Adaptation of Cognitive Behavior Therapy for Autistic Children During the Pandemic: A Mixed-Methods Program Evaluation

Abstract

Distancing requirements due to the pandemic have halted many in-person therapeutic programs, including cognitive behavior therapy (CBT), increasing the likelihood that autistic children with mental health problems will struggle without adequate access to evidence-based care. Policies meant to limit the spread of COVID-19 have inadvertently exacerbated the difficulties experienced by autistic children and further exposed them to vulnerabilities that will impact their mental health. In response, interventions have been adapted for remote delivery. There is limited evidence of the acceptability, feasibility, and clinical utility for treating mental health challenges in autistic children through an online medium, within the context of a pandemic. The current study used an explanatory sequential mixed methods design to assess parents’ experience as they participated in an adapted manualized CBT program (Secret Agent Society: Operation Regulation, SAS:OR; Beaumont, 2013) with their autistic child. Parents reported child-related behavioral changes in pre- and post-program surveys, and both parents and therapists were interviewed about their experience through the program. The quantitative findings suggest that children learned new emotion regulation through online participation, and parents were satisfied with the program. The qualitative data supported the quantitative findings and provided new insight into factors that facilitated child engagement or made participation challenging. Overall, the findings suggest that adapted online CBT programs for autistic children can have clinical utility, and further research is needed to determine their efficacy.