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Pilot Randomized Controlled Trial of Mindful Time, a Novel Telehealth Mindfulness-Based Intervention for Autistic Adolescents and Their Caregivers

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Title: Pilot Randomized Controlled Trial of Mindful Time, a Novel Telehealth Mindfulness-Based Intervention for Autistic Adolescents and Their Caregivers
Language: English
Authors: Nicole L. Matthews (ORCID 0000-0001-7433-1142), Melissa M. Mitchell, Hannah Honda, Amanda Malligo, Summer Boyd, Broc A. Pagni (ORCID 0000-0002-9496-7604), B. Blair Braden (ORCID 0000-0001-6842-9784)
Source: Autism: The International Journal of Research and Practice. 2025 29(7):1864-1882.
Availability: SAGE Publications. 2455 Teller Road, Thousand Oaks, CA 91320. Tel: 800-818-7243; Tel: 805-499-9774; Fax: 800-583-2665; e-mail: journals@sagepub.com; Web site: https://sagepub.com
Peer Reviewed: Y
Page Count: 19
Publication Date: 2025
Document Type: Journal Articles
Reports - Research
Descriptors: Intervention, Metacognition, Autism Spectrum Disorders, Adolescents, Parents, Program Effectiveness, Depression (Psychology), Gender Differences, Symptoms (Individual Disorders), Parent Child Relationship, Executive Function, Well Being, Mental Health, Emotional Response, Videoconferencing, Anxiety, Telecommunications, Handheld Devices
Geographic Terms: Arizona
Assessment and Survey Identifiers: Kaufman Brief Intelligence Test, Childrens Depression Inventory
DOI: 10.1177/13623613251328484
ISSN: 1362-3613
1461-7005
Abstract: A growing body of research suggests that mindfulness-based interventions may be a valuable method for reducing internalizing symptoms in autistic individuals. The current study extends this work using an effectiveness-implementation hybrid type 1 study. In this parallel randomized controlled trial, we examined a novel telehealth intervention for autistic adolescents and their caregivers. MINDful TIME includes eight weekly group meetings and regular use of a commercially available mindfulness meditation app. Participants were 42 adolescent-parent dyads randomized to the treatment or delayed treatment control (DTC) group. The program was implemented with fidelity (91.24%-94.78%), and 90% of treatment group dyads completed the program. On average, participants attended >90% of sessions and reported high acceptability. Treatment group adolescents demonstrated statistically and clinically significant reductions in parent-reported depression symptoms relative to DTC (F(1, 34) = 7.31, p = 0.01, n[subscript p superscript 2] = 0.18). Female adolescents in the treatment group showed significant reductions in parent-reported anxiety symptoms (F(1, 34) = 4.22, p = 0.05, n[subscript p superscript 2] = 0.11). Exploratory analyses indicated treatment-related improvements in adolescent executive functioning, parent mindfulness and well-being, and adolescent-parent relationship dysfunction. Findings warrant future examination of MINDful TIME to address well-documented challenges with mental health in this population. This trial was registered on clinicaltrials.gov (NCT05685589).
Abstractor: As Provided
Entry Date: 2025
Accession Number: EJ1474950
Database: ERIC
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  Value: <anid>AN0185859373;f9d01jul.25;2025Jun13.01:17;v2.2.500</anid> <title id="AN0185859373-1">Pilot randomized controlled trial of MINDful TIME, a novel telehealth mindfulness-based intervention for autistic adolescents and their caregivers </title> <p>A growing body of research suggests that mindfulness-based interventions may be a valuable method for reducing internalizing symptoms in autistic individuals. The current study extends this work using an effectiveness-implementation hybrid type 1 study. In this parallel randomized controlled trial, we examined a novel telehealth intervention for autistic adolescents and their caregivers. MINDful TIME includes eight weekly group meetings and regular use of a commercially available mindfulness meditation app. Participants were 42 adolescent-parent dyads randomized to the treatment or delayed treatment control (DTC) group. The program was implemented with fidelity (91.24%–94.78%), and 90% of treatment group dyads completed the program. On average, participants attended >90% of sessions and reported high acceptability. Treatment group adolescents demonstrated statistically and clinically significant reductions in parent-reported depression symptoms relative to DTC (F (<reflink idref="bib1" id="ref1">1</reflink>, 34) = 7.31, p = 0.01, η p 2 = 0.18). Female adolescents in the treatment group showed significant reductions in parent-reported anxiety symptoms (F (<reflink idref="bib1" id="ref2">1</reflink>, 34) = 4.22, p = 0.05, η p 2 = 0.11). Exploratory analyses indicated treatment-related improvements in adolescent executive functioning, parent mindfulness and well-being, and adolescent-parent relationship dysfunction. Findings warrant future examination of MINDful TIME to address well-documented challenges with mental health in this population. This trial was registered on clinicaltrials.gov (NCT05685589). Previous research studies have found that mindfulness (i.e. focused attention on, and acceptance of, the present moment) training programs can reduce stress, depression, and anxiety. However, more research is needed to understand whether mindfulness strategies are helpful for autistic teens. We examined a new telehealth intervention for autistic teens and their caregivers. MINDful TIME is an 8-week group program that meets weekly through Zoom meetings. Participants learn mindfulness strategies through didactic lessons and using a commercially available mindfulness meditation mobile app. We randomly assigned 42 teens (ages 13–18 years) with an autism diagnosis and their parents to complete MINDful TIME or an 8-week wait period before beginning the program. Ninety percent of teens and parents assigned to MINDful TIME completed the program and reported that they found the program to be acceptable. Teens who completed MINDful TIME showed large reductions in depression symptoms, whereas teens in the wait period group did not. Females who completed MINDful TIME also showed reductions in anxiety symptoms, whereas males who completed MINDful TIME and females and males in the wait period group did not. Parents who completed MINDful TIME with their teens showed increased mindfulness traits, well-being, and adolescent-parent relationship functioning. Findings suggest that MINDful TIME is a promising program that may improve accessibility of mindfulness strategies for autistic teens and their caregivers. Future research with a larger sample size is needed to fully understand the benefits of the program.</p> <p>Keywords: adolescents; autism; caregivers; mindfulness-based intervention; mobile app; telehealth</p> <hd id="AN0185859373-2">Introduction</hd> <p>Autism spectrum disorder (ASD) is a neurodevelopmental condition characterized by challenges with social communication and restricted and repetitive behaviors ([<reflink idref="bib1" id="ref3">1</reflink>]). Many individuals with ASD experience co-occurring mental health conditions, including depression and anxiety ([<reflink idref="bib31" id="ref4">31</reflink>]). A small but growing body of research suggests that mindfulness-based interventions (MBIs) that teach strategies for cultivating present-moment awareness through focused attention and acceptance of one's experience may be a valuable method for reducing internalizing symptoms in individuals with ASD ([<reflink idref="bib25" id="ref5">25</reflink>]). The current study extends this work by examining a telehealth intervention designed to teach mindfulness techniques to autistic adolescents and their parents.</p> <hd id="AN0185859373-3">ASD and internalizing symptoms</hd> <p>At least 50% of autistic individuals have co-occurring anxiety, depression, or both ([<reflink idref="bib35" id="ref6">35</reflink>]), and autistic youth and adults are at increased risk of suicidality ([<reflink idref="bib45" id="ref7">45</reflink>]). Internalizing symptoms limit engagement and functioning in several settings, including interpersonal relationships, school, and work. Furthermore, many autistic individuals have difficulty identifying and reporting their emotions ([<reflink idref="bib48" id="ref8">48</reflink>]), which may interfere with accurate diagnosis and treatment of mental health symptoms.</p> <p>There is a growing body of research on psychosocial interventions for internalizing symptoms in autistic individuals, with a focus on adapting existing approaches like cognitive behavioral therapy (CBT) and MBIs. Several randomized controlled trials (RCTs) have shown moderate to large effects of CBT approaches for treating anxiety in autistic individuals ([<reflink idref="bib52" id="ref9">52</reflink>]); however, less is known about whether adapted CBT approaches are effective for treating depression (see [<reflink idref="bib63" id="ref10">63</reflink>] for a review; [<reflink idref="bib11" id="ref11">11</reflink>]). Effect sizes for improvements in anxiety and depression in previous studies have varied widely based on informants, with blinded clinician ratings showing the largest effects, followed by parent-rated symptoms, and small to negligible effects when studying self-report ([<reflink idref="bib52" id="ref12">52</reflink>]; [<reflink idref="bib61" id="ref13">61</reflink>]). Furthermore, the poor quality of existing evidence for mental health interventions has been highlighted, indicating a need for additional high-quality research to increase relative certainty of the effectiveness of CBT and other interventions for autistic individuals ([<reflink idref="bib40" id="ref14">40</reflink>]).</p> <p>There is also emerging evidence indicating benefits of several types of MBIs.[<reflink idref="bib9" id="ref15">9</reflink>] A meta-analysis of 10 studies of MBIs for autistic children and adults and/or their caregivers indicated significant short-term benefits in subjective well-being; however, the authors identified considerable methodological limitations of existing studies and the need for more controlled trials to better understand potential benefits ([<reflink idref="bib25" id="ref16">25</reflink>]). More recently, [<reflink idref="bib18" id="ref17">18</reflink>] conducted a systematic review of six Mindfulness-Based Stress Reduction (MBSR) interventional studies focused on the treatment of autistic adults, three of which included a randomized control group. They concluded that MBSR was effective in reducing symptoms of anxiety and depression. However, the certainty of findings was rated as low and moderate, respectively, due to the inconsistency in study designs and statistical significance and the high risk of publication bias. The authors identified the need for additional research with randomized control groups ([<reflink idref="bib18" id="ref18">18</reflink>]). [<reflink idref="bib47" id="ref19">47</reflink>] built on evidence supporting MBSR for autistic adults with the largest sample to date and an active control group receiving social support and education. Participants in the MBSR group demonstrated improvements in executive functioning and mindfulness traits relative to the active control group. Participants in both groups demonstrated significant reductions in depression and anxiety ([<reflink idref="bib47" id="ref20">47</reflink>]).</p> <p>Less is known about MBIs for autistic adolescents. However, there is preliminary evidence supporting effectiveness of the Emotion Awareness and Skills Enhancement (EASE) program, which targets emotion regulation and was developed specifically for autistic adolescents without intellectual disability. The program consists of one-on-one, in-person therapy sessions for 16 weeks. Therapists teach participants to use mindfulness and CBT techniques for individualized emotion-regulation and socialization obstacles, and therapy sessions are augmented with a proprietary online platform that includes session summaries, meditation exercises, and other resources. Participants in the pilot study demonstrated moderate to large improvements in emotion regulation, anxiety, depression, and problem behaviors ([<reflink idref="bib12" id="ref21">12</reflink>]). Efficacy findings were preliminary and should be considered in the context of the relatively small sample size and lack of comparison to a randomized control group. A notable strength of the EASE program is its focus on individualization through weekly one-to-one sessions with a therapist. However, this model may limit scalability and accessibility considering the paucity of community-based practitioners with the necessary experience and desire to work with the autistic population. Group-based and telehealth models may help to bridge this gap.</p> <p>MyMind is a group-based MBI originally developed for youth with ADHD that has been adapted for autistic youth without intellectual disability and their parents. Three different within-group studies of MyMind[<reflink idref="bib10" id="ref22">10</reflink>] have reported treatment-related reductions in parent-reported autism symptoms and improvements in mindful parenting and/or parent mindfulness. However, none of the studies found improvements in youth self-reported mindfulness, and findings regarding youth internalizing and externalizing symptoms were mixed ([<reflink idref="bib15" id="ref23">15</reflink>]; [<reflink idref="bib49" id="ref24">49</reflink>]; [<reflink idref="bib50" id="ref25">50</reflink>]). One RCT of MyMind was conducted with Chinese autistic adolescents and their parents in Hong Kong. The study documented feasibility of the program and preliminary evidence for improvements in parent mindfulness and parent-child relationship dysfunction. However, it did not find improvements in youth autism symptoms, internalizing and externalizing symptoms, or executive functioning ([<reflink idref="bib29" id="ref26">29</reflink>]). Additional research with randomized control groups is needed to understand whether MyMind and other group-based MBIs are efficacious for autistic youth.</p> <hd id="AN0185859373-4">Telehealth-delivered interventions for autistic individuals</hd> <p>Historically, many autistic individuals and their families have faced barriers to accessing evidence-based interventions and supports. The COVID-19 pandemic magnified this issue ([<reflink idref="bib55" id="ref27">55</reflink>]) and accelerated the development of telehealth services. A recent systematic review suggested that telehealth-delivered interventions for autistic children had significant positive outcomes for children and implementers ([<reflink idref="bib16" id="ref28">16</reflink>]). Further support for the use of telehealth interventions comes from a widely disseminated evidence-based social skills program for autistic adolescents (PEERS; [<reflink idref="bib39" id="ref29">39</reflink>]) that was adapted to a telehealth model during the pandemic. Telehealth participants demonstrated comparable outcomes to participants who completed the in-person model ([<reflink idref="bib17" id="ref30">17</reflink>]).</p> <p>There is considerable evidence supporting online delivery of MBIs in the general population and clinical samples. A meta-analysis of 97 RCTs found that online MBIs yielded moderate improvements in depression and stress and small improvements in anxiety. Notably, effect sizes for stress reduction were larger for online MBIs that included therapist guidance than for those that did not ([<reflink idref="bib54" id="ref31">54</reflink>]). Far less is known about the effectiveness of online MBIs for autistic individuals, and the existing research presents mixed findings. [<reflink idref="bib26" id="ref32">26</reflink>] reported significant challenges with recruitment and retention for an RCT examining the use of a self-guided mindfulness app in autistic children and adults and their caregivers. The mindfulness app was commercially available and originally developed for use in general population children and adults. The authors identified that expanded recruitment strategies and regular communication with participants to increase retention could improve feasibility of future trials. Barriers to intervention adherence were also identified, including challenges identifying times to meditate regularly and challenges with motivation and concentration during meditations ([<reflink idref="bib26" id="ref33">26</reflink>]). In contrast, [<reflink idref="bib19" id="ref34">19</reflink>] found that autistic adults demonstrated reduced anxiety after completing a web-based MBI developed for use in the general population or a CBT program compared to a waitlist control group. Although treatment-related improvements were observed at a 3-month follow-up, treatment-group participants did not show an advantage at the 6-month follow-up due to a spontaneous improvement in the waitlist control group ([<reflink idref="bib19" id="ref35">19</reflink>]).</p> <p>A recent trial conducted by members of our team extended these findings by randomizing autistic adults to a brief habit-formation strategy referred to as "anchoring," in which daily app-based mindfulness meditation practice was paired to an established routine, such as brushing teeth. Participants who received access to the commercially available app (developed for use in the general population) and brief habit training were compared to an app-only group and a waitlist control group. Findings indicated that the habit-formation training group showed the greatest decline in depression symptoms and lower levels of depression in the 6 months following intervention. Whereas both groups with access to the app demonstrated increased meditation practice relative to the waitlist control group, the habit-formation training group showed a larger increase in meditation during the intervention period and significantly more meditation days during an 8-week post-intervention period than the app-only group ([<reflink idref="bib57" id="ref36">57</reflink>]). Findings suggest that implementing habit-formation strategies may mitigate challenges in long-term adherence that are commonly seen with mobile health interventions ([<reflink idref="bib20" id="ref37">20</reflink>]) and that autistic individuals may benefit from mindfulness meditation apps with appropriate guidance and support. Beyond the three studies described earlier, no other previous research to our knowledge has examined online MBIs for autistic individuals.</p> <hd id="AN0185859373-5">Stress in parents of autistic individuals</hd> <p>Parents of autistic children experience more stress than parents of non-autistic children, likely due to the unique needs of autistic individuals ([<reflink idref="bib8" id="ref38">8</reflink>]; [<reflink idref="bib27" id="ref39">27</reflink>]). From the context of family systems theory ([<reflink idref="bib14" id="ref40">14</reflink>]), core and co-occurring symptoms may have a bidirectional relationship with parent stress and quality of life. Parents' stress levels may be heightened when their children demonstrate challenging behaviors or internalizing symptoms, and in return, heightened parent stress could result in parent-child interactions that intensify existing symptoms ([<reflink idref="bib42" id="ref41">42</reflink>]; [<reflink idref="bib64" id="ref42">64</reflink>]). Thus, parents of autistic individuals and the parent-child relationship may also benefit from emotion-regulation techniques like mindfulness. Several studies have documented positive effects of MBIs for parents of autistic children (see [<reflink idref="bib10" id="ref43">10</reflink>]), including parent-specific programs ([<reflink idref="bib6" id="ref44">6</reflink>]), programs for youth and their parents (e.g. [<reflink idref="bib15" id="ref45">15</reflink>]), parents implementing early intervention with their child ([<reflink idref="bib62" id="ref46">62</reflink>]), and telehealth MBIs ([<reflink idref="bib41" id="ref47">41</reflink>]).</p> <hd id="AN0185859373-6">The current study</hd> <p>We developed the MINDful TIME (<emph>M</emph>indfulness-based <emph>I</emph>ntervention for <emph>N</emph>euro<emph>D</emph>iverse Teens: <emph>T</emph>elehealth <emph>I</emph>nstr-uction, <emph>M</emph>obile-app <emph>E</emph>nhanced) curriculum based on our team's past research on mindfulness-based strategies for autistic adults and community-implemented, parent-assisted psychoeducational interventions for adolescents. To maximize accessibility, we aimed to develop a program that could be delivered through telehealth by professionals in the autism field without the requirement for mindfulness expertise or certification. We combined a parent-assisted psychoeducational approach with the use of [<reflink idref="bib23" id="ref48">23</reflink>], formally Ten Percent Happier), a commercially available mobile app that includes mindfulness instruction and meditations guided by mindfulness experts.</p> <p>The first aim was to document whether MINDful TIME is a feasible and acceptable approach. Feasibility and acceptability data were reviewed on an ongoing basis and used to refine the program for subsequent groups in the study. The second aim was to collect pilot efficacy data using an RCT design. Adolescent-parent dyads were randomized to the treatment or DTC group. Participants in the treatment group completed the 8-week program while DTC participants engaged in an 8-week treatment as usual wait period, after which they began the 8-week program. The primary goal of MINDful TIME is to teach adolescents to use mindfulness strategies to manage mood symptoms. Thus, primary outcomes included change in adolescent depression, anxiety, and mindfulness traits. Parent-report measures of adolescent depression and anxiety were chosen as primary outcomes over adolescent self-report because findings from previous research on interventions for autistic youth suggest that parent report of adolescent mood symptoms may be more sensitive to treatment-related changes ([<reflink idref="bib52" id="ref49">52</reflink>]; [<reflink idref="bib61" id="ref50">61</reflink>]). We hypothesized that adolescents in the treatment group would demonstrate larger improvements in parent-reported depression and anxiety and self-reported mindfulness relative to the DTC group. The inclusion criteria for the current study did not require participants to demonstrate clinically significant depression or anxiety symptoms. For this reason, we conducted post hoc follow-up analyses to explore potential treatment effects among adolescents whose parents reported elevated symptoms on the respective measure at baseline. In addition, we utilized exploratory analyses to test (a) whether treatment-group adolescents would show improvements in self-reported depression, anxiety, and well-being, as well as parent-reported executive, adaptive, and social functioning relative to DTC adolescents, and (b) whether treatment-group parents would show improvements in self-reported mindfulness, well-being, adolescent-parent relationship functioning, and family quality of life. In the context of previous research suggesting sex-specific effects of MBSR among autistic adults ([<reflink idref="bib9" id="ref51">9</reflink>]), we used post hoc exploratory analyses to examine potential interactions between study group and adolescent biological sex assigned at birth (SAB) for all adolescent-specific outcome measures.</p> <hd id="AN0185859373-7">Method</hd> <p></p> <hd id="AN0185859373-8">Design</hd> <p>This report describes an effectiveness-implementation hybrid type 1 study ([<reflink idref="bib38" id="ref52">38</reflink>]) that included a pilot parallel RCT of a telehealth MBI for autistic adolescents and their parents. Adolescent-parent dyads were recruited to one of two cohorts (Spring and Fall of 2023) from January to July of 2023. Participants were randomized to the treatment or DTC group after completing baseline data collection. Randomization was stratified by adolescent age, biological SAB, and race/ethnicity (i.e. White/non-White). The data manager at the autism center, who was not otherwise involved with the study, randomized participants using a random number generator. Reported in Figure 1, DTC participants completed an 8-week wait period prior to beginning the intervention. All participants were asked to complete an immediate follow-up data collection after exiting the intervention or wait period. Baseline and follow-up study visits were conducted by a trained research assistant using (Health Insurance Portability and Accountability Act)-compliant Zoom meetings. Cohort 1 began the intervention in April 2023 (treatment group) or June 2023 (DTC). Cohort 2 began the intervention in August 2023 (treatment group) or November 2023 (DTC). The trial ended after the target sample size was enrolled and study procedures were completed. All study procedures were approved by the Arizona State University Institutional Review Board. This trial was pre-registered on clinicaltrials.gov (NCT05685589).</p> <p>Graph: Figure 1. CONSORT diagram.</p> <hd id="AN0185859373-9">Participants</hd> <p>The target sample size (<emph>n</emph> = 40 dyads) was determined based on the feasibility of delivering the program to four groups (two treatment-group cohorts and two DTC cohorts) over the year-long funding period. Participants were recruited through phone calls and emails to families in a database maintained by the autism center where the study was conducted; sponsored and unsponsored social media posts; distribution of school-approved study flyers to students at schools throughout Arizona; and recruitment at community events. We oversampled for participants traditionally underrepresented in research by prioritizing recruitment and enrollment of adolescent participants of non-White race/ethnicity and/or with an annual household income below the median for the state of Arizona with a goal that at least half of the adolescent sample would meet one or both criteria. Eligible adolescents had to be 13–18 years of age and have a formal clinical or educational ASD diagnosis confirmed by records review. Adolescent-parent dyads had to be willing to be randomized to the treatment or DTC group, able to attend at least seven of eight group meetings, be English speaking, and live in the state of Arizona. Adolescents had to report experiencing stress, anxiety symptoms, and/or depression symptoms during an intake interview and indicate that they would like to learn strategies for managing those symptoms. Potential participants were excluded if the adolescent was non-verbal, had an IQ < 70, had co-occurring symptoms (e.g. selective mutism) that prevented participation in weekly group meetings, reported active suicidal ideation, or reported passive suicidal ideation and were not under the care of a mental health professional.</p> <p>Adolescent-parent dyads who met basic eligibility criteria during a phone screening were scheduled for a 90-minute remote intake visit held using HIPAA-compliant Zoom Meetings, during which informed consent and assent were obtained using REDCap. Separate intake interviews were conducted with each teen and parent to determine eligibility, and the teen completed online administration of the Kaufman Brief Intelligence Test (KBIT-2) to confirm that their IQ was ⩾70. Recent research suggests consistency between in-person and online administration of the KBIT-2 for autistic adolescents ([<reflink idref="bib2" id="ref53">2</reflink>]). Of 104 families that discussed participation with the study coordinator, 42 adolescent-parent dyads met inclusion criteria, consented/assented to participate, completed baseline data collection, and were randomized to the treatment group (<emph>n</emph><emph>=</emph> 21 dyads) or DTC group (<emph>n</emph><emph>=</emph> 21 dyads; see Table 1 for participant demographics).</p> <p>Table 1. Participant demographics.</p> <p>Graph</p> <p> <ephtml> <table><colgroup><col align="left" /><col align="char" char="." /><col align="char" char="." /><col align="char" char="." /><col align="char" char="." /></colgroup><thead><tr><th /><th align="left">Treatment (<italic>n</italic> = 19)</th><th align="left">Control (<italic>n</italic> = 20)</th><th align="left">Group comparisons</th><th align="left">Lost to attrition (<italic>n</italic> = 3)</th></tr></thead><tbody><tr><td colspan="5"><bold>Adolescent variables</bold></td></tr><tr><td> Age (years)</td><td>15.32 (1.60)</td><td>15.10 (1.55)</td><td><italic>t</italic>(37) = −0.43, <italic>p</italic> = 0.67</td><td>14.67 (0.58)</td></tr><tr><td> Sex assigned at birth (% male)</td><td>68.4%</td><td>60.0%</td><td>χ2(1) = 0.30, <italic>p</italic> = 0.58</td><td>66.7%</td></tr><tr><td colspan="5"> Gender identity</td></tr><tr><td> Male</td><td>57.9%</td><td>60.0%</td><td /><td>66.7%</td></tr><tr><td> Female</td><td>26.3%</td><td>25.0%</td><td /><td>33.3%</td></tr><tr><td> Gender variant, non-conforming, or transgender</td><td>10.6%</td><td>10.0%</td><td /><td>0.0%</td></tr><tr><td> Prefer not to answer</td><td>5.3%</td><td>5.0%</td><td /><td>0.0%</td></tr><tr><td> Underrepresented racial/ethnic group<xref ref-type="table-fn" rid="tfn1">a</xref></td><td>42.1%</td><td>45.0%</td><td>χ2(1) = 0.03, <italic>p</italic> = 0.86</td><td>66.7%</td></tr><tr><td colspan="5"> Race</td></tr><tr><td> American Indian or Alaskan Native</td><td>5.3%</td><td>0.0%</td><td /><td>0.0%</td></tr><tr><td> Asian</td><td>0.0%</td><td>15.0%</td><td /><td>0.0%</td></tr><tr><td> Black or African American</td><td>5.3%</td><td>5.0%</td><td /><td>66.7%</td></tr><tr><td> White</td><td>73.7%</td><td>70.0%</td><td /><td>33.3%</td></tr><tr><td> Multiple</td><td>10.6%</td><td>10.0%</td><td /><td>0.0%</td></tr><tr><td> Other</td><td>5.3%</td><td>0.0%</td><td /><td>0.0%</td></tr><tr><td> Ethnicity (Hispanic or Latino)</td><td>26.3%</td><td>20.0%</td><td /><td>0.0%</td></tr><tr><td> Annual household income</td><td /><td /><td>Fisher's exact <italic>p</italic> = 1.00<xref ref-type="table-fn" rid="tfn2">b</xref></td><td /></tr><tr><td> <$20,000</td><td>5.3%</td><td>5.0%</td><td /><td>0.0%</td></tr><tr><td> $20,000–$40,000</td><td>10.5%</td><td>0.0%</td><td /><td>33.3%</td></tr><tr><td> $40,001–$65,000</td><td>10.5%</td><td>20.0%</td><td /><td>0.0%</td></tr><tr><td> $65,001–$80,000</td><td>10.5%</td><td>0.00%</td><td /><td>66.7%</td></tr><tr><td> $80,001–$100,000</td><td>15.8%</td><td>10.00%</td><td /><td>0.0%</td></tr><tr><td> >$100,000</td><td>47.4%</td><td>65.0%</td><td /><td>0.0%</td></tr><tr><td> Verbal IQ</td><td>99.47 (14.49)</td><td>96.90 (20.12)</td><td><italic>t</italic>(37) = −0.46, <italic>p</italic> = 0.65</td><td>80.67 (11.02)</td></tr><tr><td> Elevated/Very elevated depression symptoms</td><td>63.2%</td><td>60.0%</td><td>χ2(1) = 0.04, <italic>p</italic> = 0.84<xref ref-type="table-fn" rid="tfn3">c</xref></td><td>33.3%</td></tr><tr><td> Elevated/Very elevated anxiety symptoms</td><td>73.7%</td><td>70.0%</td><td>χ2(1) = 0.07, <italic>p</italic> = 0.80<xref ref-type="table-fn" rid="tfn3">c</xref></td><td>66.7%</td></tr><tr><td colspan="5"><bold>Parent variables</bold></td></tr><tr><td> Age (years)</td><td>47.84 (5.81)</td><td>47.55 (7.42)</td><td><italic>t</italic>(37) = −0.14, <italic>p</italic> = 0.89</td><td>36.67 (3.22)</td></tr><tr><td> Sex assigned at birth (% female)</td><td>94.7%</td><td>95.0%</td><td>Fisher's exact <italic>p</italic> = 1.00</td><td>100%</td></tr><tr><td> Highest level of education</td><td /><td /><td>Fisher's exact <italic>p</italic> = 1.00<xref ref-type="table-fn" rid="tfn4">d</xref></td><td /></tr><tr><td> Trade school</td><td>0.0%</td><td>0.0%</td><td /><td>33.3%</td></tr><tr><td> Some college</td><td>21.1%</td><td>20.0%</td><td /><td>0%</td></tr><tr><td> College degree</td><td>36.8%</td><td>25.0%</td><td /><td>66.7%</td></tr><tr><td> Graduate degree</td><td>42.1%</td><td>55.0%</td><td /><td>0%</td></tr></tbody></table> </ephtml> </p> <p>1 Includes participants who identified as American Indian or Alaskan Native, Asian, Black or African American, Multiple, Other, and/or Hispanic/Latino.</p> <ulist> <item>2 Fisher's exact compared the proportion of families above and below the median annual household income for the state of Arizona ($65,000) at the time of study enrollment.</item> <item>3 Chi-square compared the proportion of adolescents with scores <65 and ⩾65 on the Children's Depression Inventory, Second Edition (CDI-2) and Multidimensional Anxiety Scale for Children (MASC-2), respectively.</item> <item>4 Fisher's exact compared the proportion of parents with a college/graduate degree to the percentage of parents whose highest level of education was trade school or some college.</item> </ulist> <hd id="AN0185859373-10">MINDful TIME intervention</hd> <p>MINDful TIME (see Table 2) is a group-based telehealth intervention for autistic adolescents and their caregivers. The program teaches mindfulness-based strategies and habit-formation techniques with a primary goal of supporting adolescents to develop a regular mindfulness meditation practice using a commercially available mindfulness meditation mobile app ([<reflink idref="bib23" id="ref54">23</reflink>]). Habit-formation techniques were informed by behavior economics literature (e.g. identifying intrinsic motivation and extrinsic motivators; anchoring regular mindfulness meditations to an existing routine) and strategies identified through interviews with autistic adults in a previous study (e.g. energy accounting; [<reflink idref="bib44" id="ref55">44</reflink>]). Key mindfulness concepts, meditations, and exercises were adapted from MBSR ([<reflink idref="bib33" id="ref56">33</reflink>]). Weekly lesson plans were documented in a program protocol and followed by delivering clinicians.</p> <p>Table 2. Summary of MINDful TIME group meetings and home practice.</p> <p>Graph</p> <p> <ephtml> <table><colgroup><col align="left" /><col align="char" char="." /><col align="char" char="." /><col align="char" char="." /></colgroup><thead><tr><th align="left">Week</th><th align="left">Topics</th><th align="left">Activities</th><th align="left">Home practice</th></tr></thead><tbody><tr><td>1</td><td>• Introductions and agreements• Defining stress, anxiety, and depression• What is mindfulness?• What is meditation?• Introduce Ten Percent Happier App</td><td>• Mindful coloring• Guided meditation and inquiry: 5-minute body scan</td><td>• Teens and parents read the Week 1 handout together• Teens and parents complete one 5-minute body scan meditation for 5 of 7 days• Teens and parents discuss what they noticed during home practice at least one time</td></tr><tr><td>2</td><td>• Home Practice Review• Intrinsic motivation to practice mindfulness• Mindfulness key concepts: non-judgment, non-striving, and mental noting• Habit formation key concept: Energy Accounting</td><td>• Mindful kaleidoscope activity• Guided meditation and inquiry: 5-minute body scan</td><td>• Teens and parents read the Week 2 handout together• Teens and parents complete one 5-minute body scan for 5 of 7 days• Teens and parents discuss what they noticed during home practice at least one time• Teens and parents should pay attention to their energy levels throughout the week and identify times when they have enough energy to do their meditation home practice each day.</td></tr><tr><td>3</td><td>• Home Practice Review• Mindfulness key concepts: Beginner's mind and curiosity• Stress response; neurology of big emotions and mindfulness• Introduce longer meditations• Introduce mindful movement</td><td>• Mindfully eating a raisin• Guided meditation and inquiry: 10-minute gentle mindful movement</td><td>• Teens and parents read the Week 3 handout together• Teens and parents complete one meditation (up to 10 minutes) for 6 of 7 days. Alternate mindful movement and body scan meditations• Teens and parents discuss what they noticed during home practice at least one time• Mindful daily activities: Choose one daily activity that you will bring mindfulness to this week and pay attention to what you notice.</td></tr><tr><td>4</td><td>• Home Practice Review• Habit formation key concepts: planning, anchoring, and tracking your behavior• Mindfulness key concepts: acceptance, letting go, trust</td><td>• Awareness of breath pinwheel activity• Guided meditation and inquiry: 10-minute awareness of breath</td><td>• Teens and parents read the Week 4 handout together• Teens and parents complete a meditation for 6 of 7 days (up to 10 minutes). Alternate awareness of breath and body scan meditations• Teens and parents discuss what they noticed during home practice at least one time• Mindful daily activities: Choose one daily activity that you will bring mindfulness to this week and pay attention to what you notice.</td></tr><tr><td>5</td><td>• Home Practice Review• Habit formation key concepts: rewarding yourself• Mindfulness key concepts: patience, STOP Method• Introduce walking meditations</td><td>• Listening to music mindfully• Guided meditation and inquiry: 15-minute formal walking meditation</td><td>• Teens and parents read the Week 5 handout together• Teens and parents use the STOP Method when feeling panicked or overwhelmed• Teens and parents complete a meditation (up to 15 minutes) for 6 of 7 days. Alternate mindful walking and body scan meditations• Teens and parents discuss what they noticed during home practice at least one time• Mindful daily activities: Choose one daily activity that you will bring mindfulness to this week and pay attention to what you notice.</td></tr><tr><td>6</td><td>• Home practice review with mindful listening• Mindfulness key concepts: gratitude and generosity</td><td>• Gratitude journal• Guided meditations and inquiry: 10-minute gratitude meditation and 10-minute loving kindness meditation</td><td>• Teens and parents read the Week 6 handout together• Teens and parents write down three things they are grateful for in their gratitude calendar each day• Teens and parents complete a meditation (up to 20 minutes) for 6 of 7 days. Alternate between gratitude, loving kindness, and mindful movement meditations• Teens and parents discuss what they noticed during home practice at least one time• Mindful daily activities: Choose one daily activity that you will bring mindfulness to this week and pay attention to what you notice.• Teens and parents should use the STOP Method when feeling panicked or overwhelmed</td></tr><tr><td>7</td><td>• Home practice review with mindful listening• Mindfulness key concepts: impermanence, letting go of what you can't control</td><td>• Listening to music mindfully• Circles of influence handout• Guided meditation and inquiry: 20-minute accepting change meditation</td><td>• Teens and parents read the Week 7 handout together• Teens and parents complete a meditation (up to 20 minutes) for 6 of 7 days. Alternate between gratitude, loving kindness, and mindful movement meditations• Teens and parents discuss what they noticed during home practice at least one time• Mindful daily activities: Choose one daily activity that you will bring mindfulness to this week and pay attention to what you notice.• Teens and parents should use the STOP Method when feeling panicked or overwhelmed</td></tr><tr><td>8</td><td>• Home practice review• Review of mindfulness key concepts• Review of habit formation key concepts• Plan for continuing meditation practice</td><td>• Mindful coloring• Guided meditation and inquiry: 10-minute present moment</td><td>• Continue formal meditations using the app for at least 5 minutes just about every day• Continue bringing mindfulness to daily activities• Continue checking in with your parent/teen</td></tr></tbody></table> </ephtml> </p> <p>Teens and parents attended separate weekly 90-minute group meetings held through Zoom on a weeknight (teen group 4:00–5:30 pm; parent group 5:30–7:00 pm) for 8 weeks. Teen group meetings were led by two bachelor's-level clinicians, and parent group meetings were led by a licensed psychologist. Group facilitators had considerable experience in the autism field (5–17 years) but did not have formal training in teaching mindfulness techniques. However, facilitators had familiarity with mindfulness techniques through their own mindfulness practice. Teens and parents were introduced to key mindfulness and habit formation concepts using didactic lessons, the Socratic method, activities, and guided meditations from the Happier app. Parents and teens were assigned weekly home practice, which included regular mindfulness meditations and other activities to apply concepts learned during the group. Parents were included in the program to support adolescent engagement with program strategies outside of group meetings. During group meetings, parents learned strategies to facilitate their adolescents' home practice and troubleshoot barriers to program engagement with the parent group facilitator. In addition, parents learned the same content as adolescents and were encouraged to establish their own mindfulness practice. This component of the program was designed to equip parents to better support their adolescents but may also directly benefit caregivers by providing strategies to manage their own stress and mood symptoms. Many adolescent-parent dyads chose to complete their home practice together; however, this was not a required component of the assignment. The research team offered loaner devices and/or Internet hotspots to families who would have otherwise been unable to participate. Two families borrowed a loaner device; no families required an Internet hot spot. Facilitators and research assistants met weekly to review participants' progress and fidelity of implementation (FOI). Brief (5–15 minutes) individualized side meetings were held with adolescents as needed before or after the weekly group meetings to troubleshoot barriers to progress. Side meetings were held with 10 of the 21 treatment group adolescents (48%); eight participated in one side meeting, whereas two participated in two side meetings.[<reflink idref="bib11" id="ref57">11</reflink>] Topics of side meetings included strategies for paying attention during the group meetings (e.g. removing distracting stimuli; fidgets; appropriately asking for a short break), increasing engagement with home practice assignments, and strategies for remembering details from their own home practice to report back to the group. Depending on the topic and the adolescent's support needs, some side meetings also included the parent.</p> <hd id="AN0185859373-11">DTC group</hd> <p>Participants in the DTC group were instructed to continue treatment as usual during their 8-week wait period. Parent-reported treatments for both study groups are reported in Table 3. After completing their wait period and first follow-up data collection, DTC participants began MINDful TIME.</p> <p>Table 3. Parent-reported co-occurring mood disorders and therapies.</p> <p>Graph</p> <p> <ephtml> <table><colgroup><col align="left" /><col align="char" char="." /><col align="char" char="." /></colgroup><thead><tr><th /><th align="left">Treatment (<italic>n</italic> = 19)</th><th align="left">DTC (<italic>n</italic> = 20)</th></tr></thead><tbody><tr><td colspan="3"><bold>Co-occurring mood disorders</bold></td></tr><tr><td>Depression</td><td>2 (11%)</td><td>5 (25%)</td></tr><tr><td>Anxiety</td><td>7 (37%)</td><td>7 (35%)</td></tr><tr><td>Obsessive compulsive</td><td>0 (0%)</td><td>2 (10%)</td></tr><tr><td>Impulse mood disorder</td><td>1 (5.3%)</td><td>0 (0%)</td></tr><tr><td><bold>Behavioral therapies</bold><xref ref-type="table-fn" rid="tfn6">a</xref></td><td>9 (47%)</td><td>8 (40%)</td></tr><tr><td>Counselor/Psychologist (CBT/talk therapy/unspecified approach)</td><td>8</td><td>8</td></tr><tr><td>Speech therapy</td><td>0</td><td>4</td></tr><tr><td>ABA therapy</td><td>0</td><td>1</td></tr><tr><td>Occupational therapy</td><td>1</td><td>1</td></tr><tr><td colspan="3"><bold>Medications</bold></td></tr><tr><td>ADHD<xref ref-type="table-fn" rid="tfn7">b</xref></td><td>2 (10.5%)</td><td>7 (35%)</td></tr><tr><td>Antidepressants</td><td>7 (37%)</td><td>10 (50%)</td></tr><tr><td>Mood stabilizers</td><td>0 (0%)</td><td>2 (10%)</td></tr><tr><td>Typical or atypical antipsychotics<xref ref-type="table-fn" rid="tfn7">b</xref></td><td>4 (21%)</td><td>2 (10%)</td></tr></tbody></table> </ephtml> </p> <ulist> <item>5 DTC = delayed treatment control; CBT = cognitive behavioral therapy; ABA = applied behavior analysis.</item> <item>6 One or more behavioral therapies.</item> <item>7 One or more medication of this type.</item> </ulist> <hd id="AN0185859373-12">Feasibility and acceptability measures</hd> <p>Assessment of implementation feasibility included interventionist retention, treatment fidelity, feedback to and from interventionists, program adherence, home practice engagement, program retention, and adolescent and parent ratings of program acceptability ([<reflink idref="bib58" id="ref58">58</reflink>]). A trained research assistant recorded attendance, completed an FOI checklist, and recorded home practice completion during group meetings. For each meeting, an FOI percentage was calculated by dividing the number of checklist items completed by the total number of checklist items. FOI percentages were averaged across all program sessions for each cohort. FOI was reviewed weekly by the principal investigator (PI). During weekly supervision meetings, the PI provided feedback related to FOI to interventionists as needed, and interventionists were asked to provide feedback on the respective week's implementation protocol. Program adherence was operationalized as percentage of sessions attended. Home practice engagement was operationalized as the number of home practice meditations completed. During home practice review, a research assistant took notes on adolescent and parent reports of the number of app-based guided meditations they completed each week. Despite instructions and probing from the group facilitators to report the number of meditations completed, some adolescents and parents gave vague responses (e.g. a few meditations; almost every day). For this reason, engagement with home practice meditations was coded as "Complete" if there was a clear report of five or more meditations; "Partially complete" if there was a clear report of one to four meditations or unclear report indicating at least one meditation was completed, or "Incomplete" if no meditations were completed. Parents and teens completed 26- and 10-item online acceptability questionnaires, respectively, adapted from the study by [<reflink idref="bib56" id="ref59">56</reflink>]; see Table 5). The acceptability questionnaires also included open-ended questions about strengths and limitations of the program.</p> <hd id="AN0185859373-13">Primary outcome measures</hd> <p></p> <hd id="AN0185859373-14">Children's Depression Inventory, Second Edition parent rating form</hd> <p>The Children's Depression Inventory, Second Edition (CDI-2) is a 27-item questionnaire that evaluates depressive symptoms in children and adolescents. Parents rated the frequency of their child's symptoms on a 4-point Likert-type scale ranging from 0 (<emph>Not at all</emph>) to 3 (<emph>Much or most of the time</emph>). Total <emph>T</emph>-scores range from 30 to 90, with higher scores indicating higher levels of depression symptoms ([<reflink idref="bib36" id="ref60">36</reflink>]). The CDI-2 has consistently shown strong psychometric properties including internal consistency and test–retest reliability, along with concurrent, construct, and predictive validity ([<reflink idref="bib28" id="ref61">28</reflink>]; [<reflink idref="bib37" id="ref62">37</reflink>]).</p> <hd id="AN0185859373-15">Multidimensional Anxiety Scale for Children parent form</hd> <p>The Multidimensional Anxiety Scale for Children (MASC-2) Parent form is a 50-item questionnaire that evaluates anxiety symptoms in children and adolescents between 8 and 19 years. Parents rated their child's symptoms on a Likert-type scale ranging from 0 (<emph>Never</emph>) to 3 (<emph>Often</emph>). <emph>T-</emph>scores range from 30 to 90, with higher scores indicating higher levels of anxiety symptoms. There is consistent evidence that the MASC-2 has good psychometric properties, including high internal consistency (α = 0.89), high test–retest reliability (<emph>r</emph>s = 0.80–0.93), and evidence of convergent construct validity ([<reflink idref="bib43" id="ref63">43</reflink>]).</p> <hd id="AN0185859373-16">Child and Adolescent Mindfulness Measure</hd> <p>The Child and Adolescent Mindfulness Measure (CAMM) is a 10-item self-report measure created to assess mindfulness in children and adolescents (ages 8–18 years). Adolescents rated the extent to which they engaged in mindfulness on a 5-point Likert-type scale ranging from 0 (<emph>Never true</emph>) to 4 (<emph>Always true</emph>). Scores range from 0 to 40, with higher scores indicating higher levels of mindfulness. The CAMM has adequate internal consistency (α = 0.81) and convergent validity ([<reflink idref="bib22" id="ref64">22</reflink>]).</p> <hd id="AN0185859373-17">Exploratory outcome measures</hd> <p>Exploratory outcome measures included adolescent self-report on the Beck Youth Inventories, Second Edition (BYI-2) Depression Subscale ([<reflink idref="bib4" id="ref65">4</reflink>]), MASC-2 Self-Report form ([<reflink idref="bib43" id="ref66">43</reflink>]), and World Health Organization Five Wellbeing Index (WHO-5; [<reflink idref="bib59" id="ref67">59</reflink>]); parent report of adolescent functioning on the Adaptive Behavior Assessment System, Third Edition (ABAS-3) Parent Form ([<reflink idref="bib24" id="ref68">24</reflink>]), Social Responsiveness Scale, Second Edition (SRS-2) School-Age Form ([<reflink idref="bib13" id="ref69">13</reflink>]), and Behavior Rating Inventory of Executive Function, Second Edition (BRIEF-2) Parent Form ([<reflink idref="bib21" id="ref70">21</reflink>]); and parent self-report on the Five Facets Mindfulness Questionnaire (FFM; [<reflink idref="bib3" id="ref71">3</reflink>]), WHO-5, Family Quality of Life Scale (FQOL; [<reflink idref="bib30" id="ref72">30</reflink>]), and Stress Index for Parents of Adolescents (SIPA) Adolescent-Parent Dysfunction Domain ([<reflink idref="bib53" id="ref73">53</reflink>]). Exploratory measures are described in Supplemental Appendix A.</p> <hd id="AN0185859373-18">Data analytic plan</hd> <p></p> <hd id="AN0185859373-19">Feasibility and acceptability</hd> <p>Descriptive statistics were calculated for interventionist-retention percentages, FOI, adolescent and parent attendance percentages, percentage of weeks with complete, partially complete, and incomplete home practice meditations, and quantitative items from the adolescent and parent acceptability surveys. Feedback from interventionists about the weekly protocols was discussed during supervision meetings; when feasible, modifications were made to the protocol for use with future groups.</p> <hd id="AN0185859373-20">Pilot efficacy</hd> <p>Baseline equivalency for demographic and primary outcome variables was tested using independent samples <emph>t</emph>-tests. To compare between-group differences in primary outcome variables, a Multivariate Analysis of Covariance (MANCOVA) was conducted with positive change scores (i.e. improvement from baseline) for parent-reported adolescent depression (CDI-2) and anxiety symptoms (MASC-2) and teen-reported mindfulness (CAMM) as dependent variables. Baseline scores for each variable (CDI-2, MASC-2, and CAMM) were entered as covariates; alpha was set at 0.05. Separate follow-up 2 (study group: Treatment or DTC) × 2 (SAB: male or female) ANCOVAs were conducted to examine the potential group by biological sex interactions. In addition, separate follow-up ANCOVAs were conducted for CDI-2 and MASC-2 among participants with elevated or very elevated scores (i.e. <emph>T-</emph>score ⩾ 65) at baseline.</p> <p>Separate ANCOVAs with positive change scores for secondary outcome variables were conducted with baseline scores for the respective variable entered as a covariate. Due to the exploratory nature of analyses for secondary outcome variables, we did not correct for multiple comparisons; alpha was set at 0.05. Only statistically significant results are reported for exploratory variables in the text; descriptive statistics and effect sizes are reported for all exploratory variables in Table 4.</p> <p>Table 4. Descriptive statistics, baseline t -tests, and univariate tests for primary and secondary outcome variables.</p> <p>Graph</p> <p> <ephtml> <table><colgroup><col align="left" /><col align="char" char="." /><col align="char" char="." /><col align="char" char="." /><col align="char" char="." /><col align="char" char="." /><col align="char" char="." /><col align="char" char="." /><col align="char" char="." /><col align="char" char="." /><col align="char" char="." /><col align="char" char="." /></colgroup><thead><tr><th align="left">Primary outcome variables</th><th align="left" colspan="4">MINDful TIME treatment group (<italic>n</italic> = 19)</th><th align="left" colspan="4">Delayed treatment control group (<italic>n</italic> = 20)</th><th align="left">Baseline <italic>t</italic>-test</th><th align="left" colspan="2">Follow-up univariate test or exploratory ANCOVA</th></tr><tr><th /><th align="left">Baseline, <italic>M</italic> (<italic>SD</italic>)</th><th align="left">Time 2, <italic>M</italic> (<italic>SD</italic>)</th><th align="left">Positive change score, <italic>M</italic> (<italic>SD</italic>)</th><th align="left">Positive change score, <italic>Adj M</italic> (<italic>SE</italic>)</th><th align="left">Baseline, <italic>M</italic> (<italic>SD</italic>)</th><th align="left">Time 2, <italic>M</italic> (<italic>SD</italic>)</th><th align="left">Positive change score, <italic>M</italic> (<italic>SD</italic>)</th><th align="left">Positive change score, <italic>Adj M</italic> (<italic>SE</italic>)</th><th align="left"><italic>p</italic>-Value</th><th align="left"><italic>p</italic>-Value</th><th align="left"><p><math display="inline" xmlns="http://www.w3.org/1998/Math/MathML"><mrow xmlns=""><msubsup><mi>η</mi><mi>p</mi><mn>2</mn></msubsup></mrow></math></p></th></tr></thead><tbody><tr><td><bold> CDI-2 (parent report)</bold></td><td><bold>65.89 (10.21)</bold></td><td><bold>59.53 (7.86)</bold></td><td><bold>6.37 (7.14)</bold></td><td><bold>6.24 (1.61)</bold></td><td><bold>66.10 (9.93)</bold></td><td><bold>66.10 (12.21)</bold></td><td><bold>0.00 (7.05)</bold></td><td><bold>0.12 (1.57)</bold></td><td><bold>.95</bold></td><td><bold>.01</bold></td><td><bold>.18</bold></td></tr><tr><td> MASC-2 (parent report)</td><td>75.89 (14.54)</td><td>71.95 (12.53)</td><td>3.95 (8.35)</td><td>3.58 (1.49)</td><td>72.00 (16.83)</td><td>69.75 (17.00)</td><td>2.25 (5.12)</td><td>2.60 (1.45)</td><td>.45</td><td>.65</td><td>.01</td></tr><tr><td> CAMM (adolescent report)</td><td>19.79 (6.77)</td><td>21.95 (8.20)</td><td>2.16 (5.43)</td><td>2.21 (1.27)</td><td>22.05 (9.35)</td><td>20.90 (10.10)</td><td>−1.15 (6.21)</td><td>−1.20 (1.24)</td><td>.40</td><td>.06</td><td>.10</td></tr><tr><td colspan="12"><bold>Secondary outcome variables</bold></td></tr><tr><td colspan="12">Teen functioning</td></tr><tr><td> BYI-2 (Teen report)</td><td>57.53 (9.86)</td><td>56.42 (9.22)</td><td>1.11 (8.30)</td><td>0.81 (1.54)</td><td>55.80 (11.00)</td><td>56.45 (9.90)</td><td>−0.65 (6.58)</td><td>−0.37 (1.50)</td><td>.61</td><td>.59</td><td>.01</td></tr><tr><td> MASC-2 (teen report)</td><td>63.42 (14.14)</td><td>64.32 (16.52)</td><td>−0.90 (8.93)</td><td>−0.81 (1.84)</td><td>64.95 (19.98)</td><td>66.60 (18.08)</td><td>−1.65 (7.34)</td><td>−1.73 (1.80)</td><td>.79</td><td>.72</td><td>.00</td></tr><tr><td> WHO-5 Quality of Life (teen report)</td><td>54.53 (22.44)</td><td>62.67 (16.28)</td><td>8.14 (20.19)</td><td>6.20 (3.33)</td><td>62.40 (18.60)</td><td>62.40 (19.00)</td><td>0.00 (13.98)</td><td>1.85 (3.24)</td><td>.24</td><td>.36</td><td>.02</td></tr><tr><td><bold> BRIEF-2 (parent report)</bold></td><td><bold>66.47 (8.88)</bold></td><td><bold>63.95 (8.94)</bold></td><td><bold>2.53 (3.64)</bold></td><td><bold>2.57 (1.04)</bold></td><td><bold>69.00 (11.87)</bold></td><td><bold>69.90 (12.88)</bold></td><td><bold>−0.90 (5.13)</bold></td><td>−<bold>0.94 (1.01)</bold></td><td><bold>.46</bold></td><td><bold>.02</bold></td><td><bold>.14</bold></td></tr><tr><td> ABAS-3 (parent report)</td><td>79.16 (10.31)</td><td>83.05 (11.99)</td><td>3.90 (7.79)</td><td>4.00 (1.56)</td><td>77.45 (12.39)</td><td>78.90 (12.11)</td><td>1.45 (5.77)</td><td>1.35 (1.52)</td><td>.64</td><td>.23</td><td>.04</td></tr><tr><td> SRS-2 (parent report)</td><td>71.00 (10.87)</td><td>68.68 (11.10)</td><td>2.32 (6.08)</td><td>2.88 (1.57)</td><td>76.65 (12.10)</td><td>76.30 (11.68)</td><td>0.35 (7.78)</td><td>−0.19 (1.53)</td><td>.13</td><td>.18</td><td>.05</td></tr><tr><td colspan="12">Parent functioning</td></tr><tr><td><bold> Five Facet Mindfulness Questionnaire</bold></td><td><bold>3.47 (0.58)</bold></td><td><bold>3.77 (0.47)</bold></td><td><bold>0.30 (0.50)</bold></td><td><bold>0.35 (0.08)</bold></td><td><bold>3.19 (0.49)</bold></td><td><bold>3.17 (0.50)</bold></td><td>−<bold>0.02 (0.29)</bold></td><td>−<bold>0.07 (0.08)</bold></td><td><bold>.11</bold></td><td><bold>.001</bold></td><td><bold>.26</bold></td></tr><tr><td><bold> WHO-5 Well-being</bold></td><td><bold>55.58 (20.87)</bold></td><td><bold>61.26 (14.43)</bold></td><td><bold>5.68 (19.79)</bold></td><td><bold>6.39 (3.36)</bold></td><td><bold>52.80 (17.68)</bold></td><td><bold>47.00 (19.89)</bold></td><td>−<bold>5.80 (14.54)</bold></td><td>−<bold>6.47 (3.28)</bold></td><td><bold>.66</bold></td><td><bold>.01</bold></td><td><bold>.17</bold></td></tr><tr><td colspan="12">Teen-parent functioning</td></tr><tr><td><bold> SIPA—Adolescent-Parent Relationship Dysfunction</bold></td><td><bold>49.74 (26.90)</bold></td><td><bold>42.16 (28.41)</bold></td><td><bold>7.58 (11.90)</bold></td><td><bold>7.78 (3.60)</bold></td><td><bold>52.45 (26.40)</bold></td><td><bold>57.15 (26.65)</bold></td><td>−<bold>4.70 (18.98)</bold></td><td>−<bold>4.89 (3.51)</bold></td><td><bold>.75</bold></td><td><bold>.02</bold></td><td><bold>.15</bold></td></tr><tr><td> Family QoL—Family Interaction</td><td>3.92 (0.94)</td><td>4.22 (0.80)</td><td>0.30 (0.49)</td><td>0.31 (0.10)</td><td>3.73 (0.84)</td><td>3.84 (0.93)</td><td>0.11 (0.44)</td><td>0.09 (0.10)</td><td>.51</td><td>.14</td><td>.06</td></tr><tr><td> Family QoL—Emotional Well-being</td><td>3.37 (1.17)</td><td>3.87 (0.86)</td><td>0.50 (0.90)</td><td>0.50 (0.16)</td><td>3.38 (0.98)</td><td>3.58 (0.96)</td><td>0.21 (0.87)</td><td>0.21 (0.16)</td><td>.99</td><td>.23</td><td>.04</td></tr></tbody></table> </ephtml> </p> <p>8 CDI-2 = Children's Depression Inventory, Second Edition. MASC-2 = Multidimensional Anxiety Scale, Second Edition. CAMM = Child and Adolescent Mindfulness Measure. BYI-2 = Beck Youth Inventories, Depression Subscale. Bolded rows indicate statistically significant between group differences for the respective outcome variable.</p> <hd id="AN0185859373-21">Community involvement</hd> <p>Autistic community members were not involved with the conception of the study or interpretation of findings. However, many of the program topics (e.g. energy accounting; preferred mindfulness strategies) were derived from a program developed by our team for autistic adults, which included involvement of autistic adults as members of the study team and a community advisory board ([<reflink idref="bib44" id="ref74">44</reflink>]). The current authorship team includes immediate family members of autistic children and adults.</p> <hd id="AN0185859373-22">Results</hd> <p></p> <hd id="AN0185859373-23">Feasibility and acceptability</hd> <p>Descriptive statistics for FOI, attendance, and parent/teen acceptability surveys for the dyads who completed the program are reported in Table 5. All three interventionists (two teen group co-leaders and one parent group leader) were retained throughout the duration of the study. Interventionist feedback on the weekly protocols was primarily related to the amount of time needed to complete specific sections of the protocol or activities, participant understanding of concepts, and participant like/dislike of specific guided meditations. When feasible, minor modifications were made to the respective weekly protocol for future groups (e.g. role-plays were added to demonstrate mindfulness strategies; non-preferred guided meditations were replaced with a different meditation). FOI checklists indicated that the program was implemented as intended across both treatment groups, with fidelity percentages ranging from 91.24 to 94.78. Two dyads assigned to the treatment group (9.52%) dropped after the first week of the program due to scheduling challenges. On average, adolescents and parents attended more than 90% of the group sessions. Reasons for absences included parents caring for other children, vacations, illness, and an Internet outage.</p> <p>Table 5. Descriptive statistics for fidelity of implementation, attendance, and acceptability data.</p> <p>Graph</p> <p> <ephtml> <table><colgroup><col align="left" /><col align="char" char="." /><col align="char" char="." /><col align="char" char="." /></colgroup><thead><tr><th /><th align="left">Full treatment group (<italic>n</italic> = 19), <italic>M</italic> (<italic>SD</italic>)</th><th align="left">Cohort 1 (<italic>n</italic> = 9), <italic>M</italic> (<italic>SD</italic>)</th><th align="left">Cohort 2 (<italic>n</italic> = 10), <italic>M</italic> (<italic>SD</italic>)</th></tr></thead><tbody><tr><td colspan="4"><bold>Fidelity of implementation (%)</bold></td></tr><tr><td>Teen group</td><td>93.53 (4.91)</td><td>92.28 (5.32)</td><td>94.78 (3.42)</td></tr><tr><td>Parent group</td><td>91.58 (5.49)</td><td>91.24 (5.95)</td><td>91.92 (4.36)</td></tr><tr><td colspan="4"><bold>Program adherence: Attendance (% sessions attended)</bold></td></tr><tr><td>Teen group</td><td>96.05 (7.28)</td><td>95.83 (6.25)</td><td>96.25 (8.44)</td></tr><tr><td>Parent group</td><td>91.45 (8.39)</td><td>90.28 (8.33)</td><td>92.50 (8.74)</td></tr><tr><td colspan="4"><bold>Teen acceptability</bold></td></tr><tr><td>Composite score</td><td>5.85 (0.73)</td><td>5.92 (0.62)</td><td>5.79 (0.86)</td></tr><tr><td>1. I would suggest this program to other teens who want to better manage their emotions.</td><td>6.05 (0.85)</td><td>6.00 (0.71)</td><td>6.10 (0.99)</td></tr><tr><td>2. I understood the topics presented during weekly lessons.</td><td>6.16 (0.96)</td><td>6.44 (0.53)</td><td>5.90 (1.20)</td></tr><tr><td>3. The weekly lessons helped me to learn the program strategies.</td><td>6.00 (0.75)</td><td>5.89 (0.60)</td><td>6.10 (0.88)</td></tr><tr><td>4. The group leaders were knowledgeable.</td><td>6.53 (0.61)</td><td>6.56 (0.73)</td><td>6.50 (0.53)</td></tr><tr><td>5. I understand which skills I was working on in the program and why.</td><td>6.00 (1.00)</td><td>6.22 (0.67)</td><td>5.80 (1.23)</td></tr><tr><td>6. I understood the home practice assignments.</td><td>5.79 (1.44)</td><td>6.00 (1.00)</td><td>5.60 (1.78)</td></tr><tr><td>7. I had enough time to complete the home practice assignments each week.</td><td>5.00 (1.60)</td><td>5.44 (1.51)</td><td>4.60 (1.65)</td></tr><tr><td>8. I am better at managing my emotions because of the strategies I learned in this program.</td><td>5.68 (0.95)</td><td>5.67 (1.12)</td><td>5.70 (0.82)</td></tr><tr><td>9. I use the strategies I learned from this program regularly.</td><td>5.26 (1.52)</td><td>5.00 (1.58)</td><td>5.50 (1.51)</td></tr><tr><td>10. I will continue to use the strategies I learned after the program is over.</td><td>6.05 (0.85)</td><td>6.00 (0.87)</td><td>6.10 (0.88)</td></tr><tr><td colspan="4"><bold>Parent acceptability</bold></td></tr><tr><td>Composite score</td><td>6.32 (0.70)</td><td>6.25 (0.67)</td><td>6.39 (0.75)</td></tr><tr><td>1. This is an acceptable program for teaching mindfulness-based strategies to teens with autism spectrum disorder.</td><td>6.74 (0.45)</td><td>6.78 (0.44)</td><td>6.70 (0.48)</td></tr><tr><td>2. This is an acceptable program for teaching mindfulness-based strategies to parents of teens with autism spectrum disorder.</td><td>6.74 (0.45)</td><td>6.67 (0.50)</td><td>6.80 (0.42)</td></tr><tr><td>3. I enjoyed this program.</td><td>6.32 (1.29)</td><td>6.33 (0.87)</td><td>6.30 (1.64)</td></tr><tr><td>4. My teen enjoyed this program.</td><td>6.05 (1.13)</td><td>5.89 (0.93)</td><td>6.20 (1.32)</td></tr><tr><td>5. I would suggest this program to other parents.</td><td>6.53 (0.91)</td><td>6.56 (0.73)</td><td>6.50 (1.08)</td></tr><tr><td>6. The parent group lessons were clear and understandable.</td><td>6.63 (0.60)</td><td>6.56 (0.73)</td><td>6.70 (0.48)</td></tr><tr><td>7. The parent group lessons helped me to learn the program strategies.</td><td>6.58 (0.84)</td><td>6.56 (0.73)</td><td>6.60 (0.97)</td></tr><tr><td>8. The amount of training and support I received was sufficient for me to learn the program strategies.</td><td>6.68 (0.58)</td><td>6.78 (0.44)</td><td>6.60 (0.70)</td></tr><tr><td>9. The parent group leader was knowledgeable.</td><td>6.63 (0.76)</td><td>6.44 (0.88)</td><td>6.80 (0.63)</td></tr><tr><td>10. The teen group leader was knowledgeable.</td><td>6.84 (0.69)</td><td>7.00 (0.00)</td><td>6.70 (0.95)</td></tr><tr><td>11. The goals of the program are important to my teen's functioning at home and in the community.</td><td>6.63 (0.68)</td><td>6.44 (0.73)</td><td>6.80 (0.63)</td></tr><tr><td>12. I use the program strategies at home.</td><td>6.42 (0.69)</td><td>6.33 (0.87)</td><td>6.50 (0.53)</td></tr><tr><td>13. I understand how to use the program techniques during everyday activities.</td><td>6.58 (0.51)</td><td>6.67 (0.50)</td><td>6.50 (0.53)</td></tr><tr><td>14. This program was a good way to teach mindfulness-based strategies to my teen.</td><td>6.37 (0.83)</td><td>6.63 (0.50)</td><td>6.40 (1.08)</td></tr><tr><td>15. This program was a good way for me to learn mindfulness-based strategies.</td><td>6.53 (0.77)</td><td>6.44 (0.53)</td><td>6.60 (0.97)</td></tr><tr><td>16. I understand which skills my teen was working on in the program and why.</td><td>6.68 (0.67)</td><td>6.78 (0.67)</td><td>6.60 (0.70)</td></tr><tr><td>17. The home practice assignments were clear.</td><td>6.58 (0.69)</td><td>6.67 (0.71)</td><td>6.50 (0.71)</td></tr><tr><td>18. The home practice assignments were manageable.</td><td>6.05 (0.91)</td><td>5.78 (0.97)</td><td>6.30 (0.82)</td></tr><tr><td>19. The program was effective in teaching my teen strategies for managing stress, anxiety, and/or depression.</td><td>5.89 (1.37)</td><td>5.78 (1.39)</td><td>6.00 (1.41)</td></tr><tr><td>20. The program was effective in teaching me strategies for managing stress, anxiety, and/or depression.</td><td>6.21 (1.03)</td><td>6.11 (1.17)</td><td>6.30 (0.95)</td></tr><tr><td>21. I feel my teen's mood symptoms have improved because of the strategies they learned in this program.</td><td>5.74 (1.15)</td><td>5.56 (1.24)</td><td>5.90 (1.10)</td></tr><tr><td>22. The program will produce lasting improvement in my teen's mood symptoms.</td><td>5.68 (1.42)</td><td>5.56 (1.74)</td><td>5.80 (1.14)</td></tr><tr><td>23. Other areas of my teen's functioning (e.g., social skills; rigidity) were also improved by strategies they learned in this program.</td><td>5.63 (1.61)</td><td>5.56 (1.94)</td><td>5.70 (1.34)</td></tr><tr><td>24. Participating in this program not only improved my teen's functioning at home, but in other settings (e.g., school, community).</td><td>5.63 (1.46)</td><td>5.56 (1.74)</td><td>5.70 (1.25)</td></tr><tr><td>25. I use the program strategies I learned with my teen regularly.</td><td>5.24 (1.13)</td><td>5.44 (1.13)</td><td>6.10 (1.10)</td></tr><tr><td>26. I will continue to use the program strategies I learned with my teen after the group ends.</td><td>6.26 (1.20)</td><td>6.00 (1.58)</td><td>6.50 (0.71)</td></tr></tbody></table> </ephtml> </p> <p>During the first treatment group, adolescents and parents were asked to report on their home practice during each weekly meeting. However, reporting and troubleshooting took considerably longer in the parent group, which interfered with delivery of the didactic lesson and guided meditation. Thus, in subsequent groups, parents reported on their family's home practice every other week (i.e. half of the group reported in Weeks 2, 4, and 6, and the other half reported during Weeks 3, 5, and 7). When time allowed, the group facilitator asked additional parents to report and made efforts to ensure equal opportunities to share and receive guidance. This approach allowed adequate time to deliver other components of the protocol but resulted in inconsistent parent-reported home practice data. For this reason, only adolescent-reported home practice compliance data are reported. On average, adolescents reported completing five or more meditations per week 33.16% of the time (<emph>SD</emph> = 28.69), one to four meditations per week 65.05% of the time (<emph>SD</emph> = 28.57), and zero meditations per week 1.79% (<emph>SD</emph> = 5.45) of the time. Adolescents reported that their home practice meditations ranged in length from 5 to 20 minutes, but the majority reported completing 5-minute meditations.</p> <p>Participants reported high acceptability of the program (average teen composite scores: 5.85; average parent composite score: 6.32). Open-ended responses on the acceptability survey highlighted program strengths and limitations. The most commonly reported limitation was that the weekly group meetings and/or home practice meditations were too long. These statements were consistent with relatively low teen and parent ratings on acceptability questionnaire items related to whether home practice assignments were manageable. After receiving this feedback from the first treatment group, home practice assignments for the remaining groups were adjusted to allow for more individualization. Instead of incrementally increasing home practice assignments from 5 to 20 minutes for all participants at the same pace, assignments were revised to include the wording "up to" (i.e. parents and teens should do <emph>up to</emph> a 15-minute meditation session for 6 of 7 days this week). Participants were encouraged to increase the length of home practice meditations at their own pace and only if they were tolerating shorter meditations. In addition, several parents shared that they would have preferred to participate in-person, but many acknowledged that may not have been feasible for their family. There were no reported adverse events during the study period.</p> <hd id="AN0185859373-24">Primary outcome variables</hd> <p>There was a significant effect of treatment group on the combined dependent variables (i.e. CDI-2, MASC-2, and CAMM positive change scores) when controlling for baseline values (Pillai's Trace = 0.217, <emph>F</emph>(<reflink idref="bib3" id="ref75">3</reflink>, 32) = 2.95, <emph>p</emph> = 0.047, <ephtml> <math display="inline" xmlns="http://www.w3.org/1998/Math/MathML"><mrow><msubsup><mi>η</mi><mi>p</mi><mn>2</mn></msubsup></mrow></math> </ephtml> = 0.22). Follow-up univariate tests indicated a large, statistically significant effect of treatment group on CDI-2 change scores (<emph>F</emph>(<reflink idref="bib1" id="ref76">1</reflink>, 34) = 7.31, <emph>p</emph> = 0.01, <ephtml> <math display="inline" xmlns="http://www.w3.org/1998/Math/MathML"><mrow><msubsup><mi>η</mi><mi>p</mi><mn>2</mn></msubsup></mrow></math> </ephtml> = 0.18). Adjusted means indicated that parent-reported adolescent depression symptoms for the treatment group improved by 6.24 points relative to an improvement of 0.12 points in the DTC group. Exploratory follow-up analysis including only participants with elevated CDI-2 scores at baseline revealed a similar pattern and indicated an even larger effect size ( <ephtml> <math display="inline" xmlns="http://www.w3.org/1998/Math/MathML"><mrow><msubsup><mi>η</mi><mi>p</mi><mn>2</mn></msubsup></mrow></math> </ephtml> = 0.31; see Supplemental Appendix B). There was not a statistically significant between-group difference in MASC-2 change scores in the full sample (parent report; <emph>F</emph>(<reflink idref="bib1" id="ref77">1</reflink>, 34) = 0.22, <emph>p</emph> = 0.65, <ephtml> <math display="inline" xmlns="http://www.w3.org/1998/Math/MathML"><mrow><msubsup><mi>η</mi><mi>p</mi><mn>2</mn></msubsup></mrow></math> </ephtml> = 0.01) or for an exploratory comparison of participants with elevated MASC-2 scores at baseline (See Supplemental Appendix C). The univariate test for CAMM change scores was approaching statistical significance with a medium effect size (<emph>F</emph>(<reflink idref="bib1" id="ref78">1</reflink>, 34) = 3.67, <emph>p</emph> = 0.06, <ephtml> <math display="inline" xmlns="http://www.w3.org/1998/Math/MathML"><mrow><msubsup><mi>η</mi><mi>p</mi><mn>2</mn></msubsup></mrow></math> </ephtml> = 0.10). Adjusted means indicated that self-reported mindfulness increased by an average of 2.21 points in treatment group adolescents and decreased by an average of 1.20 points in DTC adolescents.</p> <p>Exploratory ANCOVAs examining potential effects of SAB on primary outcome variables indicated a significant treatment group by SAB interaction for the MASC-2 (parent report; <emph>F</emph>(<reflink idref="bib1" id="ref79">1</reflink>, 34) = 4.22, <emph>p</emph> = 0.05, <ephtml> <math display="inline" xmlns="http://www.w3.org/1998/Math/MathML"><mrow><msubsup><mi>η</mi><mi>p</mi><mn>2</mn></msubsup></mrow></math> </ephtml> = 0.11). There was a significant difference between female adolescents in the treatment and DTC groups (<emph>F</emph>(<reflink idref="bib1" id="ref80">1</reflink>, 34) = 4.24, <emph>p</emph> = 0.05, <ephtml> <math display="inline" xmlns="http://www.w3.org/1998/Math/MathML"><mrow><msubsup><mi>η</mi><mi>p</mi><mn>2</mn></msubsup></mrow></math> </ephtml> = 0.11), but not males (<emph>F</emph>(<reflink idref="bib1" id="ref81">1</reflink>, 34) = 0.44, <emph>p</emph> = 0.51, <ephtml> <math display="inline" xmlns="http://www.w3.org/1998/Math/MathML"><mrow><msubsup><mi>η</mi><mi>p</mi><mn>2</mn></msubsup></mrow></math> </ephtml> = 0.01). Adjusted means indicated that parents of treatment group females reported an average improvement of 8.66 points in adolescent anxiety, whereas parents of DTC females reported an average improvement of 1.66 points. There were no significant group × SAB interactions for the CDI-2 (<emph>F</emph>(<reflink idref="bib1" id="ref82">1</reflink>, 34) = 0.00, <emph>p</emph> = 0.99, <ephtml> <math display="inline" xmlns="http://www.w3.org/1998/Math/MathML"><mrow><msubsup><mi>η</mi><mi>p</mi><mn>2</mn></msubsup></mrow></math> </ephtml> = 0.00) or the CAMM (<emph>F</emph>(<reflink idref="bib1" id="ref83">1</reflink>, 34) = 1.01, <emph>p</emph> = 0.32, <ephtml> <math display="inline" xmlns="http://www.w3.org/1998/Math/MathML"><mrow><msubsup><mi>η</mi><mi>p</mi><mn>2</mn></msubsup></mrow></math> </ephtml> = 0.03).</p> <hd id="AN0185859373-25">Exploratory outcome variables</hd> <p>There was no significant effect of treatment group on BYI-2 change scores (see Table 4). However, a follow-up ANCOVA indicated a significant group × SAB interaction (<emph>F</emph>(<reflink idref="bib1" id="ref84">1</reflink>, 34) = 5.01, <emph>p</emph> = 0.03, <ephtml> <math display="inline" xmlns="http://www.w3.org/1998/Math/MathML"><mrow><msubsup><mi>η</mi><mi>p</mi><mn>2</mn></msubsup></mrow></math> </ephtml> = 0.13). There was a significant difference between female adolescents in the treatment and DTC groups (<emph>F</emph>(<reflink idref="bib1" id="ref85">1</reflink>, 34) = 4.11, <emph>p</emph> = 0.05, <ephtml> <math display="inline" xmlns="http://www.w3.org/1998/Math/MathML"><mrow><msubsup><mi>η</mi><mi>p</mi><mn>2</mn></msubsup></mrow></math> </ephtml> = 0.11), but not males (<emph>F</emph>(<reflink idref="bib1" id="ref86">1</reflink>, 34) = 1.05, <emph>p</emph> = 0.31, <ephtml> <math display="inline" xmlns="http://www.w3.org/1998/Math/MathML"><mrow><msubsup><mi>η</mi><mi>p</mi><mn>2</mn></msubsup></mrow></math> </ephtml> = 0.03). Adjusted means indicated that female adolescents in the treatment group reported that their depression symptoms improved by an average of 1.10 points, whereas females in the DTC group reported their depression symptoms worsened by an average of 5.53 points.</p> <p>There was a significant effect of study group on BRIEF-2 General Executive Composite (GEC) change scores (parent-reported executive functioning; <emph>F</emph>(<reflink idref="bib1" id="ref87">1</reflink>, 36) = 5.77, <emph>p</emph> = 0.02, <ephtml> <math display="inline" xmlns="http://www.w3.org/1998/Math/MathML"><mrow><msubsup><mi>η</mi><mi>p</mi><mn>2</mn></msubsup></mrow></math> </ephtml> = 0.14). Adjusted means indicated that treatment group parents reported that adolescent general executive functioning skills improved by an average of 2.57 points, whereas DTC group parents reported an average reduction in executive functioning skills of 0.94 points. A follow-up ANCOVA indicated that there was no significant group × SAB interaction (<emph>F</emph>(<reflink idref="bib1" id="ref88">1</reflink>, 34) = 2.02, <emph>p</emph> = 0.17, <ephtml> <math display="inline" xmlns="http://www.w3.org/1998/Math/MathML"><mrow><msubsup><mi>η</mi><mi>p</mi><mn>2</mn></msubsup></mrow></math> </ephtml> = 0.06). GEC scores reflect several indices of executive functioning, including behavioral regulation, emotion regulation, and cognitive regulation. Post hoc analyses were used to explore whether one or more of these indices was driving the observed effect. There was a significant effect of study group on behavior-regulation change scores (<emph>F</emph>(<reflink idref="bib1" id="ref89">1</reflink>, 36) = 5.83, <emph>p</emph> = 0.02, <ephtml> <math display="inline" xmlns="http://www.w3.org/1998/Math/MathML"><mrow><msubsup><mi>η</mi><mi>p</mi><mn>2</mn></msubsup></mrow></math> </ephtml> = 0.14). Adjusted means indicated that treatment-group parents reported an average improvement in adolescent behavior regulation of 3.54 points, whereas DTC parents reported an average improvement of 0.04 points. The effect of study group on emotion-regulation change scores was approaching significance (<emph>F</emph>(<reflink idref="bib1" id="ref90">1</reflink>, 36) = 3.63, <emph>p</emph> = 0.07, <ephtml> <math display="inline" xmlns="http://www.w3.org/1998/Math/MathML"><mrow><msubsup><mi>η</mi><mi>p</mi><mn>2</mn></msubsup></mrow></math> </ephtml> = 0.09) and followed a similar pattern. Adjusted means indicated that treatment-group parents reported an average improvement of 3.52 points in adolescent emotion regulation, whereas DTC parents reported an average reduction of 0.40 points in adolescent emotion regulation. The study groups did not differ in cognitive regulation change scores (<emph>F</emph>(<reflink idref="bib1" id="ref91">1</reflink>, 36) = 2.03, <emph>p</emph> = 0.16, <ephtml> <math display="inline" xmlns="http://www.w3.org/1998/Math/MathML"><mrow><msubsup><mi>η</mi><mi>p</mi><mn>2</mn></msubsup></mrow></math> </ephtml> = 0.05).</p> <p>There was a significant effect of study group on the Five Facet Mindfulness Questionnaire change scores. Adjusted means indicated that treatment-group parents reported an average increase of 0.35 points in self-reported mindfulness relative to an average decrease of 0.07 points in the DTC group (<emph>F</emph>(<reflink idref="bib1" id="ref92">1</reflink>, 36) = 12.79, <emph>p</emph> = 0.001, <ephtml> <math display="inline" xmlns="http://www.w3.org/1998/Math/MathML"><mrow><msubsup><mi>η</mi><mi>p</mi><mn>2</mn></msubsup></mrow></math> </ephtml> = 0.26). There was also a significant effect of study group on parent well-being change scores. Adjusted means indicated that parents in the treatment group reported an average increase of 6.39 points in well-being compared to an average decrease of 6.47 points among parents in the DTC group (<emph>F</emph>(<reflink idref="bib1" id="ref93">1</reflink>, 36) = 7.47, <emph>p</emph> = 0.01, <ephtml> <math display="inline" xmlns="http://www.w3.org/1998/Math/MathML"><mrow><msubsup><mi>η</mi><mi>p</mi><mn>2</mn></msubsup></mrow></math> </ephtml> = 0.17). Last, there was a significant effect of study group on the SIPA Adolescent-Parent Relationship Dysfunction change scores. Adjusted means indicated that parents in the treatment group reported an average decrease of 7.78 points in adolescent-parent relationship dysfunction relative to an average 4.70-point increase in relationship dysfunction among parents in the DTC group (<emph>F</emph>(<reflink idref="bib1" id="ref94">1</reflink>, 36) = 6.36, <emph>p</emph> = 0.02, <ephtml> <math display="inline" xmlns="http://www.w3.org/1998/Math/MathML"><mrow><msubsup><mi>η</mi><mi>p</mi><mn>2</mn></msubsup></mrow></math> </ephtml> = 0.15).</p> <hd id="AN0185859373-26">Discussion</hd> <p>This study demonstrated feasibility, acceptability, and pilot efficacy of MINDful TIME, a novel program designed to increase accessibility of mindfulness techniques for autistic adolescents. Adolescents in the treatment group demonstrated statistically and clinically significant reductions in parent-reported depression, which is especially meaningful considering the relatively high prevalence of suicidality among autistic youth ([<reflink idref="bib45" id="ref95">45</reflink>]). Adolescents in the treatment group also showed improvement in parent-reported executive functioning, driven by behavior and emotional regulation subdomains. Parents self-reported significant increases in mindfulness, well-being, and adolescent-parent relationship functioning. Findings suggest that MINDful TIME may be a viable method for ameliorating mental health challenges in autistic adolescents and improving well-being in caregivers.</p> <p>MINDful TIME was designed to be delivered through telehealth by professionals with a background in autism, but not necessarily mindfulness (e.g. clinical psychologists, behavior analysts, social workers, speech and language pathologists). The goal of this approach was to serve families who would otherwise not have access to a mindfulness provider with the desire and specialized training that may be necessary to effectively serve autistic adolescents. The program leverages a mindfulness mobile app to connect autistic adolescents and their parents to guided meditations led by mindfulness experts. A group format was used to increase scalability of the program. Overall, the high program completion rate, attendance rates, and FOI percentages indicate program feasibility. On average, teen and parent responses on acceptability surveys ranged from "Slightly agree" to "Strongly agree," which suggests that the program was acceptable to participants. Autistic individuals have cited boredom and engagement as major contributors to poor intervention adherence and high attrition ([<reflink idref="bib26" id="ref96">26</reflink>]), which are common challenges to mobile health interventions more generally. MINDful Time may have overcome some of these challenges, while also overcoming the limitations of in-person MBIs, including transportation barriers, accessibility, and ease and flexibility of use ([<reflink idref="bib5" id="ref97">5</reflink>]; [<reflink idref="bib20" id="ref98">20</reflink>]). However, several participants noted the length of group meetings and length of home practice meditations as limitations of the program. This was partially addressed in the second treatment group by encouraging individualization of the length of home practice meditations. Future iterations of the program will examine whether shorter weekly meetings (e.g. 1 hour) will increase acceptability while maintaining program efficacy.</p> <p>MINDful TIME was associated with significant and clinically meaningful reductions in adolescent depression symptoms as reported by parents. Antidepressant response was consistent across participants regardless of SAB, suggesting that both sexes benefited from the intervention. With an average positive change score of more than 6 points, the average CDI-2 score for the treatment group went from "Elevated" at baseline to "Average" at follow-up. Furthermore, treatment-group participants who had clinically significant CDI-2 scores at baseline showed an average improvement of more than 9 points. These findings are especially promising in the context of the high prevalence of autistic individuals with co-occurring depression ([<reflink idref="bib32" id="ref99">32</reflink>]) and limited empirically supported psychosocial interventions for depression in this population ([<reflink idref="bib63" id="ref100">63</reflink>]). Accessible interventions for managing mood symptoms in adolescents could interrupt the development of more severe symptoms, thereby improving quality of life for adolescents and potentially reducing the need for more intensive support later in life.</p> <p>Conversely, there was not a statistically significant improvement in adolescent self-reported depression symptoms. This is consistent with findings from other psychosocial interventions for autistic adolescents that generally show improvements on parent-reported indicators, but not child/adolescent self-report measures ([<reflink idref="bib61" id="ref101">61</reflink>]). Many autistic individuals have challenges interpreting and reporting their own emotional state ([<reflink idref="bib48" id="ref102">48</reflink>]), which may have contributed to inconsistencies between adolescent self-report and parent report in the current and other studies. Alternatively, these inconsistencies could reflect changes in how parents are interpreting adolescent behavior. This highlights the importance of collecting both self-report and informant report of adolescent functioning, as well as the need for more objective measures like blinded clinician rating, task-based measures, and biometric measures.</p> <p>Treatment effects on adolescent anxiety were nonsignificant, which may suggest that the mental health benefits of MINDful TIME are more specific to depression. However, exploratory analysis indicated that female adolescents in the treatment group showed significant reductions in parent-reported anxiety symptoms relative to the DTC group. This suggests that females may have greater anxiolytic response relative to males. A previous study of MBSR in autistic adults found treatment improvements in health-related and mental health–related quality of life that were driven by female participants ([<reflink idref="bib9" id="ref103">9</reflink>]). Together, these findings may indicate that as a group, autistic females stand to benefit more from MBIs than autistic males. Importantly, the current findings are preliminary, and additional research with adequate statistical power is necessary to better understand the potential relationship between SAB and MBIs among autistic adolescents.</p> <p>Adolescents in the treatment group also demonstrated significant improvements in parent-reported executive functioning relative to the DTC group. Follow-up analyses of BRIEF-2 index scales indicated that improvements on general executive functioning scores were driven by improvements in emotion and behavior regulation, but not cognitive regulation. This finding aligns with an in-person MBI among autistic adults that found improvements in emotion regulation ([<reflink idref="bib46" id="ref104">46</reflink>]). Emotion regulation has also been shown to mediate mental health outcomes, suggesting that these changes may underlie therapeutic improvements. Enhancing one's emotion-regulation abilities aligns with the objective of MINDful TIME: to reduce stress, anxiety, and depression. Although behavior regulation was not a primary goal of the program, it may reflect a downstream effect of improved management of stress and mood symptoms, which decreased the likelihood of impulsive or externalizing behaviors. Alternatively, it is possible that mindfulness-based strategies may have directly improved behavior regulation, which is consistent with studies of mindfulness in other pediatric populations (e.g. [<reflink idref="bib7" id="ref105">7</reflink>]; [<reflink idref="bib60" id="ref106">60</reflink>]). Future research should examine whether treatment-related improvements in emotion and behavioral regulation mediate improvements in mood symptoms.</p> <p>Exploratory findings suggest that parents showed treatment-related improvements in mindfulness and well-being. This is relatively unsurprising considering robust literature demonstrating positive effects of in-person and online MBIs for the general population ([<reflink idref="bib34" id="ref107">34</reflink>]; [<reflink idref="bib54" id="ref108">54</reflink>]) and growing body of literature supporting effectiveness of MBIs for parents of autistic children ([<reflink idref="bib10" id="ref109">10</reflink>]). Nonetheless, improvements in parent well-being are a meaningful benefit of this telehealth program and may help to address heightened stress among parents of autistic children ([<reflink idref="bib8" id="ref110">8</reflink>]).</p> <p>Parents also reported improvements in parent-adolescent relationship functioning. This may reflect a cumulative effect of treatment-related improvements in adolescents and their parents. Home practice assignments required adolescents and parents to collaborate by discussing their mindfulness practice using a new shared "language" (i.e. key concepts). Many dyads shared that they completed their home practice together followed by a discussion, which may have facilitated opportunities to bond over common experiences, thereby improving relationship functioning. This finding is consistent with results of a study that examined a group-based mindfulness program in Chinese youth and their parents. However, that study did not find improvements in adolescent symptoms or executive functioning ([<reflink idref="bib29" id="ref111">29</reflink>]).</p> <p>The current study had several strengths, including the development of a novel and accessible MBI for autistic adolescents, oversampling for participants from historically underserved backgrounds, the hybrid effectiveness-implementation design with randomization of participants to study groups, and self-report and informant reports of adolescent functioning. Like all studies, it also had limitations. Statistical analyses were underpowered to detect small-to-moderate effects due to the pilot nature of the study. Future research with larger sample sizes is necessary to replicate findings and better understand whether small effect sizes may be clinically relevant. Self- and parent-report measures introduce the potential for expectancy effects since participants could not be blinded to their study group assignments. Furthermore, it was not possible to delineate whether improvements in parent well-being may have biased parent report of adolescent functioning. Future efficacy trials could utilize more objective methods to triangulate self-report and parent report, like informants blinded to study group (e.g. clinicians), task-based or biometric measures of stress response, and direct observation of adolescent-parent functioning.</p> <p>The program was developed and delivered at a community-based autism center by professionals with extensive experience working with autistic individuals. Future research is needed to determine whether the program is effective when implemented by professionals from various disciplines and in other settings. It also remains unclear whether participants would have demonstrated similar benefits from using the mindfulness app without the need for a weekly group meeting. Although previous research suggests that online MBIs are more effective at reducing stress when they include therapist guidance, future research should compare MINDful TIME to an active comparator group that is encouraged to use the mindfulness app regularly. Furthermore, the app publisher was unable to share user data with the investigative team. We attempted to track engagement with app-based meditations using adolescent and parent report during home practice review; however, resulting data were inconsistent, which precluded the analysis of the association between time meditating and outcome variables. Future research should include a more reliable method for tracking home practice engagement.</p> <p>Strategic efforts were made to prioritize recruitment of underrepresented populations, with more than half of the adolescent sample identifying as an underrepresented race/ethnicity and/or having household income below the median for Arizona. However, the sample was predominantly White and from middle- to upper-middle-class families. Additional research is needed to examine feasibility and efficacy of the program in marginalized groups.</p> <hd id="AN0185859373-27">Conclusion</hd> <p>Findings indicate feasibility, acceptability, and preliminary efficacy of MINDful TIME for improving depression symptoms in autistic adolescents. We documented improvement on several other exploratory outcome variables (i.e. executive functioning, parent mindfulness; parent well-being; adolescent-parent relationship functioning) and potential sex-specific effects on parent-reported adolescent anxiety, which should be examined in future studies. Together, findings warrant future examination of MINDful TIME and other group-based, telehealth mindfulness programs for autistic adolescents to address well-documented challenges with mental health in this population.</p> <hd id="AN0185859373-28">Supplemental Material</hd> <p>Graph: Supplemental material, sj-pdf-1-aut-10.1177_13623613251328484 for Pilot randomized controlled trial of MINDful TIME, a novel telehealth mindfulness-based intervention for autistic adolescents and their caregivers by Nicole L Matthews, Melissa M Mitchell, Hannah Honda, Amanda Malligo, Summer Boyd, Broc A Pagni and B Blair Braden in Autism</p> <p>The authors would like to thank the autistic adolescents and study partners who participated in this research and research assistants and staff at the Southwest Autism Research & Resource Center (SARRC) for their contributions to program delivery and data collection. This work was supported by the Blue Cross Blue Shield of Arizona (BCBSAZ) Foundation for Community & Health Advancement.</p> <ref id="AN0185859373-29"> <title> Footnotes </title> <blist> <bibl id="bib1" idref="ref1" type="bt">1</bibl> <bibtext> Nicole L Matthews: Conceptualization; Data curation; Formal analysis; Funding acquisition; Investigation; Methodology; Project administration; Supervision; Writing—original draft; Writing—review & editing. Melissa M Mitchell: Investigation; Project administration; Writing—original draft; Writing—review & editing. Hannah Honda: Investigation; Project administration; Writing—original draft; Writing—review & editing. Amanda Malligo: Investigation; Methodology; Writing—review & editing. Summer Boyd: Investigation; Writing—review & editing. Broc A Pagni: Conceptualization; Formal analysis; Methodology; Writing—review & editing. B Blair Braden: Conceptualization; Formal analysis; Methodology; Writing—review & editing.</bibtext> </blist> <blist> <bibl id="bib2" idref="ref53" type="bt">2</bibl> <bibtext> Several participants did not consent to sharing their deidentified data in a public repository. Therefore, data that support the findings of this study are available from the corresponding author upon reasonable request.</bibtext> </blist> <blist> <bibl id="bib3" idref="ref71" type="bt">3</bibl> <bibtext> The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.</bibtext> </blist> <blist> <bibl id="bib4" idref="ref65" type="bt">4</bibl> <bibtext> The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: This work was supported by the Blue Cross Blue Shield of Arizona (BCBSAZ) Foundation for Community & Health Advancement. Happier Meditation provided 1-year subscriptions to the mobile meditation app for study participants.</bibtext> </blist> <blist> <bibl id="bib5" idref="ref97" type="bt">5</bibl> <bibtext> All study procedures were approved by the Arizona State University Institutional Review Board (IRB ID: STUDY00016672) on November 27, 2022.</bibtext> </blist> <blist> <bibl id="bib6" idref="ref44" type="bt">6</bibl> <bibtext> Written (electronic signature) informed consent and assent were obtained from all adolescent-parent dyads.</bibtext> </blist> <blist> <bibl id="bib7" idref="ref105" type="bt">7</bibl> <bibtext> Nicole L Matthews</bibtext> </blist> <blist> <bibtext>Graph</bibtext> </blist> <blist> <bibtext>https://orcid.org/0000-0001-7433-1142 Broc A Pagni</bibtext> </blist> <blist> <bibtext>Graph</bibtext> </blist> <blist> <bibtext>https://orcid.org/0000-0002-9496-7604 B Blair Braden</bibtext> </blist> <blist> <bibtext>Graph https://orcid.org/0000-0001-6842-9784</bibtext> </blist> <blist> <bibl id="bib8" idref="ref38" type="bt">8</bibl> <bibtext> Supplemental material for this article is available online.</bibtext> </blist> <blist> <bibl id="bib9" idref="ref15" type="bt">9</bibl> <bibtext> MBIs in this paragraph followed a Mindfulness Based Stress Reduction (MBSR) or Mindfulness Based Cognitive Therapy (MBCT) framework. MBSR is a widely studied, manualized program that was initially developed for individuals with chronic pain and has since been delivered in other clinical populations and the general population ([34]). MBCT is an adaptation of MBSR developed for individuals with recurrent depression ([51]). Most studies utilized modifications (e.g. reduced the use of metaphors; shorter sessions and meditations) for autistic people and/or their caregivers and were delivered in-person, apart from two that used hybrid in-person/telehealth delivery.</bibtext> </blist> <blist> <bibtext> To our knowledge, all published studies of MyMind examined in-person delivery of the intervention.</bibtext> </blist> <blist> <bibtext> Exploratory Mann–Whitney U tests indicated no significant differences in primary outcome variables for adolescents who did and did not engage in at least one side meeting (<emph>p</emph>s > 0.45)</bibtext> </blist> <blist> <bibtext> Broc A Pagni is also affiliated to Department of Psychiatry, NYU Grossman School of Medicine, NYU Langone Center for Psychedelic Medicine, USA.</bibtext> </blist> </ref> <ref id="AN0185859373-30"> <title> References </title> <blist> <bibtext> American Psychiatric Association. (2022). Diagnostic and statistical manual of mental disorders (5th ed., text rev.). https://doi.org/10.1176/appi.books.9780890425787</bibtext> </blist> <blist> <bibtext> Anbar J., Metoyer M., Smith C., Matthews N. (2025). An exploration of online and in-person administration of the Kaufman Brief Intelligence Test, second edition (KBIT-2) in children and adolescents being evaluated for autism spectrum disorder. Journal of Autism and Developmental Disorders, 55, 1243–1253. https://doi.org/10.1007/s10803-024-06323-4</bibtext> </blist> <blist> <bibtext> Baer R. A., Smith G. T., Hopkins J., Krietemeyer J., Toney L. (2006). Using self-report assessment methods to explore facets of mindfulness. Assessment, 13(1), 27–45. https://doi.org/10.1177/1073191105283504</bibtext> </blist> <blist> <bibtext> Beck J. S., Beck A. T., Jolly J. B. (2005). Beck Youth Inventories–Second Edition (BYI-2). Pearson.</bibtext> </blist> <blist> <bibtext> Beck K. B., Greco C. M., Terhorst L. A., Skidmore E. R., Kulzer J. L., McCue M. P. (2020). Mindfulness-based stress reduction for adults with autism spectrum disorder: Feasibility and estimated effects. Mindfulness, 11, 1286–1297. https://doi.org/10.1007/s12671-020-01345-2</bibtext> </blist> <blist> <bibtext> Benn R., Akiva T., Arel S., Roeser R. W. (2012). Mindfulness training effects for parents and educators of children with special needs. Developmental Psychology, 48, 1476–1487.</bibtext> </blist> <blist> <bibtext> Bockmann J. O., Yu S. Y. (2023). Using mindfulness-based interventions to support self-regulation in young children: A review of the literature. Early Childhood Education Journal, 51(4), 693–703.</bibtext> </blist> <blist> <bibtext> Bonis S. (2016). Stress and parents of children with autism: A review of literature. Issues in Mental Health Nursing, 37(3), 153–163. https://doi.org/10.3109/01612840.2015.1116030</bibtext> </blist> <blist> <bibtext> Braden B. B., Pagni B. A., Monahan L., Walsh M. J., Dixon M. V., Delaney S...Ware J. E. (2022). Quality of life in adults with autism spectrum disorder: Influence of age, sex, and a controlled, randomized mindfulness-based stress reduction pilot intervention. Quality of Life Research, 31, 1427–1440. https://doi.org/10.1007/s11136-021-03013-x</bibtext> </blist> <blist> <bibtext> Cachia R. L., Anderson A., Moore D. W. (2016). Mindfulness, stress and well-being in parents of children with autism spectrum disorder: A systematic review. Journal of Child and Family Studies, 25, 1–14. https://doi.org/10.1007/s10826-015-0193-8</bibtext> </blist> <blist> <bibtext> Cameron L. A., Phillips K., Melvin G. A., Hastings R. P., Gray K. M. (2021). Psychological interventions for depression in children and young people with an intellectual disability and/or autism: Systematic review. The British Journal of Psychiatry, 218, 305–314. https://doi.org/10.1192/bjp.2020.226</bibtext> </blist> <blist> <bibtext> Conner C. M., White S. W., Beck K. B., Golt J., Smith I. C., Mazefsky C. A. (2019). Improving emotion regulation ability in autism: The emotional awareness and skills enhancement (EASE) program. Autism, 23(5), 1273–1287. https://doi.org/10.1177/1362361318810709</bibtext> </blist> <blist> <bibtext> Constantino J. N., Gruber C. P. (2012). Social Responsiveness Scale (2nd ed., SRS-2) [Manual]. Western Psychological Services.</bibtext> </blist> <blist> <bibtext> Cridland E., Jones S., Magee C., Caputi P. (2014). Family-focused autism spectrum disorder research: A review of the utility of family systems approaches. Autism: The International Journal of Research and Practice, 18(3), 213–222. https://doi.org/10.1177/1362361312472261</bibtext> </blist> <blist> <bibtext> de Bruin E. I., Blom R., Smit F. M., van Steensel F. J., Bögels S. M. (2015). MYmind: Mindfulness training for youngsters with autism spectrum disorders and their parents. Autism, 19(8), 906–914. https://doi.org/10.1177/1362361314553279</bibtext> </blist> <blist> <bibtext> de Nocker Y. L., Toolan C. K. (2023). Using telehealth to provide interventions for children with ASD: A systematic review. Review Journal of Autism and Developmental Disorders, 10, 82–112. https://doi.org/10.1007/s40489-021-00278-3</bibtext> </blist> <blist> <bibtext> Estabillo J. A., Moody C. T., Poulhazan S. J., Adery L. H., Denluck E. M., Laugeson E. A. (2022). Efficacy of PEERS® for adolescents via telehealth delivery. Journal of Autism and Developmental Disorders, 52(12), 5232–5242. https://doi.org/10.1007/s10803-022-05580-5</bibtext> </blist> <blist> <bibtext> Forbes Z. N., Miller K. (2023). Mindfulness-based stress reduction in the treatment of adults with autism spectrum disorder: A systematic review of interventional studies. Review Journal of Autism and Developmental Disorders. 1–18. https://doi.org/10.1007/s40489-023-00398-y</bibtext> </blist> <blist> <bibtext> Gaigg S. B., Flaxman P. E., McLaven G., Shah R., Bowler D. M., Meyer B...South M. (2020). Self-guided mindfulness and cognitive behavioural practices reduce anxiety in autistic adults: A pilot 8-month waitlist-controlled trial of widely available online tools. Autism, 24(4), 867–883. https://doi.org/10.1177/1362361320909184</bibtext> </blist> <blist> <bibtext> Gál E., Stefan S., Cristea I. A. (2021). The efficacy of mindfulness meditation apps in enhancing users' well-being and mental health related outcomes: A meta-analysis of randomized controlled trials. Journal of Affective Disorders, 279, 131–142. https://doi.org/10.1016/j.jad.2020.09.134</bibtext> </blist> <blist> <bibtext> Gioia G. A., Isquith P. K., Guy S. C., Kenworthy L. (2015). BRIEF-2: Behavior Rating Inventory of Executive Function, second edition [Manual]. Psychological Assessment Resources.</bibtext> </blist> <blist> <bibtext> Greco L. A., Baer R. A., Smith G. T. (2011). Assessing mindfulness in children and adolescents: Development and validation of the Child and Adolescent Mindfulness Measure (CAMM). Psychological Assessment, 23(3), 606–614. https://doi.org/10.1037/a0022819</bibtext> </blist> <blist> <bibtext> Happier. (n.d). Happier: Meditation that meets you where you are. https://<ulink href="http://www.happierapp.com">www.happierapp.com</ulink></bibtext> </blist> <blist> <bibtext> Harrison P. L., Oakland T. (2015). Adaptive behavior assessment system, third edition [Manual]. Western Psychological Services.</bibtext> </blist> <blist> <bibtext> Hartley M., Dorstyn D., Due C. (2019). Mindfulness for children and adults with autism spectrum disorder and their caregivers: A meta-analysis. Journal of Autism and Developmental Disorders, 49(10), 4306–4319. https://doi.org/10.1007/s10803-019-04145-3</bibtext> </blist> <blist> <bibtext> Hartley M., Dorstyn D., Due C. (2022). Challenges encountered with a mindfulness app: Lessons learnt from a pilot randomized trial involving caregivers and individuals with autism. Research in Autism Spectrum Disorders, 96, 101991. https://doi.org/10.1016/j.rasd.2022.101991</bibtext> </blist> <blist> <bibtext> Hayes S. A., Watson S. L. (2013). The impact of parenting stress: A meta-analysis of studies comparing the experience of parenting stress in parents of children with and without autism spectrum disorder. Journal of Autism and Developmental Disorders, 43(3), 629–642. https://doi.org/10.1007/s10803-012-1604-y</bibtext> </blist> <blist> <bibtext> Helsel W. J., Matson J. L. (1984). The assessment of depression in children: The internal structure of the Child Depression Inventory (CDI). Behaviour Research and Therapy, 22(3), 289–298. https://doi.org/10.1016/0005-7967(84)90009-3</bibtext> </blist> <blist> <bibtext> Ho R. Y. F., Zhang D., Chan S. K. C., Gao T. T., Lee E. K. P., Lo H. H. M...Wong S. Y. S. (2021). Brief report: Mindfulness training for Chinese adolescents with autism spectrum disorder and their parents in Hong Kong. Journal of Autism and Developmental Disorders, 51, 4147–4159. https://doi.org/10.1007/s10803-020-04729-4</bibtext> </blist> <blist> <bibtext> Hoffman L., Marquis J., Poston D., Summers J. A., Turnbull A. (2006). Assessing family outcomes: Psychometric evaluation of the beach center family quality of life scale. Journal of Marriage and Family, 68(4), 1069–1083. https://doi.org/10.1111/j.1741-3737.2006.00314.x</bibtext> </blist> <blist> <bibtext> Hossain M. M., Khan N., Sultana A., Ma P., McKyer E. L. J., Ahmed H. U., Purohit N. (2020). Prevalence of comorbid psychiatric disorders among people with autism spectrum disorder: An umbrella review of systematic reviews and meta-analyses. Psychiatry Research, 287, 112922. https://doi.org/10.1016/j.psychres.2020.112922</bibtext> </blist> <blist> <bibtext> Hudson C. C., Hall L., Harkness K. L. J. (2018). Prevalence of depressive disorders in individuals with autism spectrum disorder: A metaanalysis. Abnormal Child Psychology, 47(1), 165–175. https://doi.org/10.1007/s10802-018-0402-1</bibtext> </blist> <blist> <bibtext> Kabat-Zinn J. (2013). Full catastrophe living, revised edition: How to cope with stress, pain and illness using mindfulness meditation. Bantam Books.</bibtext> </blist> <blist> <bibtext> Khoury B., Sharma M., Rush S. E., Fournier C. (2015). Mindfulness-based stress reduction for healthy individuals: A meta-analysis. Journal of Psychosomatic Research, 78(6), 519–528. https://doi.org./10.1016/j.jpsychores.2015.03.009</bibtext> </blist> <blist> <bibtext> Kirsch A. C., Huebner A. R., Mehta S. Q., Howie F. R., Weaver A. L., Myers S. M...Katusic S. K. (2020). Association of comorbid mood and anxiety disorders with autism spectrum disorder. JAMA Pediatrics, 174(1), 63–70. https://doi.org/10.1001/jamapediatrics.2019.4368</bibtext> </blist> <blist> <bibtext> Kovacs M. (2010). Children's Depression Inventory 2 (CDI2). Multi-Health Systems.</bibtext> </blist> <blist> <bibtext> Kovacs M. (2014). Children's Depression Inventory (CDI and CDI 2). In Cautin R. L., Lilienfeld S. O. (Eds.), The encyclopedia of clinical psychology (pp. 1–5). Wiley. https://doi.org/10.1002/9781118625392.wbecp419</bibtext> </blist> <blist> <bibtext> Landes S. J., McBain S. M., Curran G. M. (2019). An introduction to effectiveness-implementation hybrid designs. Psychiatry Research, 280, 112513. https://doi.org/10.1016/j.psychres.2019.112513</bibtext> </blist> <blist> <bibtext> Laugeson E. A., Frankel F., Gantman A., Dillon A. R., Mogil C. (2012). Evidence-based social skills training for adolescents with autism spectrum disorders: The UCLA PEERS program. Journal of Autism and Developmental Disorders, 42, 1025–1036. https://doi.org/10.1007/s10803-011-1339-1</bibtext> </blist> <blist> <bibtext> Linden A., Lawrence B., Elise F., Roberts D., Branagan A., Tay Y. B. E...Gurusamy K. (2023). Benefits and harms of interventions to improve anxiety, depression, and other mental health outcomes for autistic people: A systematic review and network meta-analysis of randomised controlled trials. Autism: The International Journal of Research and Practice, 27(1), 7–30. https://doi.org/10.1177/13623613221117931</bibtext> </blist> <blist> <bibtext> Lunsky Y., Albaum C., Baskin A., Hastings R. P., Hutton S., Steel L...Weiss J. (2021). Group virtual mindfulness-based intervention for parents of autistic adolescents and adults. Journal of Autism and Developmental Disorders, 51, 3959–3969. https://doi.org/10.1007/s10803-020-04835-3</bibtext> </blist> <blist> <bibtext> Lyons A., Leon S., Roecker Phelps C., Dunleavy A. (2009). The impact of child symptom severity on stress among parents of children with ASD: The moderating role of coping styles. Journal of Child and Family Studies, 19(4), 516–524. https://doi.org/10.1007/s10826-009-9323-5</bibtext> </blist> <blist> <bibtext> March J. S. (2012). MASC 2: Multidimensional Anxiety Scale for Children, second edition [Technical manual]. Multi-Health Systems.</bibtext> </blist> <blist> <bibtext> Matthews N. L., Gallegos S., O'Rourke H., Hill E., Dixon M., Cortes Coria S...Braden B. B. (2024). The strengthening skills program for autistic adults across the lifespan: Feasibility, acceptability, and preliminary efficacy for improving adaptive functioning and quality of life [Manuscript submitted for publication].</bibtext> </blist> <blist> <bibtext> O'Halloran L., Coey P., Wilson C. (2022). Suicidality in autistic youth: A systematic review and meta-analysis. Clinical Psychology Review, 93, 102–144. https://doi.org/10.1016/j.cpr.2022.102144</bibtext> </blist> <blist> <bibtext> Pagni B. A., Braden B. B. (2021). Early reflections on the therapeutic effects of bindfulness-based therapies in adults with autism and suggestions for future research. Journal of Psychiatry and Brain Science, 6, Article e210013. https://doi.org/10.20900/jpbs20210013</bibtext> </blist> <blist> <bibtext> Pagni B. A., Hill E., Walsh M. J., Delaney S., Ogbeama D., Monahan L...Braden B. B. (2023). Distinct and shared therapeutic neural mechanisms of mindfulness-based and social support stress reduction groups in adults with autism spectrum disorder. Journal of Psychiatry and Neuroscience, 48(2), E102–E114. https://doi.org/10.1503/jpn.220159</bibtext> </blist> <blist> <bibtext> Poquérusse J., Pastore L., Dellantonio S., Esposito G. (2018). Alexithymia and autism spectrum disorder: A complex relationship. Frontiers in Psychology, 9, Article 1196. https://doi.org/10.3389/fpsyg.2018.01196</bibtext> </blist> <blist> <bibtext> Ridderinkhof A., de Bruin E. I., Blom R., Bögels S. M. (2018). Mindfulness-based program for children with autism spectrum disorder and their parents: Direct and long-term improvements. Mindfulness, 9(3), 773–791. https://doi.org/10.1007/s12671-017-0815-x</bibtext> </blist> <blist> <bibtext> Salem-Guirgis S., Albaum C., Tablon P., Riosa P. B., Nicholas D. B., Drmic I. E., Weiss J. A. (2019). MYmind: A concurrent group-based mindfulness intervention for youth with autism and their parents. Mindfulness, 10, 1730–1743. https://doi.org/10.1007/s12671-019-01107-9</bibtext> </blist> <blist> <bibtext> Segal Z. (2002). Mindfulness-based cognitive therapy for depression: A new approach to preventing relapse. Guilford Press.</bibtext> </blist> <blist> <bibtext> Sharma S., Hucker A., Matthews T., Grohmann D., Laws K. (2021). Cognitive behavioural therapy for anxiety in children and young people on the autism spectrum: A systematic review and meta-analysis. BMC Psychology, 9(1), Article 151. https://doi.org/10.1186/s40359-021-00658-8</bibtext> </blist> <blist> <bibtext> Sheras P. L., Abidin R. R., Konold T. R. (1998). Stress Index for Parents of Adolescents (SIPA): Professional manual. Psychological Assessment Resources.</bibtext> </blist> <blist> <bibtext> Sommers-Spijkerman M., Austin J., Bohlmeijer E., Pots W. (2021). New evidence in the booming field of online mindfulness: An updated meta-analysis of randomized controlled trials. JMIR Mental Health, 8, Article e28168. https://doi.org/10.2196/28168</bibtext> </blist> <blist> <bibtext> Stadheim J., Johns A., Mitchell M., Smith C. J., Braden B. B., Matthews N. L. (2022). A qualitative examination of the impact of the COVID-19 pandemic on children and adolescents with autism and their parents. Research in Developmental Disabilities, 124, 104232. https://doi.org/10.1016/j.ridd.2022.104232</bibtext> </blist> <blist> <bibtext> Stahmer A. C., Brookman-Frazee L., Rieth S. R., Stoner J. T., Feder J. D., Searcy K., Wang T. (2017). Parent perceptions of an adapted evidence-based practice for toddlers with autism in a community setting. Autism, 21(2), 217–230. https://doi.org/10.1177/1362361316637580</bibtext> </blist> <blist> <bibtext> Stecher C., Pagni B. A., Cloonan S., Vink S., Hill E., Ogbeama D...Braden B. B. (2024). App-based meditation habits maintain reductions in depression symptoms among autistic adults. Autism, 28(6), 1487–1502. https://doi.org/10.1177/136236132312006</bibtext> </blist> <blist> <bibtext> Teresi J. A., Yu X., Stewart A. L., Hays R. D. (2022). Guidelines for designing and evaluating feasibility pilot studies. Medical Care, 60(1), 95–103. https://doi.org/10.1097/MLR.0000000000001664</bibtext> </blist> <blist> <bibtext> Topp C. W., Østergaard S. D., Søndergaard S., Bech P. (2015). The WHO-5 well-being index: A systematic review of the literature. Psychotherapy and Psychosomatics, 84(3), 167–176. https://doi.org/10.1159/000376585</bibtext> </blist> <blist> <bibtext> Viglas M., Perlman M. (2018). Effects of a mindfulness-based program on young children's self-regulation, prosocial behavior and hyperactivity. Journal of Child and Family Studies, 27, 1150–1161. https://doi.org/10.1007/s10826-017-0971-6</bibtext> </blist> <blist> <bibtext> Wang X., Zhao J., Huang S., Chen S., Zhou T., Li Q., Luo X., Hao Y. (2021). Cognitive behavioral therapy for autism spectrum disorders: A systematic review. Pediatrics, 147(5), Article e2020049880. https://doi.org/10.1542/peds.2020-049880</bibtext> </blist> <blist> <bibtext> Weitlauf A. S., Broderick N., Stainbrook J. A., Taylor J. L., Herrington C. G., Nicholson A. G...Warren Z. E. (2020). Mindfulness-based stress reduction for parents implementing early intervention for autism: An RCT. Pediatrics, 145(Suppl. 1), S81–S92. https://doi.org/10.1542/peds.2019-1895K</bibtext> </blist> <blist> <bibtext> White S. W., Simmons G. L., Gotham K. O., Conner C. M., Smith I. C., Beck K. B., Mazefsky C. A. (2018). Psychosocial treatments targeting anxiety and depression in adolescents and adults on the autism spectrum: Review of the latest research and recommended future directions. Current Psychiatry Reports, 20, 82. https://doi.org/10.1007/s11920-018-0949-0</bibtext> </blist> <blist> <bibtext> Zaidman-Zait A., Mirenda P., Duku E., Szatmari P., Georgiades S., Volden J...Thompson A. (2014). Examination of bidirectional relationships between parent stress and two types of problem behavior in children with autism spectrum disorder. Journal of Autism and Developmental Disorders, 44(8), 1908–1917. https://doi.org/10.1007/s10803-014-2064-3</bibtext> </blist> </ref> <aug> <p>By Nicole L Matthews; Melissa M Mitchell; Hannah Honda; Amanda Malligo; Summer Boyd; Broc A Pagni and B Blair Braden</p> <p>Reported by Author; Author; Author; Author; Author; Author; Author</p> </aug> <nolink nlid="nl1" bibid="bib31" firstref="ref4"></nolink> <nolink nlid="nl2" bibid="bib25" firstref="ref5"></nolink> <nolink nlid="nl3" bibid="bib35" firstref="ref6"></nolink> <nolink nlid="nl4" bibid="bib45" firstref="ref7"></nolink> <nolink nlid="nl5" bibid="bib48" firstref="ref8"></nolink> <nolink nlid="nl6" bibid="bib52" firstref="ref9"></nolink> <nolink nlid="nl7" bibid="bib63" firstref="ref10"></nolink> <nolink nlid="nl8" bibid="bib11" firstref="ref11"></nolink> <nolink nlid="nl9" bibid="bib61" firstref="ref13"></nolink> <nolink nlid="nl10" bibid="bib40" firstref="ref14"></nolink> <nolink nlid="nl11" bibid="bib18" firstref="ref17"></nolink> <nolink nlid="nl12" bibid="bib47" firstref="ref19"></nolink> <nolink nlid="nl13" bibid="bib12" firstref="ref21"></nolink> <nolink nlid="nl14" bibid="bib10" firstref="ref22"></nolink> <nolink nlid="nl15" bibid="bib15" firstref="ref23"></nolink> <nolink nlid="nl16" bibid="bib49" firstref="ref24"></nolink> <nolink nlid="nl17" bibid="bib50" firstref="ref25"></nolink> <nolink nlid="nl18" bibid="bib29" firstref="ref26"></nolink> <nolink nlid="nl19" bibid="bib55" firstref="ref27"></nolink> <nolink nlid="nl20" bibid="bib16" firstref="ref28"></nolink> <nolink nlid="nl21" bibid="bib39" firstref="ref29"></nolink> <nolink nlid="nl22" bibid="bib17" firstref="ref30"></nolink> <nolink nlid="nl23" bibid="bib54" firstref="ref31"></nolink> <nolink nlid="nl24" bibid="bib26" firstref="ref32"></nolink> <nolink nlid="nl25" bibid="bib19" firstref="ref34"></nolink> <nolink nlid="nl26" bibid="bib57" firstref="ref36"></nolink> <nolink nlid="nl27" bibid="bib20" firstref="ref37"></nolink> <nolink nlid="nl28" bibid="bib27" firstref="ref39"></nolink> <nolink nlid="nl29" bibid="bib14" firstref="ref40"></nolink> <nolink nlid="nl30" bibid="bib42" firstref="ref41"></nolink> <nolink nlid="nl31" bibid="bib64" firstref="ref42"></nolink> <nolink nlid="nl32" bibid="bib62" firstref="ref46"></nolink> <nolink nlid="nl33" bibid="bib41" firstref="ref47"></nolink> <nolink nlid="nl34" bibid="bib23" firstref="ref48"></nolink> <nolink nlid="nl35" bibid="bib38" firstref="ref52"></nolink> <nolink nlid="nl36" bibid="bib44" firstref="ref55"></nolink> <nolink nlid="nl37" bibid="bib33" firstref="ref56"></nolink> <nolink nlid="nl38" bibid="bib58" firstref="ref58"></nolink> <nolink nlid="nl39" bibid="bib56" firstref="ref59"></nolink> <nolink nlid="nl40" bibid="bib36" firstref="ref60"></nolink> <nolink nlid="nl41" bibid="bib28" firstref="ref61"></nolink> <nolink nlid="nl42" bibid="bib37" firstref="ref62"></nolink> <nolink nlid="nl43" bibid="bib43" firstref="ref63"></nolink> <nolink nlid="nl44" bibid="bib22" firstref="ref64"></nolink> <nolink nlid="nl45" bibid="bib59" firstref="ref67"></nolink> <nolink nlid="nl46" bibid="bib24" firstref="ref68"></nolink> <nolink nlid="nl47" bibid="bib13" firstref="ref69"></nolink> <nolink nlid="nl48" bibid="bib21" firstref="ref70"></nolink> <nolink nlid="nl49" bibid="bib30" firstref="ref72"></nolink> <nolink nlid="nl50" bibid="bib53" firstref="ref73"></nolink> <nolink nlid="nl51" bibid="bib32" firstref="ref99"></nolink> <nolink nlid="nl52" bibid="bib46" firstref="ref104"></nolink> <nolink nlid="nl53" bibid="bib60" firstref="ref106"></nolink> <nolink nlid="nl54" bibid="bib34" firstref="ref107"></nolink>
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  Data: Pilot Randomized Controlled Trial of Mindful Time, a Novel Telehealth Mindfulness-Based Intervention for Autistic Adolescents and Their Caregivers
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  Data: <searchLink fieldCode="AR" term="%22Nicole+L%2E+Matthews%22">Nicole L. Matthews</searchLink> (ORCID <externalLink term="https://orcid.org/0000-0001-7433-1142">0000-0001-7433-1142</externalLink>)<br /><searchLink fieldCode="AR" term="%22Melissa+M%2E+Mitchell%22">Melissa M. Mitchell</searchLink><br /><searchLink fieldCode="AR" term="%22Hannah+Honda%22">Hannah Honda</searchLink><br /><searchLink fieldCode="AR" term="%22Amanda+Malligo%22">Amanda Malligo</searchLink><br /><searchLink fieldCode="AR" term="%22Summer+Boyd%22">Summer Boyd</searchLink><br /><searchLink fieldCode="AR" term="%22Broc+A%2E+Pagni%22">Broc A. Pagni</searchLink> (ORCID <externalLink term="https://orcid.org/0000-0002-9496-7604">0000-0002-9496-7604</externalLink>)<br /><searchLink fieldCode="AR" term="%22B%2E+Blair+Braden%22">B. Blair Braden</searchLink> (ORCID <externalLink term="https://orcid.org/0000-0001-6842-9784">0000-0001-6842-9784</externalLink>)
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  Data: <searchLink fieldCode="SO" term="%22Autism%3A+The+International+Journal+of+Research+and+Practice%22"><i>Autism: The International Journal of Research and Practice</i></searchLink>. 2025 29(7):1864-1882.
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  Data: SAGE Publications. 2455 Teller Road, Thousand Oaks, CA 91320. Tel: 800-818-7243; Tel: 805-499-9774; Fax: 800-583-2665; e-mail: journals@sagepub.com; Web site: https://sagepub.com
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  Data: 19
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  Data: 2025
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  Data: Journal Articles<br />Reports - Research
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  Data: <searchLink fieldCode="DE" term="%22Intervention%22">Intervention</searchLink><br /><searchLink fieldCode="DE" term="%22Metacognition%22">Metacognition</searchLink><br /><searchLink fieldCode="DE" term="%22Autism+Spectrum+Disorders%22">Autism Spectrum Disorders</searchLink><br /><searchLink fieldCode="DE" term="%22Adolescents%22">Adolescents</searchLink><br /><searchLink fieldCode="DE" term="%22Parents%22">Parents</searchLink><br /><searchLink fieldCode="DE" term="%22Program+Effectiveness%22">Program Effectiveness</searchLink><br /><searchLink fieldCode="DE" term="%22Depression+%28Psychology%29%22">Depression (Psychology)</searchLink><br /><searchLink fieldCode="DE" term="%22Gender+Differences%22">Gender Differences</searchLink><br /><searchLink fieldCode="DE" term="%22Symptoms+%28Individual+Disorders%29%22">Symptoms (Individual Disorders)</searchLink><br /><searchLink fieldCode="DE" term="%22Parent+Child+Relationship%22">Parent Child Relationship</searchLink><br /><searchLink fieldCode="DE" term="%22Executive+Function%22">Executive Function</searchLink><br /><searchLink fieldCode="DE" term="%22Well+Being%22">Well Being</searchLink><br /><searchLink fieldCode="DE" term="%22Mental+Health%22">Mental Health</searchLink><br /><searchLink fieldCode="DE" term="%22Emotional+Response%22">Emotional Response</searchLink><br /><searchLink fieldCode="DE" term="%22Videoconferencing%22">Videoconferencing</searchLink><br /><searchLink fieldCode="DE" term="%22Anxiety%22">Anxiety</searchLink><br /><searchLink fieldCode="DE" term="%22Telecommunications%22">Telecommunications</searchLink><br /><searchLink fieldCode="DE" term="%22Handheld+Devices%22">Handheld Devices</searchLink>
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  Data: <searchLink fieldCode="SU" term="%22Kaufman+Brief+Intelligence+Test%22">Kaufman Brief Intelligence Test</searchLink><br /><searchLink fieldCode="SU" term="%22Childrens+Depression+Inventory%22">Childrens Depression Inventory</searchLink>
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  Data: 10.1177/13623613251328484
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  Data: 1362-3613<br />1461-7005
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  Label: Abstract
  Group: Ab
  Data: A growing body of research suggests that mindfulness-based interventions may be a valuable method for reducing internalizing symptoms in autistic individuals. The current study extends this work using an effectiveness-implementation hybrid type 1 study. In this parallel randomized controlled trial, we examined a novel telehealth intervention for autistic adolescents and their caregivers. MINDful TIME includes eight weekly group meetings and regular use of a commercially available mindfulness meditation app. Participants were 42 adolescent-parent dyads randomized to the treatment or delayed treatment control (DTC) group. The program was implemented with fidelity (91.24%-94.78%), and 90% of treatment group dyads completed the program. On average, participants attended >90% of sessions and reported high acceptability. Treatment group adolescents demonstrated statistically and clinically significant reductions in parent-reported depression symptoms relative to DTC (F(1, 34) = 7.31, p = 0.01, n[subscript p superscript 2] = 0.18). Female adolescents in the treatment group showed significant reductions in parent-reported anxiety symptoms (F(1, 34) = 4.22, p = 0.05, n[subscript p superscript 2] = 0.11). Exploratory analyses indicated treatment-related improvements in adolescent executive functioning, parent mindfulness and well-being, and adolescent-parent relationship dysfunction. Findings warrant future examination of MINDful TIME to address well-documented challenges with mental health in this population. This trial was registered on clinicaltrials.gov (NCT05685589).
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      – SubjectFull: Metacognition
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      – SubjectFull: Autism Spectrum Disorders
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      – SubjectFull: Videoconferencing
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    Titles:
      – TitleFull: Pilot Randomized Controlled Trial of Mindful Time, a Novel Telehealth Mindfulness-Based Intervention for Autistic Adolescents and Their Caregivers
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            NameFull: Nicole L. Matthews
      – PersonEntity:
          Name:
            NameFull: Melissa M. Mitchell
      – PersonEntity:
          Name:
            NameFull: Hannah Honda
      – PersonEntity:
          Name:
            NameFull: Amanda Malligo
      – PersonEntity:
          Name:
            NameFull: Summer Boyd
      – PersonEntity:
          Name:
            NameFull: Broc A. Pagni
      – PersonEntity:
          Name:
            NameFull: B. Blair Braden
    IsPartOfRelationships:
      – BibEntity:
          Dates:
            – D: 01
              M: 07
              Type: published
              Y: 2025
          Identifiers:
            – Type: issn-print
              Value: 1362-3613
            – Type: issn-electronic
              Value: 1461-7005
          Numbering:
            – Type: volume
              Value: 29
            – Type: issue
              Value: 7
          Titles:
            – TitleFull: Autism: The International Journal of Research and Practice
              Type: main
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