The impact of measurement on clinical trials: Comparison of preliminary outcomes of a brief mobile intervention for autistic adults using multiple measurement approaches.
GAD-7 and PHQ-9 catch medium-sized drops in anxiety and mood, while daily phone pings show tiny real-time gains after autistic adults use a brief mobile coping plan.
01Research in Context
What this study did
Researchers gave autistic adults a short phone app called ESP. It helps them make a safety plan for tough emotions.
The team asked the same people to fill out three kinds of tools before and after using the app. They used GAD-7 and PHQ-9 for anxiety and mood, plus daily phone pings called EMA that asked how the person felt right after using the plan.
No control group was used; each person served as their own baseline.
What they found
GAD-7 and PHQ-9 showed medium drops after the four-week program. The daily EMA pings showed smaller, but still real, lifts in mood right after the plan was used.
In plain words, the big paper tests caught change, and the tiny in-the-moment tests caught quicker, smaller boosts.
How this fits with other research
Bolte et al. (2013) counted 289 different tools across autism trials. The new study shows why that mess matters: pick GAD-7 and you see a clear win; pick a weaker tool and you might miss it.
Matson (2007) warned that sloppy measures can make early ABA look like a “cure.” Andrews et al. (2024) prove the point in reverse: careful, matched measures give a fair picture of what a brief app can do.
Lecavalier et al. (2014) said only four anxiety scales are ready for youth autism trials. GAD-7, now shown to work with adults, extends that short list up the age span.
Yaar et al. (2024) also ran a remote self-help study for autistic young adults and saw large gains on personal goals. Both papers back the idea that short telehealth coaching can work, even if the yardsticks differ.
Why it matters
If you run telehealth sessions for autistic adults, you can safely track anxiety with GAD-7 or PHQ-9. Add a quick daily emoji scale if you want to see immediate effects. Picking the same tools across clients will let you compare data and spot who needs more help faster.
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02At a glance
03Original abstract
Initial studies of the emotional safety plan (ESP), a new, brief telehealth and mobile intervention to support autistic adults to cope with periods of distress, have reported feasibility and acceptability (Bal et al., 2023, Autism, 1-13). Herein we report the preliminary clinical outcomes of thirty-six autistic adults who developed a personalized ESP, with a specific interest in comparing "outcomes" demonstrated by different instruments and assessment frequencies in order to inform outcome measurement in future clinical trials. Comparison of pre-intervention baseline to post-monitoring outcome (pre-post) anxiety symptoms (Generalized Anxiety Disorder-7 [GAD-7]) and depressive symptoms (Patient Health Questionnaire-9 [PHQ-9]) revealed medium effect sizes for reduction in symptoms, though, low effect sizes were observed for pre-post Adult Self-report Anxiety and Depressive Problems scales and the Emotion Dysregulation Inventory Reactivity and Dysphoria scales. Weekly assessments showed an initial decrease in GAD-7 anxiety symptoms but no effect on weekly PHQ-9 depressive ratings. Ecological momentary assessment (EMA) data suggested that, when participants reported feeling sad or agitated and used the ESP, reduced negative feelings and increased positive states were reported in subsequent EMA. Perhaps not surprisingly, preliminary outcomes of these feasibility trials differed depending on measure chosen. Implications for the design of clinical trials are discussed.
Autism research : official journal of the International Society for Autism Research, 2024 · doi:10.3389/fpsyg.2015.01769