TF-CBT for Autistic Youth Pilot Implementation - Open Pilot

Implementation Science-Guided Pilot Study of Trauma-Focused Cognitive Behavioral Therapy for Autistic Youth in Community Mental Health Settings

Compared to the general population, autistic youth are at increased risk for both exposure to potentially traumatic events and trauma-related symptoms following trauma exposure. Autistic people identify approaches to effectively addressing trauma as a top mental health research priority, yet providers in community settings often report inadequate training in trauma treatment. The purpose of this study is to conduct an open pilot to evaluate the feasibility and acceptability of an evidence-based intervention for youth affected by trauma, Trauma-Focused Cognitive Behavioral Therapy (TF-CBT), that has been modified for autistic youth served in Community Mental Health Centers.

Study Overview

• Status: Recruiting
• Conditions: Trauma and Stressor Related Disorders; Autism Spectrum Disorder; Autism; Mental Health Services; PTSD and Trauma-related Symptoms
• Intervention / Treatment: Behavioral: Trauma-Focused Cognitive Behavioral Therapy, modified for autistic youth

• Study Type: Interventional
• Enrollment (Estimated): 24
• Phase: Not Applicable

Contacts and Locations

• Study Contact: Name: Kaitlyn Ahlers, PhD; Phone Number: 603-650-7075; Email: kaitlyn.p.ahlers@hitchcock.org

Study Locations

• United States
  • New Hampshire
    • Lebanon, New Hampshire, United States, 03756
      • Recruiting
      • Dartmouth Hitchcock Medical Center
      • Contact: Kaitlyn Ahlers, PhD; Phone Number: 603-650-7075; Email: kaitlyn.p.ahlers@hitchcock.org
      • Principal Investigator: Kaitlyn Ahlers, PhD

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Child; Adult; Older Adult
• Accepts Healthy Volunteers: No

Description

Inclusion Criteria for Therapists

1. Employed as a clinician at a participating Community Mental Health Center (CMHC; publicly-funded mental health program) for at least 6 months.
2. Trained in TF-CBT.
3. Has an eligible autistic youth on current caseload (see below).

Inclusion Criteria for Child Participants

1. Between 6 and 18 years old (up to 17 years, 11 months).
2. Current medical diagnosis of autism.
3. Has a non-offending caregiver who is able to participate in treatment (i.e., caregiver who is not the perpetrator of the abuse/other trauma).
4. Initiated outpatient psychotherapy services from participating therapist within enrolled CMHC.
5. A moderate level of trauma-related distress as measured by the Child and Adolescent Trauma Screen-2 (CATS-2).

Exclusion Criteria for Child Participants

1. Does not present with trauma-related distress (score falls within the "Normal" range as measured by the Child and Adolescent Trauma Screen-2 Self- and Parent-Report).

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Health Services Research
• Allocation: N/A
• Interventional Model: Single Group Assignment
• Masking: None (Open Label)

Number of Arms

1

Arms and Interventions

Participant Group / Arm

Intervention / Treatment

Experimental: Trauma-Focused Cognitive Behavioral Therapy, modified for autistic youth; Autistic youth will receive Trauma-Focused Cognitive Behavioral Therapy (TF-CBT), modified for autistic youth, an evidence-based intervention for youth affected by trauma that has been modified for autistic youth. Enrolled clinicians will receive training in how to modify TF-CBT for autistic youth.

Behavioral: Trauma-Focused Cognitive Behavioral Therapy, modified for autistic youth; Trauma-Focused Cognitive Behavioral Therapy (TF-CBT) is a cognitive-behavioral treatment to help children and adolescents recover after trauma. It is a structured, evidence-based treatment model that addresses posttraumatic stress disorder (PTSD) symptoms and other trauma-related symptoms. In TF-CBT, modified for autistic youth, clinicians will modify their use of TF-CBT for autistic youth. Clinicians will be trained in how to deliver TF-CBT to autistic youth.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Acceptability of Intervention Measure (AIM)	Parents/caregivers and therapists will complete the Acceptability of Intervention Measure (AIM), a widely used four-item measure that assesses the extent to which individuals believe an intervention is acceptable. Participants rate the intervention on a 5-point Likert scale, with higher scores indicating greater acceptability. Scores range from a minimum score of 4 to a maximum score of 20. This measure demonstrates good reliability and validity. Parents/caregivers and therapists trained in how to modify Trauma-Focused Cognitive Behavioral Therapy (TF-CBT) for autistic youth will complete the AIM at the 6-month (post-treatment) timepoint.	6 months after starting implementation
Feasibility of Intervention Measure (FIM)	Therapists will complete the Feasibility of Intervention Measure (FIM), a widely used four-item measure that assesses the extent to which individuals believe an intervention is feasible. Participants rate the intervention on a 5-point Likert scale, with higher scores indicating greater feasibility. Scores range from a minimum score of 4 to a maximum score of 20. This measure demonstrates good reliability and validity. Therapists trained in how to modify Trauma-Focused Cognitive Behavioral Therapy (TF-CBT) for autistic youth will complete the FIM at the 6-month (post-treatment) timepoint.	6 months after starting implementation
Intervention Appropriateness Measure (IAM)	Therapists will complete the Intervention Appropriateness Measure (IAM), a widely used four-item measure that assesses the extent to which individuals find an intervention to be appropriate. Participants rate the intervention on a 5-point Likert scale, with higher scores indicating greater appropriateness. Scores range from a minimum score of 4 to a maximum score of 20. This measure demonstrates good reliability and validity. Therapists trained in how to modify Trauma-Focused Cognitive Behavioral Therapy (TF-CBT) for autistic youth will complete the IAM at the 6-month (post-treatment) timepoint.	6 months after starting implementation

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Intervention Characteristics	Therapists will complete the Perceived Characteristics of Implementation Scale (PCIS), a 20-item measure that assesses providers' views on interventions. Participants rate their perceptions of the intervention on a 5-point Likert scale from 1 (strongly disagree) to 5 (strongly agree). Higher scores reflect more positive perceptions of the intervention. This measure has good reliability and construct validity.	6 months after starting implementation
Intervention Usability	Therapists will complete the Intervention Usability Scale (IUS), a 10-item measure that is closely based on the well-validated System Usability Scale. Participants rate the intervention on a 1 to 5 scale and yield a total score from 0 to 100. High scores reflect greater usability. The IUS has good internal consistency.	6 months after starting implementation

Other Outcome Measures

Outcome Measure	Measure Description	Time Frame
Change in symptoms via the Child Behavior Checklist (CBCL)	Parents/caregivers will complete the Child Behavior Checklist (CBCL), a broadband parent report measure of child problem behavior. Caregivers rate 113 items assessing a range of child emotional and behavioral problems on a 3-point Likert scale from 0 (not true) to 2 (very true or often true). This measure demonstrates good reliability and validity. Raw scores from the internalizing and externalizing scales will be used in this study; higher scores reflect greater psychopathology.	Baseline, 6 months
Change in symptoms via the Youth Self Report (YSR)	Youth (11 and up) will complete the Youth Self-Report, a broadband self-report measure of child problem behavior. Youth rate 113 items assessing a range of child emotional and behavioral problems on a 3-point Likert scale from 0 (not true) to 2 (very true or often true). This measure demonstrates good reliability and validity. Raw scores from the internalizing and externalizing scales will be used in this study; higher scores reflect greater psychopathology.	Baseline, 6 months
Change in trauma-related cognitions via the Child Post-Traumatic Cognitions Inventory (CPTCI) score	Youth will complete the Child Post-Traumatic Cognitions Inventory (CPTCI), a 25-item measure of trauma-related cognitions. Youth rate their agreement with a list of statements on a 4-point Likert scale from "don't agree at all" to "agree a lot", and scores range from a minimum score of 25 to a maximum score of 100. Higher scores reflect more trauma-related cognitions. This measure has high internal consistency and test-retest reliability.	Baseline, 6 months
Change in child posttraumatic stress symptoms via the Child and Adolescent Trauma Screen 2 (CATS-2) Self-Report DSM-5 PTSD Total Score	The Child and Adolescent Trauma Screen 2 (CATS-2) Self-report includes 20 symptom items (assessed over the past month) that map onto the DSM-5 Posttraumatic Stress Disorder (PTSD) diagnostic criteria. Symptom items are rated on a 4-point scale from 0 (never) to 4 (almost always) based on the frequency and severity of the reported symptom experienced, with higher scores indicating greater trauma-related symptoms. Scores range from a minimum score of 0 to a maximum score of 60. This measure demonstrates acceptable to excellent internal consistency. Autistic youth will complete the CATS-2 at baseline and at the 6-month timepoints.	Baseline, 6 months
Change in child posttraumatic stress symptoms via the Child and Adolescent Trauma Screen 2 (CATS-2) Parent-Report DSM-5 PTSD Total Score	The Child and Adolescent Trauma Screen 2 (CATS-2) Parent-report includes 20 symptom items (assessed over the past month) that map onto the DSM-5 Posttraumatic Stress Disorder (PTSD) diagnostic criteria. Symptom items are rated on a 4-point scale from 0 (never) to 4 (almost always) based on the frequency and severity of the reported symptom experienced, with higher scores indicating greater trauma-related symptoms. Scores range from a minimum score of 0 to a maximum score of 60. This measure demonstrates acceptable to excellent internal consistency. Parents/caregivers will complete the CATS-2 at baseline and at the 6-month timepoints.	Baseline, 6 months
Change in behavioral avoidance via the Posttraumatic Avoidance Behavior Questionnaire (PABQ) score	Youth will complete the Posttraumatic Avoidance Behavior Questionnaire (PABQ), a 25-item measure of trauma-related avoidance behavior. Youth rate the frequency with which they avoid experiences on a 4-point Likert scale from "(almost) never" to "(almost) always", and scores range from a minimum score of 25 to a maximum score of 100. Higher scores reflect greater avoidance behavior. This measure has good test-retest validity and convergent validity with PTSD symptom severity.	Baseline, 6 months
Change in emotion regulation via the Emotion Dysregulation Inventory (EDI) Parent-Report Reactivity score	Parents will complete the Emotion Dysregulation Inventory (EDI), a 30-item measure of emotion dysregulation, including reactivity and dysphoria. Parents/caregivers rate the severity of their child's symptoms on a 5-point Likert scale from "not at all" to "very severe". The 24-item EDI Reactivity Index is scored separately from the 6-item Dysphoria Index. Scores on the Reactivity Index range from 0 to 96 and are converted to T-scores. Higher scores reflect greater emotion dysregulation. The EDI has demonstrated good validity and strong test-retest reliability in both autistic youth and general community and clinical samples.	Baseline, 6 months
Change in emotion regulation via the Emotion Dysregulation Inventory Self-Report (EDI-SR) Reactivity score	Youth (11 and up) will complete the Emotion Dysregulation Inventory Self-Report (EDI-SR), a 31-item measure of emotion dysregulation, including reactivity and dysphoria. Youth rate the severity and/or frequency of their experiences on a 5-point Likert scale from "never happens" to "almost always happens or causes a serious problem". Scores on the Reactivity Index range from 0 to 100 and are converted to T-scores. Higher scores reflect greater emotion dysregulation. The EDI-SR is based on the Emotion Dysregulation Inventory (EDI), which has demonstrated good validity and reliability.	Baseline, 6 months

Collaborators and Investigators

• Sponsor: Dartmouth-Hitchcock Medical Center
• Collaborators: National Institute of General Medical Sciences (NIGMS)
• Investigators: Principal Investigator: Kaitlyn Ahlers, PhD, Dartmouth Health

Study record dates

Study Major Dates

• Study Start (Actual): May 5, 2026
• Primary Completion (Estimated): December 31, 2026
• Study Completion (Estimated): February 28, 2027

Study Registration Dates

• First Submitted: February 12, 2026
• First Submitted That Met QC Criteria: February 12, 2026
• First Posted (Actual): February 19, 2026

Study Record Updates

• Last Update Posted (Actual): May 13, 2026
• Last Update Submitted That Met QC Criteria: May 11, 2026
• Last Verified: May 1, 2026

More Information

Terms related to this study

• Keywords: PTSD; Autism; Trauma; Implementation science; TF-CBT; Trauma-Focused Cognitive Behavioral Therapy; Mental health symptoms
• Additional Relevant MeSH Terms: Mental Disorders; Neurodevelopmental Disorders; Child Development Disorders, Pervasive; Stress Disorders, Traumatic; Autism Spectrum Disorder; Trauma and Stressor Related Disorders; Wounds and Injuries; Autistic Disorder; Stress Disorders, Post-Traumatic
• Other Study ID Numbers: STUDY02002692_1; P20GM156710 (U.S. NIH Grant/Contract)

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No