Using Acceptance and Commitment Therapy at School with Children and Adolescents with Autism and Emotional Challenges: A Preliminary Study

Background: Research on acceptance and mindfulness based interventions in schools has demonstrated positive outcomes from improving student attending, attendance, grade point average, to responding to peer aggression and bullying. However, more research is needed to determine how school social workers can use these interventions in their practice. Therefore, the current single-subject case study sought to determine the effects of an acceptance based intervention (Acceptance and Commitment Therapy; ACT) on student engagement in on-task and off-task behaviors across two classrooms with children and adolescents with autism and emotional challenges.

Methods:  Students in two special education classrooms (n=7 classroom 1; n=10 classroom 2) completed 20 minutes of group ACT sessions three times a week for 15 weeks in classroom 1 and 10 weeks in classroom 2 during the regular academic school year. ACT implementation fidelity was assessed for 27% of sessions in classroom 1 (M=93%), and 40% of sessions in classroom 2 (M=92%). Researchers measured student engagement in on and off-task behaviors during 16min observational periods, using a PLAYCHECK 20s momentary time sampling procedure (i.e., every 20 seconds, the researcher recorded instances of each target behavior across each student in the classroom).

Using a nonconcurrent multiple-baseline with withdrawal design, target behaviors were analyzed through visual analysis to identify level, trend, and variability within and across data paths (consistent with single-subject design logic). Standard mean difference scores (SMD) were also calculated, as a complementary analytic approach to provide a more comprehensive understanding of the effect of the intervention (calculated by subtracting the mean of the baseline phase from the mean of the treatment phase, and divided the difference by the standard deviation of baseline).

Results: During baseline, students across classrooms engaged in moderately high rates of off-task behavior, when compared to rates of on-task behaviors. However, when treatment was implemented, students immediately engaged in higher rates of on-task behaviors (M percentage of correct responses across baseline (BL) and treatment (Tx) sessions: Class 1 BL = 44%, Tx= 70%; Class 2 M BL= 38%, Tx= 61%), when compared to rates of off-task (Class 1 M BL= 45%, Tx= 23%; Class 2 M BL= 60%, Tx= 32%). SMD outcomes suggested large effects between baseline and intervention sessions (Class 1: 2.59; 2.58, Class2: 1.42, 1.34; for on-task and off-task behaviors respectively).

Conclusions and Implications: The current study found that when (and only when) ACT was provided, students increased engagement in on-task behaviors while decreased engagement in off-task and disruptive behaviors. While preliminary, the current treatment approach may be beneficial for social workers are looking for prevention strategies to use in their clinical practice. ACT appears suitable as an intervention strategy to assist social workers in ensuring healthy development for children and youth with special or individualized needs.