Psychometric properties of the revised children’s anxiety and depression scale (RCADS) for autistic youth without co-occurring intellectual disability

Autistic youth often present with comorbid anxiety and depression yet there is a dearth of validated assessment tools. The Revised Children’s Anxiety and Depression Scale (RCADS) assesses internalizing symptoms but there is little psychometric data in autistic youth. Treatment-seeking autistic youth with anxiety or obsessive-compulsive symptoms (N = 74; age 6–14 years), and caregivers, were administered the RCADS-Parent, RCADS-Child, and assessments of internalizing, externalizing symptoms and social impairment indicative of autism. RCADS-Parent and RCADS-Child total anxiety scores demonstrated excellent internal consistency, and the six subscales demonstrated acceptable-to-good internal consistency. The RCADS-Child and Parent total anxiety scores were weakly correlated, and neither child age nor gender altered the strength of this association. Convergent validity was supported by moderate-to-strong correlations with clinician and parent-reported anxiety symptoms. Support for divergent validity was mixed. Results provide support for the RCADS-Parent and RCADS-Child as reliable, valid measures of internalizing symptoms in autistic youth

The Impact of Comorbidity on Cognitive-Behavioral Therapy Response in Youth with Anxiety and Autism Spectrum Disorder

The impact of externalizing comorbidity on treatment outcome was examined in 104 youth ages 7-16 (M = 11.09 years) with autism spectrum disorder and primary anxiety/obsessive compulsive disorder who completed modular cognitive behavioral therapy (CBT) for anxiety/OCD. Three comorbidity profiles were utilized for group comparisons: participants with oppositional defiant or conduct disorder with attention-deficit hyperactivity disorder (ODD; CD; ADHD; group EXT, n = 25); those without ODD/CD and only ADHD (group ADHD, n = 46); and those without externalizing comorbidity (NO-EXT, n = 33). Post-treatment outcomes were measured continuously (Pediatric Anxiety Rating Scale, Clinical Global Impression-Severity) and categorically (treatment response, remission). The ADHD group was four times more likely of being a treatment responder compared to NO-EXT (OR 4.05). Comorbidity group did not impact remission. After controlling for pre-treatment scores, there was a significantly greater reduction of the CGI-S for ADHD versus NO-EXT and EXT versus NO-EXT, but results did not significantly differ for the PARS. Results suggest that a modular CBT approach yields positive impact for treatment outcomes in youth with comorbid externalizing problems, particularly among those with comorbid ADHD

Characterizing the psychological distress of treatment-seeking youth and adults impacted by Hurricane Harvey

Hurricane Harvey was one of the most destructive hurricanes in U.S. history, resulting in widespread flooding and property damage in the greater Houston-metropolitan area. This study aims to characterize a group of treatment-seeking youth and adults up to 2.5 years following Hurricane Harvey. A total of 154 children, 165 adolescents, and 531 adults who presented to publicly-funded mental health services were assessed on demographics, depressive and anxiety symptomatology, and hurricane impact. Age, sex, race/ethnicity, family/social support, time since the hurricane, and hurricane impact were examined as correlates of depressive and anxiety symptoms at treatment initiation. Overall, participants presented with elevated depressive and anxiety symptoms to the clinic. Greater hurricane impact was correlated with depressive and anxiety symptoms in adults and adolescents, but not in children. In addition, poorer family/social support was linked to greater anxiety in children and higher depression scores in children and adolescents. Adolescent females had higher anxiety and depression than adolescent males. Days since Harvey and anxiety symptoms were negatively associated for adults. Clinical and research implications for psychological distress in the medium-to-long-term post-natural disaster period are discussed. •Treatment-seeking youth and adults reported elevated depressive and anxiety symptoms up to 30 months after Hurricane Harvey.•Greater diasaster impact was associated with more depressive and anxiety symptoms in adults, but not youth.•Further research is warranted to examine factors that affect individuals who do not recover in the post-acute disaster period

Primary Outcomes for Adults Receiving the Unified Protocol after Hurricane Harvey in an Integrated Healthcare Setting

The Unified Protocol for Transdiagnostic Treatment of Emotional Disorders (UP) has demonstrated efficacy for treating anxiety and depression. However, there are limited effectiveness data when conducted in real-world settings with diverse populations, including those with trauma. We evaluated treatment outcomes in a naturalistic, community setting among 279 adults who received UP following Hurricane Harvey. We examined change in overall clinical severity, depression and anxiety symptoms, functional impairment, and baseline outcome predictors (i.e., demographic characteristics, impact from Hurricane Harvey, co-occurrence of depression and anxiety symptoms). Global clinical severity, depression and anxiety symptoms, and functional impairment decreased by end-of-treatment. Participants experienced global symptom improvement to a lesser degree than demonstrated in efficacy trials. Participants who experienced greater storm impact reported larger reductions in anxiety symptoms than those less impacted by Harvey. Further studies evaluating the effectiveness of the UP post-disaster and with diverse samples are needed

Examining the Effectiveness of the Transdiagnostic Unified Protocol for Emotional Disorders Delivered to Youth Following Hurricane Harvey

BackgroundHurricane Harvey struck southeast Texas in August 2017 resulting in widespread destruction and significant emotional distress.ObjectiveWe examined the effectiveness of a transdiagnostic psychotherapeutic intervention delivered to youth with emotional disorders in a large, community health system following this hurricane.MethodsOne hundred forty-nine youth aged 5 to 17 years with a history of hurricane exposure and emotional difficulties received an average of 6.4 (SD = 3.4) psychotherapy sessions using the Unified Protocols for Transdiagnostic Treatment of Emotional Disorders in Children and Adolescents. Youth-caregiver dyads completed measures of disaster exposure and impact at baseline as well as anxiety and depression at baseline and each therapy session. Symptom severity and level of functioning were rated by the clinician. Latent growth curve modeling was used to examine symptom change over time.ResultsChildren and adolescents began treatment with moderate levels of anxiety and depressive symptoms, symptom severity, and difficulties in daily functioning. Anxiety and depressive symptoms and symptom severity declined significantly over the treatment period. Clinician ratings of functionality evidenced significant improvement over time. Older age was correlated with more depressive symptoms at baseline and superior functioning at baseline with fewer completed treatment sessions.ConclusionIn this naturalistic, community-based effectiveness study we found significant improvement on measures of anxiety, depression, symptom severity, and daily functioning. Findings suggest that a transdiagnostic intervention may be effective for addressing a range of emotional concerns in the aftermath of a natural disaster. These results can be used to inform and refine evidence-based interventions that improve the mental health and wellbeing of disaster-exposed youth

Brief, parent-led, transdiagnostic cognitive-behavioral teletherapy for youth with emotional problems related to the COVID-19 pandemic

•Implemented CBT for youth with emotional problems during the COVID-19 pandemic.•Program consisted of a six-session, parent-led, transdiagnostic telehealth protocol.•Parent-related anxiety, depression, stress, anger, family relationships, and COVID-19-related distress improved.•62% of families who completed the program were classified as responders.•Parents reported high satisfaction with the program. The COVID-19 pandemic has led to increased stress, anxiety, and depression in children. A six-session, parent-led, transdiagnostic, cognitive-behavioral teletherapy program was adapted from an established protocol to help youth aged between 5 and 13 years manage emotional problems during the pandemic. One-hundred twenty-nine parents of youth struggling with emotional problems during the COVID-19 pandemic participated in the program. Parents reported on their children's psychosocial functioning before and after treatment using validated assessments. They also reported on treatment satisfaction. Clinician-rated global improvement was assessed at each session to determine clinically significant treatment response. Significant improvements in parent proxy-reported anxiety (d = 0.56), depression (d = 0.69), stress (d = 0.61), anger (d = 0.69), family relationships (d = 0.32), and COVID-19-related distress (d = 1.08) were found, with 62% of participants who completed the program being classified as treatment responders. Parents reported high levels of satisfaction with the program. This study was limited by use of primarily parent-report assessments and a lack of a control group. Brief, parent-led, transdiagnostic cognitive-behavioral teletherapy appeared to be an effective way to help youth cope with the pandemic and may be a scalable framework in response to large-scale mental health crises