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Community therapists can help children with autism

Findings from a study published in JAMA Psychiatry support the effectiveness of training community therapists in publicly funded mental health services to deliver an evidence-based mental health intervention for children with autism spectrum disorder.

“Publicly funded [mental health] services play an important role in caring for school-age children with ASD because approximately 70% of these children meet criteria for at least one non-ASD cooccurring psychiatric disorder,” Lauren Brookman-Frazee, PhD, from the department of psychiatry, University of California, San Diego, and colleagues wrote. “There are significant concerns about the lack of [mental health] therapist training to work with the ASD population and broader concerns about the overall quality of services for children with ASD.”

The Individualized Mental Health Intervention for ASD (AIM HI) is a clinical intervention and corresponding therapist training protocol of parent-mediated and child-focused strategies delivered in publicly funded mental health services to address challenging behaviors in children with autism. The 6-month training and consultation process includes an introductory workshop, more than 10 structured consultation meetings where the therapist delivers the intervention with a client, and feedback from trainers.

Researchers examined whether training community therapists to deliver this intervention eased challenging behaviors among 202 children with ASD aged 5 to 13 years across 18 months in this cluster randomized trial conducted at 29 publicly-funded outpatient and school-based mental health programs.

Programs were randomized to immediate (wave 1) AIM HI training or to a usual care condition/delayed (wave 2) AIM HI training condition. The investigators used the Eyberg Child Behavior Inventory (ECBI) and Social Skills Improvement System (SSIS) Competing Problem Behaviors scales based on parent report to examine change in challenging behaviors at baseline and at 6-month intervals for 18 months.

Analysis yielded statistically significant group by time interactions for the ECBI Intensity (B = –0.38; P = .02) and ECBI Problem (B = –1; P = .005) scales. There were larger decreases in ECBI Intensity scores in the AIM HI group (B = –1.36; P < .001) vs. those who received the usual care (B = –0.98; P < .001). The AIM HI group also had a larger decrease in ECBI Problem scores (B = –1.22; P < .001) compared with those in the usual care group (B = –0.2; P = .29).

There were no significant differences between groups on the SSIS scales.

In addition, effect sizes showed small to medium differences between groups. Child characteristics yielded no moderating effects; however, therapist fidelity mediated intervention effects, according to the study.

“The present study results support the effectiveness of a model designed to fit the needs and structure of community services when delivered by therapists who do not specialize in ASD,” the researchers found. “The study findings highlight the importance of developing and testing implementation strategies aimed to facilitate high therapist fidelity in delivering evidence-based interventions.” – by Savannah Demko

Disclosure: The authors report no relevant financial disclosures.