Article

Effects of Cognitive Behavioral Therapy on Daily Living Skills in Children with High-Functioning Autism and Concurrent Anxiety Disorders

Department of Psychiatry, University of California, San Diego, 9500 Gilman Drive (MC: 0603), La Jolla, CA 92093-0603, USA.
Journal of Autism and Developmental Disorders (Impact Factor: 3.06). 03/2011; 41(3):257-65. DOI: 10.1007/s10803-010-1037-4
Source: PubMed

ABSTRACT CBT is a promising treatment for children with autism spectrum disorders (ASD) and focuses, in part, on children's independence and self-help skills. In a trial of CBT for anxiety in ASD (Wood et al. in J Child Psychol Psychiatry 50:224-234, 2009), children's daily living skills and related parental intrusiveness were assessed. Forty children with ASD (7-11 years) and their primary caregiver were randomly assigned to an immediate treatment (IT; n = 17) or 3-month waitlist (WL; n = 23) condition. In comparison to WL, IT parents reported increases in children's total and personal daily living skills, and reduced involvement in their children's private daily routines. Reductions correlated with reduced anxiety severity. These results provide preliminary evidence that CBT may yield increased independence and daily living skills among children with ASD.

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Available from: Amy Drahota, Nov 21, 2014
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    • "Parent involvement may actually demonstrate better treatment response in children under 7 years old. Taken as a whole, the current literature suggests the following: (a) Modification to CBT programs for anxiety in youth with ASD should focus upon social, emotional, and cognitive deficits characteristic of ASD core symptoms (e.g., language and cognition skills, motivation, insight/self-awareness; Chalfant et al., 2007; Wood, Drahota, Sze, Har, et al., 2009); (b) when such modifications are in place, CBT shows effectiveness in anxious youth with ASD as compared with waitlist and/or usual treatment (Sukhodolsky et al., 2013; Ung et al., 2014); (c) treatment-related gains among youth with ASD are durable in nature (Reaven et al., 2012; Storch et al., 2013); and (d) with proper design and planning, treatment gains generalize well to settings outside of the treatment locale (Chalfant et al., 2007; Drahota et al., 2011). The modifications used are of relevance to this discussion, as the increased intensity of focus upon building foundational skills is critical to addressing developmental differences between school-age and preschool-age children. "
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    ABSTRACT: Empirical support exists for behaviorally oriented psychosocial interventions to reduce functional impairment related to autism spectrum disorder (ASD) symptoms in young children, but little research exists examining the effectiveness of such treatments when applied to preschool-aged children with comorbid anxiety symptoms. With this in mind, the authors report on the case of Marcus, a 4-year-old boy with autistic disorder and impairing comorbid anxiety. Marcus participated in 8 weekly sessions of family-based cognitive-behavioral therapy, addressing his fear-based avoidance of social interactions and sensory stimuli, using an anxiety treatment protocol for youth with ASD modified to account for his young age. This protocol consisted of modular components addressing affective education, exposure, cognitive restructuring, and social coaching. At post-treatment assessment, Marcus exhibited markedly decreased impairment, as evidenced by parent responses to clinical interview and rating scales. In addition, Marcus displayed improvement in severity of anxiety symptoms as illustrated by a decrease in his scores on the Pediatric Anxiety Rating Scale from 17 at baseline to 8 at post-treatment. Therapeutic gains were maintained at 4-month follow-up. Implications and clinical considerations are discussed.
    Clinical Case Studies 12/2014; 14(1):47-60. DOI:10.1177/1534650114536028
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    • "Parent involvement may actually demonstrate better treatment response in children under 7 years old. Taken as a whole, the current literature suggests the following: (a) Modification to CBT programs for anxiety in youth with ASD should focus upon social, emotional, and cognitive deficits characteristic of ASD core symptoms (e.g., language and cognition skills, motivation, insight/self-awareness; Chalfant et al., 2007; Wood, Drahota, Sze, Har, et al., 2009); (b) when such modifications are in place, CBT shows effectiveness in anxious youth with ASD as compared with waitlist and/or usual treatment (Sukhodolsky et al., 2013; Ung et al., 2014); (c) treatment-related gains among youth with ASD are durable in nature (Reaven et al., 2012; Storch et al., 2013); and (d) with proper design and planning, treatment gains generalize well to settings outside of the treatment locale (Chalfant et al., 2007; Drahota et al., 2011). The modifications used are of relevance to this discussion, as the increased intensity of focus upon building foundational skills is critical to addressing developmental differences between school-age and preschool-age children. "
    Clinical Case Studies 01/2014; 14:47-60.
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    • "Similar to reductions in anxiety, these treatment gains were maintained at three month follow up. Drahota et al. (2011) conducted further analysis on the results of Wood et al. (2009a) and found that in addition to decreases in anxiety symptoms, participants in the treatment condition (n = 17) were rated by parents as having developed more living/self-care skills and as requiring less assistance in daily activities. Cognitive-behavioral therapy for anxiety in ASD has demonstrated early efficacy, however continued study is needed before clear conclusions can be made. "
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    ABSTRACT: Clinically significant anxiety affects many youth with autism spectrum disorders (ASD) and is associated with a number of functional consequences. Building from treatment approaches of anxiety in typically developing populations, pharmacological and psychotherapeutic approaches to treating anxiety in ASD are being increasingly examined. Despite being commonly prescribed, there is limited empirical support beyond open trials and case series at present for the use of antidepressants or anxiolytics in the treatment of anxiety for youth with ASD. A modest body of evidence exists supporting the application of a modified form of cognitive-behavioral therapy, with associated reductions in anxiety and some core autism improvements. Further research, refinement and replication is needed to establish the efficacy of treatment approaches for anxiety in youth with ASD, what treatment component(s) are most appropriate for which patients, what factors may play an integral role in treatment outcomes, and whether treatments result in durable and generalizable gains.
    Journal of Child and Family Studies 04/2012; 22(3). DOI:10.1007/s10826-012-9593-1 · 1.42 Impact Factor
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