Treating Anxiety Disorders in Children with High Functioning Autism Spectrum Disorders: A Controlled Trial

Macquarie University, Sydney, New South Wales, Australia
Journal of Autism and Developmental Disorders (Impact Factor: 3.34). 12/2007; 37(10):1842-57. DOI: 10.1007/s10803-006-0318-4
Source: PubMed


A family-based, cognitive behavioural treatment for anxiety in 47 children with comorbid anxiety disorders and High Functioning Autism Spectrum Disorder (HFA) was evaluated. Treatment involved 12 weekly group sessions and was compared with a waiting list condition. Changes between pre- and post-treatment were examined using clinical interviews as well as child-, parent- and teacher-report measures. Following treatment, 71.4% of the treated participants no longer fulfilled diagnostic criteria for an anxiety disorder. Comparisons between the two conditions indicated significant reductions in anxiety symptoms as measured by self-report, parent report and teacher report. Discussion focuses on the implications for the use of cognitive behaviour therapy with HFA children, for theory of mind research and for further research on the treatment components.

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    • "This 3234 J Autism Dev Disord (2015) 45:3232–3242 123 Author's personal copy measure assesses the presence of individual disorders based on DSM-IV-TR criteria (American Psychiatric Association 2000), and provides a severity rating for each disorder on a 0–8 point scale, with scores C4 indicating full diagnostic criteria were met. The ADIS-IV demonstrates good interrater reliability in children and adolescents with high functioning ASD (Ung et al. 2014) and is regularly used in treatment trials for anxiety in youth with ASD (e.g., Storch et al. 2013, 2014; Reaven et al. 2012; Chalfant et al. 2007; Ehrenreich-May et al. 2014; McNally Keehn et al. 2013). "
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    ABSTRACT: This study examined optimal guidelines to assess treatment response and remission for anxiety in youth with autism spectrum disorders (ASD) using the Pediatric Anxiety Rating Scale (PARS). Data was collected for 108 children aged 7-16 years with comorbid anxiety and ASD before and after receiving cognitive behavior therapy. Optimal cut-offs on the PARS were assessed using signal detection analyses using receiver operating characteristic methods. Maximum agreement with response criteria was achieved at 15 % reduction in symptoms on the PARS. Maximum agreement with remission criteria was achieved at 40 % reduction in symptoms, or at a score of 10 or below at post-treatment. Results have implications for standardizing criteria used in research trials and clinical practice.
    Journal of Autism and Developmental Disorders 06/2015; 45(10). DOI:10.1007/s10803-015-2483-9 · 3.06 Impact Factor
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    • "Parent report of youth anxiety was used in this study rather than child self-report due to the difficulties that some youth with ASD may have in identifying and expressing their own emotions (Blakeley-Smith et al. 2012). In fact, some researchers have been reluctant to rely primarily on child self-report as an accurate reflection of symptom presentation because of the tendency of youth with ASD to under-report their symptoms (Chalfant et al. 2007; Storch et al. 2012). "
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    ABSTRACT: In response to the high co-occurrence of anxiety symptoms in youth with autism spectrum disorder (ASD), several interventions have been developed for this population. In spite of promising findings, some youth with ASD respond only minimally to such interventions. To understand potential factors that may impact treatment response, the current study explores the role of parental anxiety in youth treatment outcome. Thirty-one youth with ASD, ages 7-18, and their parents participated in the study. Parents completed the State/Trait Anxiety Inventory pre- and post-treatment. Contrary to previous research, there was no correlation between parental anxiety and youth anxiety at baseline or post-treatment. However, parental trait anxiety significantly decreased from pre- to post-treatment for parents of treatment responders. The findings are consistent with previous research and suggest a youth-to-parent influence.
    Journal of Autism and Developmental Disorders 03/2015; DOI:10.1007/s10803-015-2410-0 · 3.34 Impact Factor
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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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