Stress Coping Help for Neurotypical Teenagers With Autism Spectrum Disorder Siblings

SibChat, an intervention designed to address resiliency and stress coping in neurotypical (NT) teenage siblings of children with autism spectrum disorder (ASD), shows promising acceptability, feasibility, and efficacy particularly for stress coping, according to study findings published in Academic Pediatrics.

Researchers sought to evaluate the acceptability, feasibility, and efficacy of a modified mind-body virtual resiliency group intervention for NT teenage siblings of children with ASD. Primary endpoints were change in stress coping and resiliency. Secondary endpoints included whether any improvements were maintained 3 months following treatment (T1).

They conducted a randomly assigned waitlist-controlled pilot trial (ClinicalTrials.gov Identifier: NCT04369417) at an academic medical center in the Northeastern US from May 2020 to November 2020 that included 40 participants (14 to 17 years of age) who spoke English, had access to the internet, and had a sibling with ASD. Potential participants (recruited through social media, online advertisements, hospital clinics, and local and national organizations) were excluded with a diagnosis of ASD or a psychiatric hospitalization within the past year, ascertained by parent report. Eligibility included only 1 NT sibling per family.

Feasibility was assessed by attendance (attending at least 6 out of the 8 sessions), enrollment (Did enough [N=40] eligible participants enroll?), and retention (completion of a follow-up questionnaire 3 months after treatment). Acceptability was evaluated with a feedback questionnaire rating the degree to which each of the SibChat sessions were helpful, immediately after the intervention. Acceptability was measured by participants practicing the suggested relaxation response exercises at least a few times per week. Efficacy was assessed by self-reported outcomes.

Researchers noted that among the 40 participants, 90% completed T1 assessments and 88% completed T2 (6 months following treatment) assessments. Participants were reimbursed $25 for each set of completed surveys and an additional $25 for completing all 3 surveys.

Participants (more than half were girls; 80.0% White, 7.5% Asian, 5.0% Black) were randomly assigned to immediate intervention (IG; n=20) or waitlist control (WLC; n=20). Participants were randomly assigned 2 different times so that IG and WLC groups consisted of 10 participants each/time. Intervention consisted of 60-minute weekly (8) video conference group sessions. Among eligible teenagers screened, 83% were enrolled. Of those enrolled, most participants attended at least 6 of 8 sessions (IG, 90%; WLC, 75%).

Researchers noted among the 19 IG participants who completed the posttreatment survey, almost 80% reported practicing relaxation response exercises at least a few times per week. They noted that over 70% found the program sessions helpful. There were no adverse events reported.

Researchers found IG participants showed better relative moderate change in stress coping (anxiety symptoms) (Cohen’s d=0.60) and a small difference in resiliency (distress) (d=0.24) comparing change from baseline to T1 vs participants in the WLC group. Better relative changes were larger in scores for worry (d=.80) and mindfulness (d=.85).

Study limitations include study execution during the pandemic which added unaccounted stressors to teenagers and consequences for families of children with ASD and may have affected study results, as well as the preponderance of White and higher socioeconomic groups which limited generalizability.

Researchers concluded “Given the high rates of stress, distress, and mental health issues among teenagers in the US and among NT siblings combined with movement towards embracing telemedicine and remote delivery of interventions, this intervention offers a promising timely approach to addressing these problems.”