The main student outcome measure used by 10 studies was the SCAS (S). One conclusion that I have reached through examining this case, is that it is important to question care decisions and clinical decision making processes, even if you are in the minority (Daly, 1998). Conclusions: The CBT manual employed in this study is one of the first adaptations of an evidence‐based treatment for children with autism spectrum disorders. Writers’ block can arise owing to various reasons, primarily psychological, in nature. There were high levels of heterogeneity across the studies (I2 = 85%). A preliminary search of PROSPERO, MEDLINE, the Cochrane Database of Systematic Reviews (apart from this copublished protocol), and the JBI Database of Systematic Reviews and Implementation Reports was conducted and no current or underway systematic reviews on the topic were identified. For seven of the studies, the averaged parent‐ and student‐reported SCAS (six instances) or SCARED (one instance) were used. O'Gr., M. U., G. V., and D. H. contributed to the writing and revising of the original study protocol as well as this report. J. et al (1996) The assessment of discomfort in elderly confused patients: a preliminary study. A sensitivity analysis was carried out by removing this study, reducing the overall SMD to −0.71 (95% CI: −0.97, −0.46; z = −5.42, p < .01). Hoare K. (2004) Care home placement: can admission direct from acute hospital be justified? 's (2019) findings, treatments that had family involvement resulted in a larger overall effect size than treatments without parental involvement, a difference equivalent to 2‐month additional progress. What is the effectiveness of acute hospital treatment of older people with mental disorders? A., Marquis, J. G., Lenz, B. K., Schumaker, J. Free resources to assist you with your university studies! Other factors, such as the development of self‐awareness and understanding of health concepts, have been suggested by other researchers as potential sources of inconsistency in self‐reports with children, and more particularly with children with ASD (Kreslins et al., 2015). (2006). Finding Answers About Writing Difficulties. Weighted mean differences and their 95% CIs were calculated for analysis. Australian Council for Educational Research, Adelaide, South Australia, Australia, Division of Child and Adolescent Psychiatry, Stanford Autism Center, Department of Psychiatry and Behavioral Sciences, School of Medicine, Stanford University, Palo Alto, California, A. J. Drexel Autism Institute, Dornsife School of Public Health, Drexel University, Philadelphia, Pennsylvania, Olga Tennison Autism Research Centre, School of Psychology and Public Health, College of Science, Health and Engineering, LaTrobe University, Bundoora, Victoria, Australia. New York: The Guildford Press. In addition, teachers tend to perceive students with ASD as having more difficulty with academic success and with anxiety than their typically developing peers (Ashburner et al., 2010). Dr Amanda Richdale, Associate Professor, Olga Tennison Autism Research Centre, La Trobe University, Australia. All writing treatment subgroups also had positive average weighted ES, but only four were statistically different from zero (i.e., strategy instruction ES = 1.09, dictation ES = 0.55, goal setting ES = 0.57, and process writing ES = 0.43). Sofronoff_2005 included two treatment arms, one in which children received CBT on their own and another in which their parents participated in the treatment with them. Given the diversity of interventions and the potentially small sample of included studies within each intervention type, it was important to conduct a sensitivity analysis of the impact of a single study, particularly if it is an outlier, on the overall observed effect size for interventions in any meta‐analysis. This review included all treatments for anxiety where the large majority of participants were of mainstream school age, with ASD which occurred in schools, families or in clinical settings and that encompassed at least one of the elements outlined by Rotheram‐Borus et al. Otherwise, this review followed the approaches to search strategies and analyses specified in the study protocol (Lietz et al., 2018) which was published by the Campbell Collaboration prior to starting the research. Once this outlier was removed, the overall SMD decreased to −0.53 (95%CI −0.76, −0.31; z = −4.73, p < .01). However, the selected sources are focused on the English language in keeping with our database subscriptions and the primary language of the authors. Journal of Clinical Nursing 13 562-570. Although reflection is known to be, at times, an imperfect means of reviewing practice, because there is always the possibility of biased reflection, or poor memory (Jones, 1995), it is a means of allowing student nurses and qualified nurses to ask questions about their practice and look at it in the light of knowledge and evidence. Often, SMD s of 0.2, 0.5, and 0.8 are taken to be indicative of small, moderate, and large effects, respectively (Cohen, 1988). K. H., K. D., K. A., P. L., E. Any queries (other than missing content) should be directed to the corresponding author for the article. Treatment gains were maintained at 3‐month follow‐up. Accordingly, this review aimed to synthesize evidence about interventions to reduce anxiety symptoms in school‐aged children with ASD. A thesis is the most important write up in a researcher's life. Journal of Advanced Nursing 28 (2) 323-331. Since children spend a significant portion of their day at school, teachers and clinicians working in the education sector have significant responsibility for recognizing signs of ASD and anxiety, and in implementing interventions and supports that are evidence‐based and tailored to the needs of the child. People with ASD are likely to be able to shed important insight into the strengths and weaknesses of different approaches, and also to the specific skills required of therapists working with this population. Arthur is accustomed to regular social activities at the local Home Guard club, some of which Anne attends with him, and also to going into the local shopping area most days to buy a paper. What is the relative effectiveness of interventions for managing anxiety of school‐aged children with ASD that have been used in school, family, and clinical settings? (2004). Changes between pre‐ and post‐treatment were examined using clinical interviews as well as child‐, parent‐ and teacher‐report measures. No group comparison presented. This poses a considerable burden on health and social care. Students with LDs who have difficulties in writing are often accused of procrastination or lack of effort, and indeed may become discouraged if they do not get help. Effects are also larger for individual one‐on‐one interventions compared to treatments delivered in a group with peers. The CBT model emphasized behavioral experimentation, parent‐training, and school consultation. For American Doctoral Dissertations (EBSCO), the search statement was: PRISMA flow diagram outlining process of study selection, Forest plot of studies included in the meta‐analysis, with risk of bias summary, Forest plot of clinician‐reported outcome measures with risk of bias summary, Forest plot of parent‐reported outcome measures with risk of bias summary, Forest plot of self‐reported outcome measures with risk of bias summary, Forest plot comparing treatments with and without family involvement, Forest plot comparing treatments that involve individual or group participation. A flow diagram of the study selection is presented in Figure 1. This Campbell systematic review examines the effects of interventions for reducing anxiety in school‐aged children with ASD, compared to treatment‐as‐usual. It then outlines a frequent oversight in the literature regarding motor development and resonance difficulties in this population, which forms the basis for developing motor-based interventions for these individuals. The trend of somewhat weaker effects of interventions when outcomes are measured via self‐report, noted here and in similar reviews (e.g., Kreslins et al., 2015; Sukhodolsky et al., 2013) warrants further investigation. Instead, children and adolescents with ASD should be able to provide formative feedback and be involved in redesign. The quality of the evidence can be considered moderate. Edinburgh: Churchill Livingstone. There are those who would argue that making this decision for Arthur is the wrong course of action, because he has been functioning well at home prior to hospital admission for a medical problem, and there is no reason why he could not carry on with the same level of support for the time being (Hoare, 2004). Do you have a 2:1 degree or higher? Treatments that were administered individually one‐on‐one (SMD = −1.24, 95% CI −1.75, −0.74; z = −4.87, p < .01), indicated larger effects than for treatments delivered in a group context with peers (SMD = −0.37, 95% CI −0.54, −0.19; z = −4.10, p < .01). The study design of vanSteensal_2015 was relatively more complex, compared to other included studies, in that it included two treatment groups—one with ASD and anxiety disorders, one with anxiety disorders but no ASD diagnosis—and a wait‐list control (WLC) subgroup of the ASD group. If left untreated, anxiety persists into adulthood and can progress into other disorders, such as depression (Seligman & Ollendick, 1998; US Public Health Service, 2000). A total of 931 (764 male and 167 females) participants most of whom were of mainstream school age (6–16) were included in these studies (note that subjects in pre‐post studies only counted once). A random effects meta‐analysis was employed due to the variability in outcome measurement instruments and interventions across the included studies. & Low, L. (2005). Each professional presented their case, and discussed Arthur’s current state of health, and the support, care and input he needed. In order to compare the potential moderating effect of treatment format, two groups of studies were formed and assessed based on whether the treatment was administered on an individual basis (n = 9), like the Thai massage (Piravej et al., 2009), or in a group setting (n = 14), such as the peer‐mediated, theater‐based intervention (Corbett et al., 2017). Kolb, D. A. There are numerous interventions currently available for the treatment of anxiety in children and young people. Studies spanned the period 2005 to 2018 and were mostly carried out in Australia, the UK, and the USA. Visual inspection of the both the forest plot and the funnel plot, as presented in Figure 3, identified the SMD score reported by Chalfant_2007 as an outlier. I would also seek out and gather together as much of the evidence base as possible relating to the patient’s care, in order to make a more reasoned decision. Hargreaves, J. No adverse events were reported. SUPERVISOR: DR L.D.N. Third edition. In summary, studies were included in the review if they met the following criteria: A broad range of bibliographic databases were electronically searched for studies that matched our inclusion criteria: Our general search statement, set out below, was customized to fit the available search features of the bibliographic databases (see Appendix A in the Supporting Information Material for the customized statements). The patient/client population was school‐aged children (5 to 18 years old) diagnosed with ASD (inclusive of autism, ASD, Autistic Disorder, Asperger's Disorder, Asperger Syndrome, atypical autism, and PDD‐NOS) by a professional eligible to diagnose these conditions, and also experiencing anxiety symptoms or a diagnosis of an anxiety disorder provided by a professional eligible to diagnose such conditions. There are several risk‐of‐bias issues in most studies included in the review, mainly due to the unavoidable limitation that participants cannot be blinded to the treatment group, which may upwardly bias the estimated effects. CBT is a relatively popular alternative to pharmacological intervention for anxiety symptoms that incorporates a number of these elements. Given this high risk of bias, the results, particularly those based on parent or self‐report should be interpreted with caution. Six of the studies were classified as quasi‐experimental designs, in that they employed a control or comparison group that was not randomly assigned, while the remaining 18 studies used a randomized WLC design (with varying degrees of fidelity). UNIVERSITY OF SOUTH AFRICA . Since the direction of the scales was the same for all outcome measures, no adjustments of the scores were required. At least one outcome measure was a standardized continuous measure of anxiety (parent, clinician or self‐reported). While 19 of the interventions were conducted in a clinical setting (either a university‐based clinic or a community clinic, such as Child and Adolescent Mental Health), the intention of the studies was to address issues that were pertinent to the subjects’ lives—either at home or in school. Because of his increasing debilitation, reports of his wandering behaviours on the ward, and his increasing dependence on carers, it was decided that Arthur should not be discharged home, but instead a place should be found in an EMI nursing home, where he could receive the level of support believed to be necessary for him. New table of content alerts were also set up for key journal titles including Research in Autism Spectrum Disorders, Autism, and the Journal of Autism and Developmental Disorders. CBT and other psychosocial interventions have been developed as alternatives to pharmacological intervention to treat anxiety symptoms in students with ASD without co‐occurring intellectual disability. I would ensure that the patient and their primary carers were included in the discharge planning conference, that their preferences, experiences and opinions were sought, and that these were incorporated into the clinical decision making process. Efraimsson, E., Sandman, P. Hyden, L-C., and Rasmussen, B.H. Given the diversity of interventions and the potentially small sample of included studies within each intervention type, it was important to conduct a sensitivity analysis of the impact of a single study, particularly if it is an outlier, on the overall observed effect size for interventions in any meta‐analysis. Certain traits and behaviors, such as social avoidance or rigid, ritualistic behaviors, can be a manifestation of both core ASD symptomatology and indicative of comorbid anxiety (Kerns et al., 2015). Although this may be seen as a source of variability and imprecision in the results, all of the instruments used adhered to published recommendations for reliability and quality (Lecavalier et al., 2014; Wigham & McConachie, 2014) and have been analyzed in previous reviews (Kreslins et al., 2015). It would appear from this reflection that a significant decision making process such as this, even when many good principles are adhered to, is complex and difficult, and it is important to make sure that all aspects of the client’s needs are being met, not just their safety and medical/social care needs. The large number of studies meeting our original inclusion criteria was of sufficient size to warrant restricting the results to a meta‐analysis of RCTs and quasi‐experimental studies. The greatest risk of bias of this review was the selection of studies, specifically, the decision to limit the inclusion criteria to randomized control studies and quasi‐experimental studies. Overall, writing interventions had a statistically significant positive impact on the writing quality of students with LD (ES = 0.74). Anne helps him manage his medication. Clinician reports indicate a very high statistically significant effect, parent reports indicate a high significant effect, and self‐reports indicate only a moderate significant effect on the reduction of anxiety in students with ASD. You can be signed in via any or all of the methods shown below at the same time. Implications for the types of writing treatments and the types of instruction that may be most beneficial to students with LD are discussed and directions for future research are provided. Improving school functioning by reducing anxiety for children on the spectrum, Effects of Thai traditional massage on autistic children's behavior, Cognitive‐behavioral group treatment for anxiety symptoms in children with high‐functioning autism spectrum disorders: A pilot study, Group cognitive behavior therapy for children with high‐functioning autism spectrum disorders and anxiety: A randomized trial, A randomised controlled trial of a CBT intervention for anxiety in children with Asperger syndrome, CBT for anxiety disorders in children with and without autism spectrum disorders, The effect of cognitive‐behavioral therapy versus treatment as usual for anxiety in children with autism spectrum disorders: A randomized, controlled trial, A randomized controlled trial of cognitive‐behavioral therapy versus treatment as usual for adolescents with autism spectrum disorders and comorbid anxiety, Effects of cognitive‐behavioral therapy on anxiety in children with autism spectrum disorders: A randomized controlled trial, Randomized controlled trial: Multimodal anxiety and social skill intervention for adolescents with autism spectrum disorder, Cognitive behavioral therapy for anxiety in children with autism spectrum disorders: a randomized, controlled trial, Cognitive behavioral therapy for early adolescents with autism spectrum disorders and clinical anxiety: A randomized, controlled trial, Treatment choices in autism spectrum disorder: The role of parental illness perceptions, Medication and parent training in children with pervasive developmental disorders and serious behavior problems: results from a randomized clinical trial, Comorbid ADHD and anxiety affect social skills group intervention treatment efficacy in children with autism spectrum disorders, Environmental enrichment therapy for autism: Outcomes with increased access, The short‐term effects of music therapy on anxiety in autistic children, Group social skills intervention for adolescents with Asperger Syndrome or high‐functioning Autism Spectrum Disorder: Curriculum, process, and outcomes. Nineteen studies reported one or more parent reported outcome measures, with 21 reports in total. The overall SMD was d = −0.68 (95% CI: −1.05, −0.31); z = −3.64, p < .01), indicating that the difference between the treatment and control groups at posttreatment reached significance. The primary outcome for included studies was anxiety, thus studies that focused on social skills interventions or other symptomatology of ASD as primary outcomes were excluded from this review. The effects of text-based and graphics-based software tools on planning and organizing of stories, Teaching expressive writing to students with learning disabilities: Research-based applications and examples, Fostering reflectivity in the argumentative thinking of students with different learning histories, The effects of a strategic writing program for students with and without learning disabilities in inclusive fifth-grade classes, Effectiveness of question exploration to enhance students’ written expression of content knowledge and comprehension, Efficacy of writers’ workshop for students with significant writing deficits, Journal of Research in Childhood Education, Enhancing writing self-efficacy beliefs of students with learning disabilities improves their writing processes and products, Effects of dictation and advanced planning instruction on the composing of students with writing and learning problems, The effectiveness of a program based on self-regulated strategy development on the writing skills of writing-disabled secondary school students, Making strategies and self-talk visible: Writing instruction in regular and special education classrooms. The search of the databases yielded 3,417 records, with an additional 177 records identified through other sources. The e-mail addresses that you supply to use this service will not be used for any other purpose without your consent. The JBI Database of Systematic Reviews and Implementation Reports. (2001) Nursing Older People. A summary of some of the key elements of the included studies is presented in Table 2. Quantitative data were, where possible, pooled by way of statistical meta‐analysis. Arthur developed pneumonia following a viral infection, and was admitted with dyspnoea, pyrexia and increased confusion, alongside dehydration. Figure 5 presents a forest plot of the results, along with a summary of the risk of bias. Risk of bias in the selected studies was rated as high risk (bias that potentially reduces the reliability of the results), or low risk (bias that is unlikely to alter the results), with an unclear category used in cases in which there was insufficient information in the published study for the judgment of bias to be made. One study used peer‐mediated theater therapy and one study examined the benefits of Thai traditional massage for reducing anxiety. Moreover, these can be interpreted, respectively as, 1 month, 3 months, 6 months, and 9 months additional developmental progress. The results of this review are, thus, in line with previous reviews, and suggest that interventions can have positive effects on the experiences of young people with ASD and anxiety, although more research is needed to identify the underlying cause or causes of the discrepancy in effectiveness depending on the respondent.

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