Association of Emotional Self-Efficacy (ESE)

and Anxiety (ANX) in Children with Autism Spectrum Disorder (ASD)

Eric Chang, Sharon C. Hui, Patricia Renno, and Cori Fuji, and Jeffrey J. Wood

University of California, Los Angeles

Introduction

• Autism Spectrum Disorders (ASD)

• General deficiencies in…– social awareness, – verbal/non-verbal communication skills, – and atypical levels of interest in others

(1) Autistic Disorder (AD),

(2) Pervasive Developmental Disorder, Not Otherwise Specified (PDD-NOS),

(3) Asperger's Disorder (AS),

(4) Rett's Disorder, and

(5) Childhood Disintegrative Disorder.

Within the DSM-IV* classification of ASD:

• Prevalence of ASDs:

Sample Study: 1 in 150 children in America is diagnosed with an ASD (2009).

Population Study: 1 in 38 school-age children are on the AS in S. Korea (2011).

• 30-80% of individuals with ASD also had an anxiety disorder diagnosis (2009).

• Anxiety (ANX) may be a significant focus of treatment for positive outcome.

Anxiety (ANX)

• enhanced negative emotional reactivity, and there is a positive correlation between ANX severity and negative emotionality

• Anxiety disorder can be predicted by emotion dysregulation.

• Emotion dysregulation may also mediate stressful life events and ANX.

Cognitive Behavioral Therapy (CBT)

• CBT is effective in improving emotional regulation and reducing ANX in typical children with anxiety disorders

• CBT treatment has proven to be effective in lowering ANX in children with ASD comorbiding anxiety disorder

CBT and ANX in Children w/ ASD

• In a RCT study by Wood, Drahota, Sze, Har, Chiu, and Langer (2009),

– Children with ASD and anxiety disorders received CBT treatment…

• Coping skills training prior to vivo exposures.• Parents (Positive reinforcement techniques)

– CBT effectively lowered ANX in children.

Opportunities in Self-Evaluation

Self-Evaluation & Academic Self-Efficacy

• In an academic goal and self-evaluation study by Schunk and Ertmer, the relatedness of self-regulatory strategies and self-efficacy were examined (1999).

• It was suggested that self-evaluation may have increased one’s academic self-efficacy.

Emotional Self Efficacy (ESE)

• What is it?

• Self-Efficacy = the “knowingness”/”mastery”/”how well do you understand it?”/”how well you can control it?”

• The “knowingness” of one’s emotional world.

2 Ideas that Inspired this Paper

(1) Self-Evaluation (SE) may have increased one’s Academic Self-Efficacy (ASE).

(2) CBT and ANX in Children w/ ASD --- Opportunities in Self-Evaluation (SE).

This paper examines CBT treatment’s effect on the ESE of children with ASD and anxiety disorders, as well as the relationship between ESE and ANX.

3 Hypotheses

(1) CBT treatment increases ESE of children

with ASD and anxiety disorders. (Due to the

increased SE opportunities.)

(2) The ESE and ANX of children with ASD and

anxiety disorders have a negative relationship

(Higher the ESE; Lower the ANX…vice versa)

• (3) Increases in ESE will predict decreases in ANX in our subject sample (children with ANX and ASDs).

Method

• This research reports on the same database analyzed in: – Wood, J. J., Drahota, A., Sze, K., Har, K., & Chiu,

A. (2009). Cognitive behavioral therapy for anxiety in children with autism spectrum disorders: a randomized, controlled trial. Journal of Child Psychology and Psychiatry, 50(3), 224-234.

• A special thanks to Dr. Jeffrey J. Wood, Patricia Renno, and Cori Fuji.

Participants

* 40 children with ASD and one Anxiety

disorder, from 7 to 11 years old, and

their primary parents.

• Table 1. Descriptive information for participating families.

Measurement

• Children’s anxiety (ANX) was assessed by the Multidimensional Anxiety Scale for Children-Parent version (MASC-P).

• Children’s emotional self-efficacy (ESE) was assessed by a subscale from the Self-Efficacy Questionnaire for Parent (SEQ-P), that consisted 8 questions identified to be reliable and valid for ESE measurement (Muris, 2001).

Procedure

• According to the inclusion and exclusion criteria, children were block randomized into either (1) immediate treatment (IT) or (2) wait list (WL) group.

• Baseline assessments were conducted prior to the CBT treatment.

Inclusion criteria of the study:

(a) met research criteria for a diagnosis of autism, Asperger syndrome, or PDD-NOS;

(b) met research criteria for one of the following anxiety disorders:

(1) separation anxiety disorder (SAD),(2) social phobia, or(3) obsessive compulsive disorder (OCD)

(c) were not taking any psychiatric medication at the baseline assessment, or were taking a stable dose of psychiatric medication (i.e. at least one month at the same dosage prior to the baseline assessment), and

(d) if medication was being used, children maintained the same dosage throughout the study.

Exclusion criteria of the study:

(a) the child had a verbal IQ less than 70 (as assess in previous testing, or, if there was any question about the child’s verbal abilities noted by the independent evaluator at baseline, on the basis of the Wechsler Intelligence Scale for Children-IV administered by the independent evaluator);

(b) the child was currently in psychotherapy or social skills training, or was receiving behavioral interventions such as ABA;

(c) the family was currently in family therapy or a parenting class;

(d) for any reason the child or parents appeared unable to participate in the intervention program.

• 16 weekly sessions• Building Confidence CBT program

treatment (Wood & McLeod, 2008). • 3 sessions: basic coping skills,• 8 sessions: vivo exposures to attempt

increasingly fearful activities. • Parents: trained on providing support to

their children in vivo exposures, using…– positive reinforcement,– using communication skills

to encourage children’s independenceand autonomy in daily routines.

• Remaining sessions (out of the 16), therapy modules: – highly individualized

– selected on a session-by-session basis to address the child’s most pressing clinical needs.

Assessment Schedule:

Subjects fill out MASC-P and SEQ-P…

(1) Waiting List(2) Pre-treatment (1) Pre-tx(3) Post-treatment or (2) Post-tx

Post tx assessments were conducted on the final day of treatment (or within a week of termination).

• Before the CBT treatment, the ESE of the two groups (IT and WL) were not significantly different.

• After the CBT treatment, the ESE is significantly different between the two groups (IT and WL).

Result

• The ESE score was negatively correlated with the ANX score.

• Linear regression analyses: Change in ESE is a significant predictor of anxiety after treatment (p< 0.05).

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Treatment Phases

Mean Ratings

Emotional Self-Efficacy

Anxiety

Discussion

• Hypothesis 1 - Support: – ESE is increased by the CBT treatment.

• Hypothesis 2 - Support: – The ESE and ANX of children with ASD and

anxiety disorders have a negative relationship. (Higher the ESE; Lower the ANX.)

• Hypothesis 3 Support. Linear Regression told us:

ESE subscale scores from SEQ-P can predictANX scores from MASC-P.

So What?

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Treatment Phases

Mean Ratings

Emotional Self-Efficacy

Anxiety

• So what?

–Suggests: • Treatment models that targets ESE may yield promising result in ANX reduction.

• The Self-evaluation opportunities provided in CBT might have contributed to the increased ESE (Future Study).

• Seeing how dx symptoms interact with tx and taking them apart (dx symptom: ANX, tx: CBT. Taking it apart: ESE as one of the components) may help us better understand the interacting nature of a Dx and the Tx. This helps to inspire future studies to pinpoint exactly what the treatment is doing right.

(Future Studies)• Treatment models (ex: CBT)

that target/address ESE may have better generalization because such tx also providing intervention at a meta cognitive level (vs. ABA on behavioral level only).

Reference

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Wood, J. J., Drahota, A., Sze, K., Har, K., Chiu, A., & Langer, D. A. (2009). Cognitive behavioral therapy for anxiety in children with autism spectrum disorders: A randomized, controlled trial. Journal of Child Psychology and Psychiatry, 50(3), 224–234.

Wood, J. J., McLeod, B. D., Hiruma, L. S., & Phan, A. Q. (2008). Child anxiety disorders: A family-based treatment manual for practitioners. New York: W. W. Norton & Co.