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


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
    • "Third, improvements were found for quality of life, behavioral problems, and ASD-like behaviors. While such findings are in line with previous studies (Chalfant et al., 2007;Drahota et al., 2011;Wood et al., 2009), it is unclear whether these effects stem from (a) the CBT-intervention directly, (b) a more indirect effect of a decrease in anxiety, and/or (c) a more positive responding of the participants (e.g., it may be that participants are in a more positive mood state at post-and follow-up assessments and therefore report less problems in general). Fourth, IQ was not formally assessed, and thus it is unknown exactly how high-functioning our ASD sample is. "
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    ABSTRACT: The effectiveness of cognitive-behavioral therapy (CBT) for anxiety disorders in children with autism spectrum disorders (ASD) was examined, and compared with children without ASD. Children with ASD and comorbid anxiety disorders (n = 79, 58 boys; Mage = 11.76) and children with anxiety disorders (n = 95, 46 boys; Mage = 12.85), and their parents, participated. All families were referred to 1 of 7 mental health care centers and received the same CBT. Anxiety, quality of life, ASD-like behaviors, and emotional-behavioral problems were measured at waitlist (ASD-group only, n = 17), pretest, posttest, and 3 months, 1 year, and 2 years after CBT. CBT was more effective than waitlist for treating anxiety disorders (d = -1.45) and anxiety symptoms (d = -0.48) in children with ASD. At 2 years follow-up, 61% of the children with and 64% without ASD were free of their primary anxiety disorder (percentages not significantly different). The decrease in severity of anxiety disorders after CBT (d values ranging between -1.05 and -1.46) was not different for children with and without ASD. Improvements were less in children with ASD for (only) 2 out of 7 continuous outcomes measures: anxiety symptoms (d values ranging between -0.68 and -0.94 vs. d values ranging between -0.98 and -1.25) and quality of life (d values ranging between 0.39 and 0.56 vs. d values ranging between 0.77 and 0.98). CBT for anxiety disorders is effective for children with ASD, also in the long-term. Treatment gains may be somewhat less compared with children without ASD. (PsycINFO Database Record (c) 2015 APA, all rights reserved).
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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.
    Full-text · Article · Dec 2014 · Clinical Case Studies
    • "The results from the available treatment outcome studies suggest CBT may bring about clinically significant reductions in anxiety, increased use of helpful coping strategies, and increased independence and daily living skills in youth with ASD (Drahota et al. 2011; for a systematic review, see Lang et al. 2010). The studies that have employed a wait-list control group have all consistently reported that CBT outperforms no treatment, an important first step in establishing the viability of an intervention. "
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    ABSTRACT: Individuals with autism spectrum disorder (ASD) experience high levels of anxiety symptomatology with an estimated prevalence rate of anxiety disorders as high as 40 %. It is likely that anxiety is prominent in individuals with ASD throughout the life-span and that factors such as age, IQ, and ASD symptoms may influence the rates, symptoms, or anxiety subtypes. The high comorbidity rate of anxiety in ASD is likely to be explained by ASD deficits that make the individual more prone to develop anxiety disorders; however, diagnostic overlap may also partly explain the high rates of anxiety. In addition, there is some limited evidence that the same risk factors identified in the development and maintenance of anxiety disorders in typically developing children may also play a role in youth with ASD. Self-reports as well as other informant reports, physiological measures, and direct observations are likely to be useful in assessing anxiety in ASD. To date, cognitive-behavioral therapy appears to hold the most evidence in treating anxiety in individuals with ASD. Other psychosocial interventions (including mindfulness-based and social-recreational interventions) may also be considered, although evidence has only recently began to emerge and more work is needed to understand which ASD-specific modifications or adaptations are likely to be most helpful.
    No preview · Chapter · Jan 2014
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