A photo of Lauren Pascarella

Lauren Pascarella

Every year, the Hogg Foundation gives the Frances Fowler Wallace Memorial Award for Mental Health Dissertation Research to eligible doctoral candidates at institutions of higher education in Texas. Awardees receive a scholarship to help cover research-related expenses.

One of our 2020 recipients is Lauren Pascarella, a PhD candidate in clinical psychology at Texas Tech University. Her primary areas of research focus on child psychopathology, child anxiety disorders, and Autism Spectrum Disorders (ASD) in children. We talked with Lauren about her latest research on young children with comorbid anxiety and ASD.

Your project explores the effects of a modified Parent-Child Intervention Therapy (PCIT) program on child anxiety among children with comorbid anxiety and ASD, as well as parental outcomes (i.e., accommodation, parental anxiety, and stress). What led you to take a professional interest in this topic, and what questions are you trying to answer with this research?

I became interested in this topic because of my prior experiences in both anxiety and autism in children. As an undergraduate, I worked in a lab whose main focus was on anxiety and emotion dysregulation in children, which has always been a passion of mine. I also worked several years as an Applied Behavior Analysis therapist for children with autism, which sparked my interest in autism in children. It was not until I worked as a research coordinator at an autism center that I began to learn more about the manifestation of anxiety disorders in ASD and I began to realize there was a lack of measures and assessments for anxiety in children with ASD.

While at Texas Tech University, I studied more about comorbid anxiety and autism spectrum disorder, focusing on risk factors, assessment, and treatment in this population, which ultimately inspired my dissertation topic. Ultimately, I would like to answer the question of whether this treatment program will reduce child anxiety symptoms in those with ASD. Furthermore, since this is a parent-training program, I want to explore whether parents’ symptoms of anxiety, stress, and accommodating behaviors for the child also decrease throughout the treatment program. 

How do you think your research methods and approach will help you answer the questions you’re posing?

My study is using a multiple baseline design consisting of five caregiver-child pairs who will begin intervention at staggered timepoints. Multiple baseline designs provide strengths over other designs and are good designs for initial investigation, such as showing causal relations between the intervention and the behavior change. Another strength of multiple baseline design is that individual change in the data can be seen through the more frequent assessment methods, as opposed to large-sample designs that often only give pre- and post-assessment data. I am using a multitude of assessment measures in my study, including measures examining child and caregiver symptoms throughout treatment. Parents are reporting on their child’s symptoms since the children may be too young to report on their own symptoms. My study is also utilizing measures specific to looking at anxiety in children with ASD since it may present differently than anxiety in typically developing children. In addition, semi-structured interviews will be conducted with the caregiver to obtain information about child symptoms and satisfaction with the treatment from pre- to post-treatment. 

What, from your perspective, is the biggest area of need — or the greatest opportunity — related to this topic? In other words, how could we really move the needle on this front?

It is estimated there is a 40 percent prevalence rate of anxiety disorders in children with ASD which is a high percentage! Although there are studies and treatments available for children who struggle with anxiety and ASD, many of these treatments are for children who are older (above the age of 7 or 8). Less attention has been given to children who have comorbid ASD and anxiety, are below the age of 7 or 8, and may be lower functioning. Given the important role that parents play in a child’s life and the potential to exacerbate or alleviate child symptoms, this parent training program is expected to help these children. Lastly, modified PCIT programs have been conducted with promising findings for children with anxiety and separately for children with ASD, but to my knowledge, this is the first study that will examine a modified PCIT intervention for children with ASD and anxiety. It really is an area that needs more research and successful interventions, which I hope to achieve with my study! 

Can you suggest a few readings/resources for those who are interested in learning more about this topic?

  • http://www.pcit.org/what-is-pcit.html
  • https://childmind.org/article/detecting-childhood-anxiety/
  • Comer, J. S., Puliafico, A. C., Aschenbrand, S. G., McKnight, K., Robin, J. A., Goldfine, M. E., & Albano, A. M. (2012). A pilot feasibility evaluation of the CALM Program for anxiety disorders in early childhood. Journal of anxiety disorders, 26(1), 40-49.
  •  Keen, D., Adams, D., Simpson, K., Den Houting, J., & Roberts, J. (2019). Anxiety-related symptomatology in young children on the autism spectrum. Autism, 23(2), 350-358.
  •  McNeil, C. B., Quetsch, L. B., & Anderson, C. M. (Eds.). (2019). Handbook of Parent-Child Interaction Therapy for Children on the Autism Spectrum. Switzerland: Springer. doi:10.1007/978-3-030-03213-5
  •  Puliafico, A. C., Comer, J. S., & Pincus, D. B. (2012). Adapting parent-child interaction therapy to treat anxiety disorders in young children. Child and Adolescent Psychiatric Clinics, 21(3), 607-619. doi:10.1016/j.chc.2012.05.005
  • van Steensel, F. J. A., Bögels, S. M., & Perrin, S. (2011). Anxiety disorders in children and adolescents with autistic spectrum disorders: A meta-analysis. Clinical Child and Family Psychology Review, 14(3), 302–317. https://doi.org/10.1007/s10567-011-0097-0


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