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治疗：三种学习方法的比较与正常发育的儿童和其他发育障碍的儿童相比，患有高功能自闭症谱系障碍（ASD）的儿童出现精神症状，特别是焦虑症状的风险更大。焦虑问题会对自闭症患者的学业表现、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，从而使自闭症患者尤其“虚弱”。认知行为治疗（CBT）经常用于普通儿科人群，并取得了良好的成功，以减少焦虑症状。最近发表的研究表明，经过改进的CBT干预后，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，因此推广到其他临床环境的可能性可能有限。为了提高新干预措施的可移植性和普遍性，重要的是将干预措施引入现实世界，为方案制定提供信息，提高干预措施的可接受性，并随后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，确定干预所需的指导方法也很重要，以达到保真度。这项提议有两个主要目标。首先，培训门诊医生（心理学专业人员）忠实于针对8-14岁高功能ASD和临床焦虑儿童的原始、手动组CBT（面对你的恐惧- FYF）干预。其次，通过比较学习FYF干预的三种不同教学方法，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4个顺序治疗组（4名儿童及其家庭）提供FYF干预。临床医生将以三人一组的方式工作。将编制培训材料，并对门诊队列的临床医生进行培训，使其忠实于FYF干预措施。在第二阶段，将从三个地点招募36名临床医生，向三个顺序治疗组提供FYF干预。临床医生将被随机分配到三种指导方法之一。—1)仅使用手册（manual）， 2)使用手册加三天工作坊（workshop），以及3)使用手册加三天工作坊，加上每两周一次的监督咨询（workshop - plus）。不同教学方法的效果将通过检查a)临床医生获得干预技术的增加和b) ASD儿童焦虑症状的减少来评估。

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.