Facing Your Fears in Schools: Using the ADIS/ASA to characterize anxiety and intervention outcomes in students with autism or suspected autism

Judy Reaven^1*Kelly Theresa Cosgrove^1,2Ainsley Losh^1,3Sarah Nickles^1,2Connor Kerns⁴Katherine Pickard⁵Audrey Blakeley-Smith¹Lisa Hayutin^1,3Allison Meyer^1,3Caitlin Middleton^1,3Nuri Reyes^1,3Richard Boles^1,3

• ¹JFK Partners, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
• ²School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, United States
• ³Children's Hospital Colorado, Aurora, Colorado, United States
• ⁴University of British Columbia, Vancouver, British Columbia, Canada
• ⁵School of Medicine, Emory University, Atlanta, Georgia, United States

Background: Autistic youth are at higher risk of developing anxiety compared to their peers, with as many as 40% experiencing clinical anxiety. Emerging research suggests that these rates are an underestimate as distinct presentations of anxiety (e.g., fear of change, idiosyncratic fears) are often not recognized. CBT is a well-established approach for managing anxiety in autistic youth, but many have difficulty accessing these interventions. School-based CBT programs, like Facing Your Fears in Schools (FYF-S), have shown effectiveness in reducing anxiety in autistic students and may increase access to care. The Anxiety Symptom Interview Scale -IV Autism Spectrum Addendum (ADIS/ASA) is a semi-structured interview that captures both DSM-5 and distinct presentations of anxiety. This study aimed to: 1) characterize a subsample of students with autism or suspected autism and anxiety and 2) examine effectiveness of FYF-S using the ADIS/ASA. Methods: This study utilized a subsample of students (N=37; ages 7-14) from a larger Type 1 hybrid-effectiveness trial who had either autism or suspected autism. Students were randomized to either FYF-S or Usual Care (UC). Caregivers completed the ADIS/ASA at baseline and post-intervention. The ADIS/ASA was administered by clinicians rigorously trained to reliability and masked to condition. Results: Students had both DSM-5 and distinct anxiety diagnoses at Time 1. Further, students in FYF-S demonstrated significant reductions in anxiety compared to UC, as evidenced by fewer anxiety diagnoses overall and significant improvement in total anxiety. Conclusion: This is the first schoolbased study using the ADIS/ASA to characterize anxiety and measure outcomes in autistic students. Overall, results indicate that FYF-S may be a promising school-based intervention for autistic youth.