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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    • "Cognitive behavioral therapy (CBT) to treat anxiety disorders in children with ASD is considered evidence-based because multiple laboratories using rigorous research designs and methods (e.g., randomized controlled trials) have found evidence supporting its use to alleviate or reduce anxiety symptoms or interference with large treatment effect sizes at post-treatment compared to control conditions [44-46]. Moreover, evidence suggests that intervening on children’s anxiety disorders has distal outcomes such as increasing social and daily living skills, and family functioning [44,47,48]. Preliminary data gathered from ASD Leaders indicate that anxiety is a significant problem for some of the school-age children being provided services at ASD community-based agencies. "
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    ABSTRACT: Background Currently, 1 out of 88 children are diagnosed with an autism spectrum disorder (ASD), and the estimated cost for treatment services is $126 billion annually. Typically, ASD community providers (ASD-CPs) provide services to children with any severity of ASD symptoms using a combination of various treatment paradigms, some with an evidence-base and some without. When evidence-based practices (EBPs) are successfully implemented by ASD-CPs, they can result in positive outcomes. Despite this promise, EBPs are often implemented unsuccessfully and other treatments used by ASD-CPs lack supportive evidence, especially for school-age children with ASD. While it is not well understood why ASD-CPs are not implementing EBPs, organizational and individual characteristics likely play a role. As a response to this need and to improve the lives of children with ASD and their families, this study aims to develop and test the feasibility and acceptability of the Autism Model of Implementation (AMI) to support the implementation of EBPs by ASD-CPs. Methods/design An academic-community collaboration developed to partner with ASD-CPs will facilitate the development of the AMI, a process specifically for use by ASD community-based agencies. Using a mixed methods approach, the project will assess agency and individual factors likely to facilitate or hinder implementing EBPs in this context; develop the AMI to address identified barriers and facilitators; and pilot test the AMI to examine its feasibility and acceptability using a specific EBP to treat anxiety disorders in school-age children with ASD. Discussion The AMI will represent a data-informed approach to facilitate implementation of EBPs by ASD-CPs by providing an implementation model specifically developed for this context. This study is designed to address the real-world implications of EBP implementation in ASD community-based agencies. In doing so, the AMI will help to provide children with ASD the best and most effective services in their own community. Moreover, the proposed study will positively impact the field of implementation science by providing an empirically supported and tested model of implementation to facilitate the identification, adoption, and use of EBPs.
    Implementation Science 09/2012; 7(1):85. DOI:10.1186/1748-5908-7-85 · 3.47 Impact Factor
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