The Effectiveness of a Computer-Assisted, Cognitive-Behavior Program for Treating Anxiety Symptoms in Children with Autism Spectrum Disorder" (2015)
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Philadelphia College of Osteopathic Medicine DigitalCommons@PCOM PCOM Psychology Dissertations Student Dissertations, Theses and Papers 2015 The ffecE tiveness of a Computer-Assisted, Cognitive-Behavior Program for Treating Anxiety Symptoms in Children with Autism Spectrum Disorder Jennifer A. Zabel Philadelphia College of Osteopathic Medicine, [email protected] Follow this and additional works at: http://digitalcommons.pcom.edu/psychology_dissertations Part of the Applied Behavior Analysis Commons, Behavior and Behavior Mechanisms Commons, Child Psychology Commons, Cognitive Behavioral Therapy Commons, Mental Disorders Commons, Nervous System Diseases Commons, Psychiatric and Mental Health Commons, Psychological Phenomena and Processes Commons, Quantitative Psychology Commons, and the School Psychology Commons Recommended Citation Zabel, Jennifer A., "The Effectiveness of a Computer-Assisted, Cognitive-Behavior Program for Treating Anxiety Symptoms in Children with Autism Spectrum Disorder" (2015). PCOM Psychology Dissertations. Paper 334. This Dissertation is brought to you for free and open access by the Student Dissertations, Theses and Papers at DigitalCommons@PCOM. It has been accepted for inclusion in PCOM Psychology Dissertations by an authorized administrator of DigitalCommons@PCOM. For more information, please contact [email protected]. Running head: COMPUTER-ASSISTED CBT FOR ASD AND ANXIETY Philadelphia College of Osteopathic Medicine Department of Psychology THE EFFECTIVENESS OF A COMPUTER-ASSISTED, COGNITIVE-BEHAVIOR PROGRAM FOR TREATING ANXIETY SYMPTOMS IN CHILDREN WITH AUTISM SPECTRUM DISORDER By Jennifer A. Zabel Submitted in Partial Fulfillment of the Requirements for the Degree of Doctor of Psychology May 2015 PHILADELPHIA COLLEGE OF OSTEOPATIDC MEDICINE DEPARTMENT OF PSYCHOLOGY Dissertation Approval This is to certify that the thesis presented to us by Jennifer A. Zabel on the 8th day ofApril, 2015, in partial fulfillment of the requirements for the degree of Doctor of Psychology, has been examined and is acceptable in both scholarship and literary quality. Committee Members' Signatures: Diane Smallwood, PsyD, NCSP, Chairperson Jessica Glass Kendorski, PhD, NCSP, BCBA-D William Young, PhD, NCSP, ABSNP Robert A DiTomasso, PhD, ABPP, Chair, Department of Psychology Acknowledgements I would like to express my deepest gratitude and appreciation to my wonderful husband, Luke. Thank you for all of your patience and encouragement throughout my doctoral education at PCOM and while researching and writing this dissertation. Your friendship and endless support has helped me to accomplish many goals that would seem impossible without you. iv Abstract Autism Spectrum Disorder (ASD) is a complex and multifaceted, neurodevelopmental disorder that severely impacts children and families across a variety of settings. Prevalence rates of ASD are continuing to increase rapidly, with sizeable intervention and treatment costs placed on families and society. Further complicating the matter, many individuals with ASD also evidence co-occurring anxiety symptoms or disorders and tend to be at a higher risk for developing such problems when compared to other clinical populations or typically developing children. This study investigated the effectiveness of a computer-assisted CBT program, Camp Cope-A-Lot (CCAL), in regards to reducing anxiety symptoms in four participants diagnosed with ASD. Data from quantitative measures revealed inconsistent results, yet informal, qualitative feedback from parents as well as information from the researcher’s observations and progress notes appeared more promising for use of the CCAL intervention for this population of children. Keywords: autism, anxiety, cognitive behavior therapy v Table of Contents Acknowledgements ........................................................................................................ iii Abstract .......................................................................................................................... iv List of Figures .............................................................................................................. viii List of Tables .................................................................................................................. x Chapter 1: Introduction ................................................................................................... 1 Statement of the Problem ............................................................................................ 2 Chapter 2: Review of the Literature ................................................................................ 5 Theoretical Foundations for Understanding Autism Spectrum Disorder & Increased Vulnerability for Developing Anxiety Disorders ....................................................... 8 The Anxious Brain .................................................................................................... 11 Cognitive-Behavioral Therapy (CBT) as an Effective Treatment ............................ 15 Computer-Based and Computer-Assisted CBT Treatments ..................................... 19 Using Technology with Children with Autism Spectrum Disorder.......................... 22 Purpose of the Study ................................................................................................. 23 Chapter 3: Method ........................................................................................................ 25 Participants ................................................................................................................ 25 Recruitment ............................................................................................................... 30 Measures and Materials ............................................................................................ 31 Research Design........................................................................................................ 44 Procedure .................................................................................................................. 45 Chapter 4: Results ......................................................................................................... 49 Overview ................................................................................................................... 49 vi Sally’s SCAS: Parent Version Results ...................................................................... 50 Sam’s SCAS: Parent Version Results ....................................................................... 52 John’s SCAS: Parent Version Results ...................................................................... 54 Matthew’s SCAS: Parent Version Results ................................................................ 57 Sally’s SCAS: Child Version Results ....................................................................... 60 Sam’s SCAS: Child Version Results ........................................................................ 63 John’s SCAS: Child Version Results ........................................................................ 65 Sally’s SSS Results ................................................................................................... 68 Sam’s SSS Results .................................................................................................... 70 John’s SSS Results .................................................................................................... 72 Matthew’s SSS Results ............................................................................................. 75 Sally’s ASRS: Parent Rating Form Results .............................................................. 79 Sam’s ASRS: Parent Rating Form Results ............................................................... 81 John’s ASRS: Parent Rating Form Results ............................................................... 83 Matthew’s ASRS: Parent Rating Form Results ........................................................ 85 Sally’s Performance on the TEA-Ch ........................................................................ 91 Sam’s Performance on the TEA-Ch ......................................................................... 92 John’s Performance on the TEA-Ch ......................................................................... 94 Matthew’s Performance on the TEA-Ch .................................................................. 95 Chapter 5: Discussion ................................................................................................... 98 Summary of Findings ................................................................................................ 98 Limitations of the Current Study ............................................................................ 107 Future Research ...................................................................................................... 109 vii Summary and Conclusions ..................................................................................... 110 References ................................................................................................................... 127 Appendix A: Basic Computer Skills Checklist ........................................................... 142 Appendix B: Recruitment Flyer .................................................................................. 143 Appendix C: Intake Procedure Protocol ..................................................................... 144 Appendix D: