Protocol for a longitudinal study investigating the role of anxiety on academic outcomes in children on the autism spectrum

Brief Report: School Anxiety, School Attendance and School Refusal/Distress Following an Autism-Specific Parent-Mediated Intervention for Anxiety in Preschoolers

PURPOSE

Autistic children have an increased likelihood of experiencing anxiety, even in the preschool years. Studies evaluating anxiety interventions in autistic children have tended to focus upon home or community settings. This study expands upon previous work to evaluate whether a parent-mediated intervention for autistic preschool children's anxiety impacts later school anxiety and school attendance.

METHOD

Data for this study comes from a randomised controlled trial of an autism-specific program designed to reduce and/or prevent anxiety in autistic preschoolers; CLK-CUES. In addition to pre- and post-group anxiety measures, the trial included data from parents and teachers one year later, once the children started school. Teacher-reported school anxiety and parent-reported school attendance data were available for the CLK-CUES (n = 15) and control group (n = 13).

FINDINGS

Children whose parents received CLK-CUES had lower levels of separation anxiety in school and significantly lower non-attendance rates than the control group. This was predominantly due to a significant between-group difference in the number of days missed due to school refusal/distress.

INTERPRETATION

Findings indicate promise for this autism-specific anxiety program to reduce school anxiety and support school attendance in young autistic children. Further research with larger samples and an extended follow-up is warranted.

Using Q-sort method to explore autistic students' views of the impacts of their anxiety at school

LAY ABSTRACT

Many autistic students experience anxiety, but there is little research that explores how anxiety might affect autistic students in the school environment. In this study, 45 autistic students, aged 7 to 17 years, completed an online sorting activity to tell us how anxiety impacts them at school. The students were given 21 statements about possible social and academic effects of anxiety (for example, 'When I'm worried it's hard to start my schoolwork' or 'When I'm worried I talk less to my friends or other students'), and sorted them based on how much they agreed each statement was true for them. The three statements most highly rated as being impacted by anxiety were difficulties related to schoolwork. By comparing the information provided by students, six smaller groups of students were identified who sorted the statements in a similar order. These groups show that anxiety affects different autistic students in different ways, including missing school or activities, communicating less with friends and teachers and finding it harder to complete schoolwork. This online sorting activity enabled autistic students themselves to report how anxiety affects them at school. The results suggest that it is important to provide individualised support for autistic students who experience anxiety at school, to reduce the impact of their anxiety on their participation, communication and interactions, and schoolwork. Further research about the effects of anxiety on the academic outcomes of autistic students is also needed.

Prevention and Reduction of Anxiety in Autistic Preschoolers Through an Autism-Specific Parent-Mediated Intervention: A Pilot Randomised Controlled Trial Evaluating Short and Longer Term Outcomes

Anxiety is a common co-occurring condition for autistic preschoolers. Whilst there has been extensive research evaluating anxiety prevention/reduction interventions for neurotypical preschoolers, such research is limited for autistic children. Fifty-seven parents of autistic 4-5-year olds, with varying levels of anxiety, participated in a randomised controlled trial of an autism-specific, parent-mediated intervention (CLK-CUES) to prevent or reduce anxiety in autistic preschoolers. Baseline, short-term (post-intervention) and longer term (12 months follow-up) assessments included child anxiety (ASC-ASD-P and PAS-R), intolerance of uncertainty, and parent well-being. (Trial registration ACTRN12620001322921). There were no reports of harmful effects of the intervention or trial. Linear mixed models show a significant group x time interaction for ASC-ASD-P Total score and the Uncertainty subscale with medium and large effect sizes. Post-hoc analyses show a significant decline for only the intervention group in anxiety (specifically, anxiety around uncertainty) from pre-post intervention, maintained at one year follow-up. There was no change on the PAS-R or other ASC-ASD-P subscales. CLK-CUES shows promise as a way to prevent and reduce anxiety in young autistic children, specifically anxiety related to uncertainty. Trials with larger samples are warranted. Findings also highlight the importance of using measures designed for autistic children.