown to affect an individual's quality of life and functioning over
and above physical illness, major depression and socioeconomic factors (Stein et al., 2010).
Around 40% of individuals with ASD will also have anxiety symptoms, and treatment for
additional mental health problems is also costly. Early work using clinical therapies with
individuals with ASD such as modified CBT indicate that the anxious symptoms which co-occur
with ASD can be modified and improvements to the anxiety recorded although further work is
needed. Therefore, focussing on interventions for individuals with ASD and anxiety may be
very beneficial. However, not all individuals with ASD that also present with anxiety will
require face to face therapy, therefore, psychoeducation could provide an effective and
cost-effective way of improving mental health in ASD through self-help strategies. This could
lead to improved outcomes for individuals and less burden on the clinical services supporting
these families.
The intervention is focused on psychoeducation. Four psychoeducation guides will be
available: parent/caregiver, adult with ASD, adolescent with ASD, and child with ASD.
Participants and their parents/caregivers will be give guides to read in their own time over
a 4 week period. The guides will be designed to improve participant's and their
parent/caregiver's knowledge of anxiety in ASD. The guides introduce the concept of anxiety
and how it presents in individuals with ASD, different anxiety triggers, strategies that can
be used to manage anxiety, and an introduction to specific anxiety disorders. Level of
detail, language and presentation of content will vary across the guides to be appropriate
for the functioning level of the readers.
The aim of this study is to recruit 30 participants with autism spectrum disorder (ASD) and
high levels of anxiety (aged 8-25 years) and their parent/caregiver into a pilot trial of a
psychoeducation intervention. Participants will be recruited through clinical services in
South London and the Maudsley (SLaM) and Guy's and St Thomas' (GSTT) NHS trusts through the
patient consent to contact register (C4C) in SLaM and via referral from clinical care
co-ordinators in the clinics in each trust. Additional participants may be recruited from
non-clinical sources such as research recruitment lists held by autism charities or
advertisements, including local newsletters, social media sites, emails or letters.
This is a pilot efficacy trial of newly developed psychoeducation guides employing a
randomized, parallel-arm, intention to treat design with a 4 week intervention. Participant
families will be randomly allocated (1:1) to either an immediate or a delayed start group to
allow measurement of anxiety symptoms over a one month period with and without the
psychoeducation guide. This design helps to control for the effects of attention (anxiety may
show a large placebo response) while allowing all participants access to the intervention.
The aim is to improve participants' and their parent/caregivers' knowledge of the
presentation of anxiety in ASD and their confidence in using simple strategies in its
management. The primary outcome is improvement of participant and parent/caregiver
understanding of the presentation and simple management strategies for anxiety in ASD.
Secondary outcomes include improvement in anxiety symptoms and confidence in managing
anxiety, feedback on acceptability, usefulness and appropriateness of the guide.
The trial analyses will be intention-to treat. Missing data will be imputed. The primary
analysis will compare the groups randomized to immediate vs delayed treatment 4 weeks post
randomisation when the immediate start group will have had the guide for 4 weeks and the
delayed start group will have been on a "waiting list" for 4 weeks, this controls for
attention and spontaneous improvement. The investigators will then check the two groups for
comparability at pre-intervention time point (Time 1). If the two groups show similar
baselines levels and magnitude of change in knowledge and symptom severity post intervention,
they will be combined to gain a further estimate of the treatment effect. Both the
knowledge/confidence measure and measure of anxiety symptoms, will be treated as continuous
variables. Linear regression models will include baseline severity and randomisation group as
predictors. The primary focus will be on parent-carer response but if sample sizes are
sufficient, separate, parallel analyses will use data from individuals with ASD.
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