Training Outpatient Clinicians to Deliver Cognitive Behavior Therapy to Children

描述(由申请人提供)：培训门诊临床医生为患有高功能自闭症谱系障碍和焦虑的儿童提供认知行为疗法：三种学习方法的比较与典型发育中儿童和其他发育障碍儿童相比，高功能自闭症谱系障碍(ASD)儿童出现精神症状，尤其是焦虑症状的风险更大。焦虑问题可能会对自闭症患者的学习成绩、同伴关系、家庭功能产生不利影响，并进一步加剧自闭症的核心缺陷，从而使自闭症患者变得特别“虚弱”。认知行为疗法(CBT)在普通儿科人群中经常被用于缓解焦虑症状，并取得了良好的效果。最近发表的研究表明，在实施改良的CBT干预措施后，ASD儿童的焦虑症状显著减少。由于这些治疗研究仅在实验室环境中进行，因此在其他临床环境中的推广可能会受到限制。为了增强新干预措施的可移植性和通用性，重要的是将干预措施引入到现实世界环境中，以便为方案的制定提供信息，增加干预措施的可接受性，从而最大限度地提高临床实践的成功。为了进一步提高可接受性，确定必要的指导方法也很重要，以便将干预交付给富达。这项提议有两个主要目标。首先，对门诊临床医生(心理学专业人员)进行培训，使其忠于针对患有高功能自闭症和临床焦虑的8-14岁儿童的原创、人性化的团体CBT(面对你的恐惧-FYF)干预。第二，通过比较三种不同的学习FYF干预的教学方法，为临床医生提供FYF干预的最佳培训模式。在第一阶段，将从一个地点招募8名临床医生，向四个顺序治疗组(四名儿童及其家人)提供FYF干预。临床医生将以三人一组的方式工作。将编写培训材料，并对临床医生的门诊队列进行培训，使其忠于FYF干预。在第二阶段，将从三个地点招募总共36名临床医生，向三个连续治疗组提供FYF干预。临床医生将被随机分为三种指导方法之一。--1)仅使用手册(手册)，2)手册加三天工作坊(工作坊)，以及3)手册加三天工作坊，外加双周指导会诊(工作坊+)。不同教学方法的有效性将通过检查a)临床医生获得干预技术的增加，以及b)ASD儿童焦虑症状的减少来评估。 公共卫生相关性：患有自闭症谱系障碍(ASD)的儿童很有可能出现共同出现的焦虑症状，这可能会严重干扰儿童参与家庭、学校和社区活动的能力。因此，认真和系统地为患有自闭症和严重精神疾病共病的儿童开发可行和有效的治疗方法，显然满足了强烈的公共卫生需求。焦虑症状的减轻可能会带来更多的主人翁意识，更少的社交孤立，以及更多参与社区活动的机会。

DESCRIPTION (provided by applicant): Training Outpatient Clinicians to Deliver Cognitive Behavior Therapy to Children with High- Functioning Autism Spectrum Disorders and Anxiety: A Comparison of Three Methods of Learning Children with high-functioning autism spectrum disorders (ASD) are at greater risk for developing psychiatric symptoms, particularly anxiety symptoms, compared to typically developing children and children with other developmental disabilities. Anxiety problems can be especially "debilitating" to individuals with ASD by adversely impacting school performance, peer relationships, family functioning, and further exacerbating the core-deficits of ASD. Cognitive behavioral treatments (CBT) are frequently used in the general pediatric population with good success to reduce anxiety symptoms. Recently published studies, have demonstrated significant reductions in anxiety symptoms for children with ASD following the delivery of modified CBT interventions. Because these treatment studies have occurred exclusively in lab settings, generalizability to other clinical settings may be limited. To enhance the portability and generalizability of novel interventions, it is important to introduce the interventions into real world settings to inform protocol development, increase acceptability of the intervention and subsequently maximize the success for clinical practice. To further enhance acceptability, it is also important to identify the instruction methods necessary for the intervention to be delivered to fidelity. There are two main goals for this proposal. First, to train outpatient clinicians (professionals in psychology) to fidelity on an original, manualized group CBT (Face Your Fears - FYF) intervention for 8-14 year old children with high-functioning ASD and clinical anxiety. Second, to develop an optimal training model for clinicians delivering the FYF intervention by comparing three different instruction methods for learning the FYF intervention. In Phase 1, eight clinicians will be recruited from one site, to deliver the FYF intervention to four sequential treatment groups (four children and their families). Clinicians will work in teams of three. Training materials will be developed, and the outpatient cohort of clinicians will be trained to fidelity on the FYF intervention. In Phase 2, 36 total clinicians will be recruited from three sites to deliver the FYF intervention to three sequential treatment groups. Clinicians will be randomized to one of three instruction methods.--1) manual only (Manual), 2) manual plus three-day workshop (Workshop), and 3) manual plus three-day workshop, plus bi-weekly supervised consultation (Workshop-Plus). The efficacy of the different instruction methods will be evaluated by examining a) the increases in the clinicians' acquisition of the intervention techniques, and b) the reductions in anxiety symptoms for children with ASD. PUBLIC HEALTH RELEVANCE: Children with autism spectrum disorders (ASD) are at high risk for developing co- occurring anxiety symptoms, which can interfere significantly with the child's ability to participate in home, school and community activities. Thus, the careful and systematic development of feasible and efficacious treatments for children with ASD and serious psychiatric co-morbidity, clearly meets a strong public health need. Anxiety symptom reduction may result in a greater sense of mastery, less social isolation and more opportunities to participate in community activities.