Secret Agent Society: A Randomized Controlled Trial of a Transdiagnostic Youth Social Skills Group Treatment

Utility of a virtual small group cognitive behaviour program for autistic children during the pandemic: evidence from a community-based implementation study

BACKGROUND

Autistic children often experience socioemotional difficulties relating to emotion regulation and mental health problems. Supports for autistic children involve the use of adapted interventions that target emotion regulation and social skills, alongside mental health symptoms. The Secret Agent Society Small Group (SAS: SG), an adapted cognitive behavioural program, has demonstrated efficacy through lab-delivered randomized control trials. However, research is still needed on its effectiveness when delivered by publicly funded, community-based autism providers under real-world ecologically valid conditions, especially within the context of a pandemic. The COVID-19 pandemic has disrupted access to community-based supports and services for autistic children, and programs have adapted their services to online platforms. However, questions remain about the feasibility and clinical utility of evidence-based interventions and services delivered virtually in community-based settings.

METHODS

The 9-week SAS: SG program was delivered virtually by seven community-based autism service providers during 2020-2021. The program included the use of computer-based games, role-playing tasks, and home missions. Caregivers completed surveys at three timepoints: pre-, post-intervention, and after a 3-month follow-up session. Surveys assessed caregivers' perception of the program's acceptability and level of satisfaction, as well as their child's social and emotional regulation skills and related mental health challenges.

RESULTS

A total of 77 caregivers (94% gender identity females; Mean = 42.1 years, SD = 6.5 years) and their children (79% gender identity males; Mean = 9.9 years, SD = 1.3 years) completed the SAS: SG program. Caregivers agreed that the program was acceptable (95%) and were highly satisfied (90%). Caregivers reported significant reduction in their child's emotion reactivity from pre- to post-intervention (-1.78 (95% CI, -3.20 to -0.29), p = 0.01, d = 0.36), that continued to decrease after the 3-month booster session (-1.75 (95% CI, -3.34 to -0.16), p = 0.02, d = 0.33). Similarly, improvements in anxiety symptoms were observed (3.05 (95% CI, 0.72 to 5.36), p = 0.006, d = 0.39).

CONCLUSIONS

As online delivery of interventions for autistic children remains popular past the pandemic, our findings shed light on future considerations for community-based services, including therapists and agency leaders, on how best to tailor and optimally deliver virtually based programming.

TRIAL REGISTRATION

This study has been registered with ISRCTN Registry (ISRCTN98068608) on 15/09/2023. The study was retroactively registered.

Distress, waitlists and unmet needs: parents' reports of child psychological difficulties in Aotearoa New Zealand

OBJECTIVE

Demand for children's mental health services has increased in New Zealand, yet little is known of young children's experience of psychological difficulties and treatment. This study investigated psychological symptoms and treatment experiences among primary-aged children.

METHOD

An online survey of parents assessed children's anxiety, depression, attentional, emotional, conduct and peer problems, and experiences seeking psychological treatment.

RESULTS

Based on 382 parental reports, between 24.9 and 34.6% of children experienced abnormal-range symptoms. Older children had higher distress, depression, and anxiety. Boys had more conduct, hyperactivity, and peer problems. Ethnicity was not associated with the incidence of symptoms, but parents of Pākeha/European children reported greater impact than Māori parents. One-third of children had been referred for assessment; more often older children, and those with higher hyperactivity, impact, and anxiety. Parents reported difficulties accessing assessment, common barriers included waitlists (53%), cost (43%), and not knowing who to contact (36%). Following intervention, only 51% of parents reported improvements.

CONCLUSION

NZ primary-aged children are experiencing more symptoms of psychological distress than previously reported and extensive difficulties accessing treatment.

IMPLICATIONS FOR PUBLIC HEALTH

There is a need for further screening and increased access to treatment to prevent worsening mental health outcomes in children.

The Effect of the Secret Agent Society Group Program on Parent-Teacher Agreement Regarding Children's Social Emotional Functioning

Differences in social-emotional processing and functioning characterize children with Attention Deficit Hyperactivity Disorder (ADHD), Autism Spectrum Disorder (ASD), and Anxiety Disorders. These can contribute to difficulties forming friendships and secondary challenges such as academic underachievement, depression, and substance use in adolescence. To be optimally successful, interventions typically require parents and teachers to have a shared understanding of a child's social-emotional needs and use consistent support strategies across home and school environments. However, research is yet to examine the effect that clinic-based programs have on parent-teacher agreement regarding children's social-emotional functioning. To the authors' knowledge, this is the first published study to explore this. A sample of eighty-nine youth (aged 8 to 12 years) with ASD, ADHD, and/or an Anxiety Disorder participated in the Secret Agent Society Program. The Social Skills Questionnaire and Emotion Regulation and Social Skills Questionnaire were administered to parents and teachers at pre-program, post-program, and six-month follow-up. Parent-teacher agreement was assessed at each time point. Pearson Product Moment correlations and intraclass correlations indicated that parent-teacher agreement on the measures of children's social-emotional functioning improved over time. These findings suggest that clinic-based programs can contribute to key stakeholders developing a shared understanding of children's social-emotional needs. The implications of these findings and directions for future research are discussed.