1. Association of
Emotional Self-Efficacy (ESE)
and Anxiety (ANX) in Children with
Autism Spectrum Disorder (ASD)
Eric Chang, Sharon C. Hui, Patricia Renno, and
Cori Fuji, and Jeffrey J. Wood
University of California, Los Angeles

2. Introduction
• Autism Spectrum Disorders (ASD)
• General deficiencies in…
– social awareness,
– verbal/non-verbal communication skills,
– and atypical levels of interest in others

3. (1) Autistic Disorder (AD),
(2) Pervasive Developmental Disorder, Not
Otherwise Specified (PDD-NOS),
(3) Asperger's Disorder (AS),
(4) Rett's Disorder, and
(5) Childhood Disintegrative Disorder.
Within the DSM-IV* classification
of ASD:

4. • Prevalence of ASDs:
Sample Study: 1 in 150 children in America is
diagnosed with an ASD (2009).
Population Study: 1 in 38 school-age children
are on the AS in S. Korea (2011).
• 30-80% of individuals with ASD also had an
anxiety disorder diagnosis (2009).
• Anxiety (ANX) may be a significant focus of
treatment for positive outcome.

5. Anxiety (ANX)
• enhanced negative emotional reactivity, and
there is a positive correlation between ANX
severity and negative emotionality
• Anxiety disorder can be predicted by emotion
dysregulation.
• Emotion dysregulation may also mediate
stressful life events and ANX.

6. Cognitive Behavioral Therapy (CBT)
• CBT is effective in improving emotional
regulation and reducing ANX in typical
children with anxiety disorders
• CBT treatment has proven to be
effective in lowering ANX in children
with ASD comorbiding anxiety disorder

7. CBT and ANX in Children w/ ASD
• In a RCT study by Wood, Drahota, Sze, Har, Chiu,
and Langer (2009),
– Children with ASD and anxiety disorders received
CBT treatment…
• Coping skills training prior to vivo exposures.
• Parents (Positive reinforcement techniques)
– CBT effectively lowered ANX in children.
Opportunities in Self-Evaluation

8. Self-Evaluation & Academic Self-Efficacy
• In an academic goal and self-evaluation study by Schunk and Ertmer, the relatedness of self-
regulatory strategies and self-efficacy were examined (1999).
• It was suggested that self-evaluation may have increased one’s academic self-efficacy.

9. Emotional Self Efficacy (ESE)
• What is it?
• Self-Efficacy = the
“knowingness”/”mastery”/”how well do
you understand it?”/”how well you can
control it?”
• The “knowingness” of one’s emotional
world.

10. 2 Ideas that Inspired this Paper
(1) Self-Evaluation (SE) may have increased
one’s Academic Self-Efficacy (ASE).
(2) CBT and ANX in Children w/ ASD ---
Opportunities in Self-Evaluation (SE).
This paper examines CBT treatment’s effect on
the ESE of children with ASD and anxiety
disorders, as well as the relationship between
ESE and ANX.

11. 3 Hypotheses
(1) CBT treatment increases ESE of children
with ASD and anxiety disorders. (Due to the
increased SE opportunities.)
(2) The ESE and ANX of children with ASD and
anxiety disorders have a negative relationship
(Higher the ESE; Lower the ANX…vice versa)

12. • (3) Increases in ESE will predict
decreases in ANX in our subject sample
(children with ANX and ASDs).

13. Method
• This research reports on the same database
analyzed in:
– Wood, J. J., Drahota, A., Sze, K., Har, K., & Chiu,
A. (2009). Cognitive behavioral therapy for anxiety
in children with autism spectrum disorders: a
randomized, controlled trial. Journal of Child
Psychology and Psychiatry, 50(3), 224-234.
• A special thanks to Dr. Jeffrey J. Wood,
Patricia Renno, and Cori Fuji.

14. Participants
* 40 children with ASD and one Anxiety
disorder, from 7 to 11 years old, and
their primary parents.

15. • Table 1. Descriptive information for
participating families.

16. Measurement
• Children’s anxiety (ANX) was assessed
by the Multidimensional Anxiety Scale
for Children-Parent version (MASC-P).
• Children’s emotional self-efficacy
(ESE) was assessed by a subscale
from the Self-Efficacy Questionnaire for
Parent (SEQ-P), that consisted 8
questions identified to be reliable and
valid for ESE measurement (Muris,
2001).

17. Procedure
• According to the inclusion and exclusion
criteria, children were block randomized into
either (1) immediate treatment (IT) or (2) wait
list (WL) group.
• Baseline assessments were conducted prior
to the CBT treatment.

18. Inclusion criteria of the study:
(a) met research criteria for a diagnosis of autism,
Asperger syndrome, or PDD-NOS;
(b) met research criteria for one of the following anxiety
disorders:
(1) separation anxiety disorder (SAD),
(2) social phobia, or
(3) obsessive compulsive disorder (OCD)
(c) were not taking any psychiatric medication at the
baseline assessment, or were taking a stable dose of
psychiatric medication (i.e. at least one month at the
same dosage prior to the baseline assessment), and
(d) if medication was being used, children maintained
the same dosage throughout the study.

19. Exclusion criteria of the study:
(a) the child had a verbal IQ less than 70 (as assess in
previous testing, or, if there was any question about
the child’s verbal abilities noted by the independent
evaluator at baseline, on the basis of the Wechsler
Intelligence Scale for Children-IV administered by the
independent evaluator);
(b) the child was currently in psychotherapy or social
skills training, or was receiving behavioral
interventions such as ABA;
(c) the family was currently in family therapy or a
parenting class;
(d) for any reason the child or parents appeared unable
to participate in the intervention program.

20. • 16 weekly sessions
• Building Confidence CBT program
treatment (Wood & McLeod, 2008).
• 3 sessions: basic coping skills,
• 8 sessions: vivo exposures to attempt
increasingly fearful activities.
• Parents: trained on providing support to
their children in vivo exposures, using…
– positive reinforcement,
– using communication skills
to encourage children’s independence
and autonomy in daily routines.

21. • Remaining sessions (out of the 16),
therapy modules:
–highly individualized
– selected on a session-by-session
basis to address the child’s most
pressing clinical needs.

22. Assessment Schedule:
Subjects fill out MASC-P and SEQ-P…
(1) Waiting List
(2) Pre-treatment (1) Pre-tx
(3) Post-treatment or (2) Post-tx
Post tx assessments were conducted on
the final day of treatment (or within a week
of termination).

23. • Before the CBT treatment, the ESE of the two groups
(IT and WL) were not significantly different.
• After the CBT treatment, the ESE is significantly
different between the two groups (IT and WL).
Result

24. • The ESE score was negatively correlated with
the ANX score.

25. • Linear regression analyses: Change in ESE is
a significant predictor of anxiety after
treatment (p< 0.05).
0
10
20
30
40
50
60
70
80
Treatment Phases
Mean Ratings
Emotional Self-Efficacy
Anxiety

26. Discussion
• Hypothesis 1 - Support:
– ESE is increased by the CBT treatment.

27. • Hypothesis 2 - Support:
– The ESE and ANX of children with ASD and
anxiety disorders have a negative
relationship. (Higher the ESE; Lower the
ANX.)

28. • Hypothesis 3 Support.
Linear Regression told us:
ESE subscale scores from SEQ-P can predict
ANX scores from MASC-P.
So What?
0
10
20
30
40
50
60
70
80
Treatment Phases
Mean Ratings
Emotional Self-Efficacy
Anxiety

29. • So what?
–Suggests:
•Treatment models that targets
ESE may yield promising result
in ANX reduction.
•The Self-evaluation
opportunities provided in CBT
might have contributed to the
increased ESE (Future Study).

30. • Seeing how dx symptoms interact
with tx and taking them apart (dx
symptom: ANX, tx: CBT. Taking it
apart: ESE as one of the
components) may help us better
understand the interacting nature of
a Dx and the Tx. This helps to
inspire future studies to pinpoint
exactly what the treatment is doing
right.

31. (Future Studies)
• Treatment models (ex: CBT)
that target/address ESE may
have better generalization
because such tx also providing
intervention at a meta cognitive
level (vs. ABA on behavioral
level only).

32. Reference
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Prevalence of autism spectrum disorders in a total population sample .
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34. Wood, J. J., Drahota, A., Sze, K., Har, K., Chiu, A., & Langer, D. A.
(2009). Cognitive behavioral therapy for anxiety in children with
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