Article

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

ABSTRACT

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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    • "For example, more direct oversight and interaction in treatment programs for schoolaged children will likely be necessary, compared with balancing the need for parental involvement (to convey information and/or generalize skills across settings), with providing opportunities for independence when working with teens (Reaven, 2011). Finally, although encouraging parent participation makes sense intuitively, and has garnered some empirical support (Chalfant et al., 2007;Puleo & Kendall, 2011), more research is needed, perhaps in the form of dismantling designs (Sukhodolsky, Golub, Stone, & Orban, 2006), in order to understand the relative contribution of parental involvement in these treatment programs. "
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    ABSTRACT: Youth with autism spectrum disorders (ASDs) are at increased risk for developing significant co-occurring psychiatric conditions. Although prevalence estimates vary, anxiety disorders, mood disorders, and attention deficit hyperactivity disorder are among the most common comorbid conditions. There has been increased interest in the assessment and treatment of these symptoms in youth with ASD, with the majority of studies thus far focusing on anxiety disorders. The present paper reviews the literature on the most common co-occurring psychiatric symptoms in youth with ASD and discusses current trends in intervention for these disorders. Given the numerous challenges involved in the identification of psychiatric conditions in youth with ASD, general guidelines for the assessment of psychiatric symptoms in youth with ASD will be provided. Information regarding the prevalence and specific assessment strategies for each mental health condition precedes a review of intervention programs. Although not specific to a single psychiatric condition, difficulties in emotion regulation are thought to underlie many of the social/emotional and behavioral difficulties characteristic of youth with ASD. Thus, the emerging research on emotion regulation interventions is also reviewed. Finally, it is important to note that the treatment programs presented in this paper have almost exclusively been developed and delivered in university-based clinic settings. Recommendations for bridging the research to practice gap for youth with ASD are discussed.
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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.
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    • "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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