Clinical and cost-effectiveness of adapted online parent-led treatment compared to treatment as usual for autistic children with anxiety problems in Child and Adolescent Mental Health Services: A randomised controlled trial

Research questions

(i) Is a therapist supported online parent-led intervention (OSI-A) non-inferior to treatment as usual (TAU) in reducing the impact of anxiety problems among autistic children? (ii) Is OSI-A more cost-effective than TAU? (iii) How do children and parents experience OSI-A? Background

Autistic children commonly experience anxiety problems yet child and adolescent mental health services (CAMHS) struggle to provide timely evidence-based care that meet the needs of families. There is good evidence for the clinical and cost-effectiveness of brief therapist-guided parent-led Cognitive Behaviour Therapy for anxiety problems in non-autistic children.

We have also shown online delivery (using the OSI platform) substantially reduces therapist time without compromising child clinical outcomes. In a recent NIHR funded study we worked with children, parents and clinicians to co-adapt this treatment content to ensure it meets the needs of autistic children and their families. We now need to incorporate this content in to the OSI platform and evaluate it within clinical services.

Aims and objectives

1.To examine whether the therapist supported online parent-led intervention (OSI-A) is non-inferior in reducing the impact of anxiety compared to treatment as usual (TAU) for anxiety problems among autistic children.

2. To evaluate the within-trial cost-effectiveness of implementing OSI-A for autistic children with anxiety problems compared to TAU.

3. To examine experiences and acceptability of OSI-A and provide insights into barriers and facilitators to engagement and benefit. Methods

A multi-site, two parallel arms open label, randomised controlled non-inferiority trial to evaluate the clinical and cost-effectiveness of OSI-A with therapist support compared to CAMHS treatment as usual, coupled with a multi-perspective qualitative study to explore parents’ and therapists’ experiences.

Timeline for delivery

Months 1-6: Study set-up and updates of OSI to create OSI-A; Months 7-14: Internal pilot; Months 16-36: Complete recruitment; Months 37-48: Complete assessments; Months 49-54: Complete analyses and dissemination. Anticipated impact and dissemination

If indicated by the trial results OSI-A could provide child mental health services with a mechanism to provide accessible, efficient and effective support for autistic children with anxiety problems and their families. We have developed a route for licensing OSI-A to services and will develop a comprehensive dissemination plan to reach services, families of autistic children and other relevant communities.