Specifying and Treating Anxiety in Autism Research (STAAR) study is testing cognitive behavioral therapy and the medication Sertraline to treat anxiety symptoms
Children diagnosed with autism spectrum disorder (ASD) express symptoms that can vary from one individual to another. However, one of the most common symptoms that surprisingly has little to no published research in this area is anxiety. According to the Mind Institute on the UC Davis Health website, at least 50% of children with ASD show symptoms of anxiety.
In 2018, the UC Davis Mind Institute began the Specifying and Treating Anxiety in Autism Research (STAAR) study and has expanded its operations online to continue conducting research in response to the pandemic. The study is currently testing two different treatments, one is cognitive behavioral therapy (CBT) and the other is a selective serotonin reuptake inhibitor (SSRI) medication called Sertraline, to which subjects are randomly selected and placed. Erika Bickel, the project manager of the STAAR study primarily overseeing the medication arm of the study, described the study’s significance and purpose.
“A really common symptom and associated issue that kids on the spectrum have is anxiety,” Bickel said. “There’s just not a lot of providers or clinicians who know how to treat anxiety, specifically in this population, and so that’s one of the things we’re trying to figure out with this study. So the hardest part of autism and anxiety is that there’s just not a lot of providers who feel capable and feel ready to administer these treatments, not because they’re not trained on how to utilize things like BIACA therapy, but that they’re just very cautious about how to do it and hope that it’s beneficial in this population.”
The UC Davis Mind Institute applies a very specifically adapted type of CBT called the Behavioral Interventions for Anxiety in Children with Autism (BIACA) program. Children selected to be in the therapy group for the study will undergo weekly one and a half hour BIACA therapy sessions for 16 weeks. Kathryn King, a research coordinator for the STAAR study, described one therapy session she observed as a family reached the end of their 16 weeks.
“I was watching a therapy session with one of our kids, and they’re nearing the end of their session,” King said. “They only have one left and it’s 16 weeks long so they were in week 15. The mom today just kind of started crying near the end when she was talking to the therapist and saying what a change she has seen in her child. It was really emotional, and she was just talking to the therapist about how she’s seeing like a 180 [degree] change in her child, and how his life is so much better because of the study and she was so glad that he did it.”
Despite the transition to online therapies, the STAAR study has not only made treatments more accessible to families who cannot travel to the MIND Institute, but also continues to deliver impactful changes for children with ASD. Concerns about potentially diminishing effects of therapy sessions becoming virtual were described as very minimal, according to both King and Konnor Davis, another research coordinator working closely with King on the STAAR study.
“Really the only way we were seeing kids every week was in person, and you can’t really do that during covid,” Davis said. “One of the main inspirations for going online which we had dabbled in before is because of COVID, and the second thing is we’ve started to modify the goals of the study. Now we’re actively researching telehealth for CBT because I really don’t think there’s stuff out there about telehealth, CBT plus autism and anxiety; I really think there are slim chances that there’s any publishable research out there on this. And that’s one of the things that we’re trying to elucidate for everyone out there.”
Along with Davis’ comment on the novel push for telehealth for CBT sessions, King further discussed the potential advantages of transitioning to online therapy.
“There was a recent paper actually published about using CBT over Zoom and when I read it, I saw a lot of the things in there that I’ve just been seeing while observing therapy in our study, mainly that it is different, but it has its benefits in it kind of has its disadvantages,” King said. “So, for example, a benefit is that the child tends to be more comfortable and can build rapport faster with the therapist. Because they’re in an environment that they’re comfortable in, they can show their pets to the therapist, they can play with their toys. A disadvantage similarly could be that they can get too distracted easily because they are in their room with all their toys and around things like that, so it definitely has very unique benefits and disadvantages.”
Bickel further elaborated on how the approaches to treating children with ASD are unique and different from person to person.
“Anxiety and autism spectrum disorders and all of that present very differently from one child to another so there’s really no general checklist that you can follow on how to treat these [disorders],” Bickel said. “It’s a very individualized plan for everyone. What’s recommended is a balancing act between the parent, the child and whoever their specialist or care providers are. And that’s kind of a very personal choice that they have to make according to the timeline of the child and as they grow and develop, and that might change what the best option is.”
Ultimately, the UC Davis Mind Institute hopes to shed light on more effective approaches to treating anxiety as a common symptom of children diagnosed with ASD. With little to no research in this area, as mentioned by Bickel and Davis, the Mind Institute is also looking at potentially combining both medication and treatment as an approach and applying different types of therapies other than the BIACA program being administered as part of the STAAR study.
“The reason we do research and clinical trials is because we want to help, not just one child, but many children,” Bickel said. “We want to help everyone that we can and so studies, like the STAAR study, and other medication trials and other research that we do here at the Mind Institute [are] really just focused on figuring out how to best help kids and how to cater treatments to them.”
Written by: Brandon Nguyen – science@theaggie.org
