Rozenblat Shir, Shimshoni Yaara, Lebowitz Eli R, Perez Michal, Koller Judah
Seymour Fox School of Education, The Hebrew University of Jerusalem, Jerusalem, Israel.
Yale University Child Study Center, New Haven, CT, USA.
Child Psychiatry Hum Dev. 2025 Feb;56(1):249-263. doi: 10.1007/s10578-023-01555-4. Epub 2023 Jun 23.
Family accommodation describes changes parents make to their behavior, intended to alleviate their child's distress, which stems from a psychopathology. In anxiety, studies show that accommodation alleviates distress in the short term but is associated with increased symptom severity, greater functional impairment, poorer treatment outcomes, increased caregiver burden and disruption to family functioning longitudinally. Research shows high prevalence of family accommodation of anxiety in autism. While the most common treatments for anxiety in autism are cognitive-behavior therapy and pharmacology, research is limited and other approaches must be considered. Supportive Parenting for Anxious Childhood Emotions (SPACE) is a parent-based, manualized treatment for anxiety targeting family accommodation, which has been found to be acceptable and efficacious in treating childhood anxiety. This pilot trial examined the feasibility, acceptability, treatment-satisfaction, and preliminary efficacy of SPACE for anxiety in autism. Parents of 15 autistic children (ages 6-10 years) with at least average cognitive abilities exhibiting high levels of anxiety participated in 13 weekly sessions of SPACE. Feasibility and acceptability were assessed through enrollment, attrition rates, and adverse events. Of 26 eligible families, 22 (84.62%) elected to participate, 15 of whom (68.18%) completed treatment. Parents rated the treatment as highly satisfactory. Anxiety symptom severity and family accommodation were significantly reduced following treatment, with 86.66% of participants showing reliable change post-treatment, and this reduction was preserved at 2-month follow-up. This study provides preliminary evidence that SPACE is feasible, acceptable, satisfactory, and produces improvement in anxiety in the autistic population.Trial registration number: NCT04747262 Date of registration: February 10, 2021.
家庭调适描述了父母为减轻孩子因精神病理学所产生的痛苦而做出的行为改变。在焦虑症方面，研究表明，调适在短期内可减轻痛苦，但从纵向来看，它与症状严重程度增加、功能损害加剧、治疗效果较差、照顾者负担加重以及家庭功能紊乱有关。研究表明，自闭症患者家庭对焦虑症进行调适的情况很普遍。虽然自闭症焦虑症最常见的治疗方法是认知行为疗法和药物治疗，但相关研究有限，必须考虑其他方法。针对焦虑儿童情绪的支持性育儿法（SPACE）是一种以父母为基础的、针对家庭调适的焦虑症手册化治疗方法，已被证明在治疗儿童焦虑症方面是可接受且有效的。这项试点试验检验了SPACE治疗自闭症焦虑症的可行性、可接受性、治疗满意度和初步疗效。15名年龄在6至10岁、至少具有平均认知能力且焦虑水平较高的自闭症儿童的父母参加了为期13周的SPACE治疗课程。通过入组率、损耗率和不良事件来评估可行性和可接受性。在26个符合条件的家庭中，22个（84.62%）选择参与，其中15个（68.18%）完成了治疗。父母对治疗的满意度很高。治疗后，焦虑症状严重程度和家庭调适情况显著降低，86.66%的参与者在治疗后显示出可靠的变化，且这种降低在2个月的随访中得以保持。这项研究提供了初步证据，表明SPACE是可行的、可接受的、令人满意的，并且能改善自闭症患者的焦虑状况。试验注册号：NCT04747262 注册日期：2021年2月10日。
