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Conaughton RJ, Donovan CL, March S. Efficacy of an internet-based CBT program for children with comorbid High Functioning Autism Spectrum Disorder and anxiety: A randomised controlled trial. J Affect Disord 2017; 218:260-268. [PMID: 28477505 DOI: 10.1016/j.jad.2017.04.032] [Citation(s) in RCA: 49] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2016] [Revised: 02/21/2017] [Accepted: 04/19/2017] [Indexed: 12/28/2022]
Abstract
BACKGROUND All trials conducted to date on BRAVE-ONLINE for youth anxiety disorders have excluded children with High Functioning Autism Spectrum Disorder (HFASD) and therefore it is unknown whether these programs might be beneficial to HFASD children. The aim of this study was to evaluate the efficacy of BRAVE-ONLINE in HFASD children with an anxiety disorder. METHODS Forty-two HFASD children, aged 8-12 years, with an anxiety disorder, and their parents, were randomly assigned to either the BRAVE-ONLINE condition (NET) or a waitlist control (WLC). Diagnostic interviews and parent/child questionnaires were completed at pre-treatment, post-treatment and 3-month follow-up. RESULTS At post- assessment, compared to children in the WLC condition, children in the NET condition demonstrated a significantly greater reduction in number of anxiety diagnoses, clinical severity of diagnosis, and self and parent reported anxiety symptoms, as well as significantly greater increases in overall functioning. However, loss of primary diagnosis in this sample was lower than in previous studies. LIMITATIONS The small sample size, coupled with attrition rates, makes it difficult to generalise the findings of the study to HFASD population and to conduct analyses regarding mediators, moderators and predictors of outcomes. CONCLUSIONS The BRAVE-ONLINE program may be useful in reducing anxiety symptoms in HFASD children, although the effects are less strong than those found in neurotypical children for a variety of reasons.
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Affiliation(s)
- Rebecca J Conaughton
- School of Applied Psychology, Menzies Health Institute Queensland, Mount Gravatt Campus, Mount Gravatt, QLD 4122, Australia.
| | - Caroline L Donovan
- School of Applied Psychology, Menzies Health Institute Queensland, Mount Gravatt Campus, Mount Gravatt, QLD 4122, Australia.
| | - Sonja March
- School of Psychology and Counselling, Institute for Resilient Regions, University of Southern Queensland, Springfield Campus, Springfield, Qld 4432, Australia
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102
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103
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Roberts-Collins C, Mahoney-Davies G, Russell A, Booth A, Loades M. Emotion awareness and cognitive behavioural therapy in young people with autism spectrum disorder. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2017; 22:837-844. [PMID: 28750544 DOI: 10.1177/1362361317710215] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Young people with autism spectrum disorder experience high levels of emotional problems, including anxiety and depression. Adapted cognitive behavioural therapy is recommended for such difficulties. However, no evidence suggests whether emotion awareness is important in treatment outcome for young people on the autism spectrum. This study aimed to investigate the potential differences in emotion awareness between (1) young people on the autism spectrum and typically developing youth and (2) young people on the autism spectrum with and without experience of cognitive behavioural therapy. Three groups (aged 11-20 years) participated: (1) typically developing young people ( n = 56); (2) young people on the autism spectrum with no experience of cognitive behavioural therapy ( n = 23); and (3) young people on the autism spectrum who had attended cognitive behavioural therapy ( n = 33). All participants completed the Emotion Awareness Questionnaire-30 item version. Young people on the autism spectrum differed significantly from typically developing young people on the emotional awareness measure. Young people on the autism spectrum who had attended cognitive behavioural therapy scored significantly lower on the Differentiating Emotions subscale, and significantly higher on the Attending to Others' Emotions subscale, compared to young people on the autism spectrum who had not attended cognitive behavioural therapy. This study highlights the importance of psycho-educational components of cognitive behavioural therapy when adapting for young people on the autism spectrum.
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Affiliation(s)
| | | | | | - Anne Booth
- 2 Oxford Health NHS Foundation Trust, UK
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104
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Kerns CM, Collier A, Lewin AB, Storch EA. Therapeutic alliance in youth with autism spectrum disorder receiving cognitive-behavioral treatment for anxiety. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2017; 22:636-640. [PMID: 28514865 DOI: 10.1177/1362361316685556] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Symptoms of autism spectrum disorder may influence alliance in psychotherapy. This study examined therapeutic alliance and its relationship with child characteristics and anxiety treatment outcomes in youth with autism spectrum disorder. Youth ( N = 64) with autism spectrum disorder and co-occurring anxiety (7-16 years, IQ > 70) received 16 sessions of modular cognitive-behavioral therapy. Post-treatment therapist, youth and parent ratings of alliance as well as pre- and post-treatment ratings of child behavior were gathered. Ratings of alliance were commensurate to ratings seen in children without autism spectrum disorder. Measures of treatment outcome, but not pretreatment characteristics, were significantly associated with therapist ratings of alliance strength. Data suggest that therapeutic alliance may not be impaired in anxious youth with autism spectrum disorder and may be associated with treatment outcome.
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105
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Spain D, Sin J, Paliokosta E, Furuta M, Prunty JE, Chalder T, Murphy DG, Happé FG. Family therapy for autism spectrum disorders. Cochrane Database Syst Rev 2017; 5:CD011894. [PMID: 28509404 PMCID: PMC6484452 DOI: 10.1002/14651858.cd011894.pub2] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
BACKGROUND Autism spectrum disorders (ASDs) are characterised by impairments in communication and reciprocal social interaction. These impairments can impact on relationships with family members, augment stress and frustration, and contribute to behaviours that can be described as challenging. Family members of individuals with ASD can experience high rates of carer stress and burden, and poor parental efficacy. While there is evidence to suggest that individuals with ASD and family members derive benefit from psychological interventions designed to reduce stress and mental health morbidity, and enhance coping, most studies to date have targeted the needs of either individuals with ASD, or family members. We wanted to examine whether family (systemic) therapy, aimed at enhancing communication, relationships or coping, is effective for individuals with ASD and their wider family network. OBJECTIVES To evaluate the clinical effectiveness and acceptability of family therapy as a treatment to enhance communication or coping for individuals with ASD and their family members. If possible, we will also seek to establish the economic costs associated with family therapy for this clinical population. SEARCH METHODS On 16 January 2017 we searched CENTRAL, MEDLINE, Embase, 10 other databases and three trials registers. We also handsearched reference lists of existing systematic reviews and contacted study authors in the field. SELECTION CRITERIA Randomised controlled trials (RCTs) and quasi-RCTs investigating the effectiveness of family therapy for young people or adults with ASD or family members, or both, delivered via any modality and for an unspecified duration, compared with either standard care, a wait-list control, or an active intervention such as an alternative type of psychological therapy. DATA COLLECTION AND ANALYSIS Two authors independently screened each title and abstract and all full-text reports retrieved. To enhance rigour, 25% of these were independently screened by a third author. MAIN RESULTS The search yielded 4809 records. Of these, we retrieved 37 full-text reports for further scrutiny, which we subsequently excluded as they did not meet the review inclusion criteria, and identified one study awaiting classification. AUTHORS' CONCLUSIONS Few studies have examined the effectiveness of family therapy for ASD, and none of these are RCTs. Further research studies employing methodologically robust trial designs are needed to establish whether family therapy interventions are clinically beneficial for enhancing communication, strengthening relationships, augmenting coping and reducing mental health morbidity for individuals with ASD and family members.
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Affiliation(s)
- Debbie Spain
- King's College LondonMRC Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology & Neuroscience16 de Crespigny Park, Denmark HillLondonUKSE5 8AF
| | - Jacqueline Sin
- University of ReadingSchool of Psychology & Clinical Language SciencesEarley GateReadingUKRG6 6AL
| | - Eleni Paliokosta
- Tavistock & Portman NHS Foundation TrustCamden MOSAIC Child and Adolescent Mental Health Service and Social Communication Assessment Service120 Belsize LaneLondonUKNW3 5BA
| | - Marie Furuta
- Graduate School of Medicine, Kyoto UniversityDepartment of Human Health Sciences53 Kawara‐cho,Shogo‐in, Sakyo‐kuKyotoKyotoJapan606‐8507
| | - Jonathan E Prunty
- Kings College LondonInstitute of Psychiatry, Psychology & NeuroscienceDenmark HillLondonUKSE5 8AF
| | - Trudie Chalder
- Institute of Psychiatry, Psychology & Neuroscience, King's College LondonDepartment of Psychological MedicineWeston Education CentreCutcombe RoadLondonUKSE5 9RH
| | - Declan G Murphy
- King’s College LondonSackler Institute for Translational Neurodevelopment, Institute of Psychiatry, Psychology & NeuroscienceP50. Institute of PsychiatryDeCrespigny ParkLondonUKSE5 8AF
| | - Francesca G Happé
- King's College LondonMRC Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology & Neuroscience16 de Crespigny Park, Denmark HillLondonUKSE5 8AF
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106
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van Steensel FJA, Zegers VM, Bögels SM. Predictors of Treatment Effectiveness for Youth with ASD and Comorbid Anxiety Disorders: It all Depends on the Family? J Autism Dev Disord 2017; 47:636-645. [PMID: 28004234 PMCID: PMC5352781 DOI: 10.1007/s10803-016-2956-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
The study aimed to explore predictors of treatment effectiveness in a sample of 79 children with ASD who received cognitive behavioral therapy (CBT) for their anxiety disorders. Severity of anxiety disorders and anxiety symptoms were used to measure treatment effectiveness and was assessed pre-treatment, post-treatment, 3 months-, 1 and 2 years after CBT. Child characteristics and maternal anxiety did not predict treatment effect. Children with anxious fathers and children in 'un-involved' families had less anxiety symptoms at pre-treatment and displayed a less steep decline. Children from 'authoritarian' families showed higher pre-treatment anxiety levels but responded quite well to treatment. Findings stress the importance of parent (father) and family factors in the treatment of anxiety disorders in youth with ASD.
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Affiliation(s)
- F J A van Steensel
- Child Development and Education, Research Priority Area YIELD, University of Amsterdam, Nieuwe Achtergracht 127, 1018 WS, Amsterdam, The Netherlands.
| | - V M Zegers
- Child Development and Education, Research Priority Area YIELD, University of Amsterdam, Nieuwe Achtergracht 127, 1018 WS, Amsterdam, The Netherlands
| | - S M Bögels
- Child Development and Education, Research Priority Area YIELD, University of Amsterdam, Nieuwe Achtergracht 127, 1018 WS, Amsterdam, The Netherlands
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107
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Targeting Heterogeneity and Comorbidity in Children with Autism Spectrum Disorder Through the Resilience Builder Group Therapy Program. CHILD & YOUTH CARE FORUM 2017. [DOI: 10.1007/s10566-017-9394-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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108
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Cook JM, Donovan CL, Garnett MS. A Parent-Mediated, Cognitive Behavioral Therapy Group Treatment for Young Children With High-Functioning Autism Spectrum Disorder and Comorbid Anxiety: Development and Case Illustration of the Fun With Feelings Program. J Cogn Psychother 2017; 31:204-224. [PMID: 32755938 DOI: 10.1891/0889-8391.31.3.204] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Comorbid anxiety is increasingly being recognized as a significant concern in children with high-functioning autism spectrum disorder (HFASD; Selles & Storch, 2013). Given the significant short and long term impact of anxiety on the functioning of a child with autism spectrum disorder (ASD; e.g., Bellini, 2004; Ben-Sasson et al., 2008), it is imperative that children with HFASD and comorbid anxiety receive intervention as early as is possible. Despite this need, there is a currently a dearth of research examining anxiety management programs for young children with HFASD. This article describes the development of a parent-mediated, cognitive behavioral therapy, group program for anxiety in 4- to 6-year-old children with HFASD. It provides a detailed discussion of the strategies taught to parents and children and highlights some of the challenges involved. A case study is also presented to illustrate progression and outcomes brought about through the program.
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Affiliation(s)
- Julia M Cook
- School of Applied Psychology, Behavioral Basis of Health and Griffith Health Institute, Griffith University, Queensland, Australia
| | - Caroline L Donovan
- School of Applied Psychology, Behavioral Basis of Health and Griffith Health Institute, Griffith University, Queensland, Australia
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109
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van Steensel FJA, Heeman EJ. Anxiety Levels in Children with Autism Spectrum Disorder: A Meta-Analysis. JOURNAL OF CHILD AND FAMILY STUDIES 2017; 26:1753-1767. [PMID: 28680259 PMCID: PMC5487760 DOI: 10.1007/s10826-017-0687-7] [Citation(s) in RCA: 90] [Impact Index Per Article: 12.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/17/2023]
Abstract
The aim of the current study was to meta-analytically examine whether anxiety levels in children with autism spectrum disorders (ASD) are elevated. A total of 83 articles were selected from a systematic literature search and were included in the meta-analyses. Results demonstrated that children with ASD had higher anxiety levels compared to typically developing children, and this difference increased with IQ. Youth with ASD also tended to have higher anxiety levels compared to clinically referred children, and this difference increased with age. Children with ASD had higher anxiety levels compared to youth with externalizing or developmental problems, but not when compared to youth with internalizing problems. The study findings highlight the importance of more research in order to fully understand the nature and development of anxiety in children with ASD. More specifically, the results suggest that especially high-functioning adolescents with ASD may be at risk for developing anxiety disorders. Therefore, it seems important to carefully follow and monitor children with ASD transcending to adolescence.
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Affiliation(s)
- Francisca J. A. van Steensel
- Child Development and Education, University of Amsterdam, Research priority area Yield, Nieuwe Achtergracht 127, 1018 WS Amsterdam, Netherlands
| | - Emma J. Heeman
- De Opvoedpoli B.V., Dorpstraat 145, 2712 AG Zoetermeer, Netherlands
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110
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Weston L, Hodgekins J, Langdon PE. Effectiveness of cognitive behavioural therapy with people who have autistic spectrum disorders: A systematic review and meta-analysis. Clin Psychol Rev 2016; 49:41-54. [DOI: 10.1016/j.cpr.2016.08.001] [Citation(s) in RCA: 116] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2016] [Revised: 06/30/2016] [Accepted: 08/02/2016] [Indexed: 01/17/2023]
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111
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McGrew JH, Ruble LA, Smith IM. Autism spectrum disorder and evidence‐based practice in psychology. ACTA ACUST UNITED AC 2016. [DOI: 10.1111/cpsp.12160] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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112
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Uljarević M, Evans DW. Relationship between repetitive behaviour and fear across normative development, autism spectrum disorder, and down syndrome. Autism Res 2016; 10:502-507. [PMID: 27459229 DOI: 10.1002/aur.1674] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2016] [Revised: 06/17/2016] [Accepted: 06/27/2016] [Indexed: 12/16/2022]
Abstract
The present study had two aims: first to compare levels of restricted and repetitive behaviours (RRB) across two groups of typically developing (TD) children, and two disorders: Autism Spectrum Disorder (ASD) and Down syndrome (DS), and second to explore the relationship between fear and repetitive behaviours in these four groups. Parents of 41 offspring with ASD (Mage = 123.39 months, SDage = 27.67), 38 offspring with DS (Mage = 125.37 months, SDage = 45.71), 45 typically developing children matched to the mental age (MA) of the DS group (TD MA; Mage = 51.13 months, SDage = 22.1), and 42 chronological age (TD CA; Mage = 117.93 months, SDage = 22.91) matched TD children, completed measures of RRB and fear. ANOVAs revealed differences across the four groups on the RRB subscale scores: "Just Right" F(3,162) = 16.62, P < 0.001; Rigid Routines F(3,162) = 52.76, P < 0.001; Sensory behaviours F(3,162) = 23.26, P < 0.001. Post-hoc comparisons revealed that children with ASD had the highest RRB levels followed by DS, TD MA, and TD CA children. In children with ASD, higher levels of fear were related to higher RRB levels. Similar, albeit less strong, patterns of associations was found among DS and TD MA children but not in older TD CA children. This study provided evidence of a fear-RRB association in children with ASD, DS, and two groups of TD children. Autism Res 2017, 10: 502-507. © 2016 International Society for Autism Research, Wiley Periodicals, Inc.
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Affiliation(s)
- Mirko Uljarević
- Olga Tennison Autism Research Centre, School of Psychology and Public Health, La Trobe University, Melbourne, Victoria, Australia.,Cooperative Research Centre for Living with Autism (Autism CRC), Brisbane, Queensland, Australia
| | - David W Evans
- Department of Psychology, Bucknell University, Lewisburg, Pennsylvania
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113
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Keefer A, Kreiser NL, Singh V, Blakeley-Smith A, Duncan A, Johnson C, Klinger L, Meyer A, Reaven J, Vasa RA. Intolerance of Uncertainty Predicts Anxiety Outcomes Following CBT in Youth with ASD. J Autism Dev Disord 2016; 47:3949-3958. [DOI: 10.1007/s10803-016-2852-z] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
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114
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Richey JA, Damiano CR, Sabatino A, Rittenberg A, Petty C, Bizzell J, Voyvodic J, Heller AS, Coffman MC, Smoski M, Davidson RJ, Dichter GS. Neural Mechanisms of Emotion Regulation in Autism Spectrum Disorder. J Autism Dev Disord 2016; 45:3409-23. [PMID: 25618212 DOI: 10.1007/s10803-015-2359-z] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Autism spectrum disorder (ASD) is characterized by high rates of comorbid internalizing and externalizing disorders. One mechanistic account of these comorbidities is that ASD is characterized by impaired emotion regulation (ER) that results in deficits modulating emotional responses. We assessed neural activation during cognitive reappraisal of faces in high functioning adults with ASD. Groups did not differ in looking time, pupilometry, or subjective ratings of faces during reappraisal. However, instructions to increase positive and negative emotional responses resulted in less increase in nucleus accumbens and amygdala activations (respectively) in the ASD group, and both regulation instructions resulted in less change in dorsolateral prefrontal cortex activation in the ASD group. Results suggest a potential mechanistic account of impaired ER in ASD.
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Affiliation(s)
- J Anthony Richey
- Carolina Institute for Developmental Disabilities, University of North Carolina at Chapel Hill School of Medicine, CB# 3366, 101 Manning Drive, Chapel Hill, NC, 27599-7160, USA.,Department of Psychology, Virginia Tech, Blacksburg, VA, USA
| | - Cara R Damiano
- Carolina Institute for Developmental Disabilities, University of North Carolina at Chapel Hill School of Medicine, CB# 3366, 101 Manning Drive, Chapel Hill, NC, 27599-7160, USA.,Department of Psychology, University of North Carolina at Chapel Hill, Davie Hall, Chapel Hill, NC, 27599-3270, USA
| | - Antoinette Sabatino
- Department of Psychology, University of North Carolina at Chapel Hill, Davie Hall, Chapel Hill, NC, 27599-3270, USA.,Geisinger-Autism and Developmental Medicine Institute, Lewisburg, PA, USA
| | - Alison Rittenberg
- Carolina Institute for Developmental Disabilities, University of North Carolina at Chapel Hill School of Medicine, CB# 3366, 101 Manning Drive, Chapel Hill, NC, 27599-7160, USA
| | - Chris Petty
- Duke-UNC Brain Imaging and Analysis Center, Duke University Medical Center, Durham, NC, 27710, USA
| | - Josh Bizzell
- Duke-UNC Brain Imaging and Analysis Center, Duke University Medical Center, Durham, NC, 27710, USA.,Department of Psychiatry, University of North Carolina at Chapel Hill School of Medicine, CB# 7160, Chapel Hill, NC, 27599-7160, USA
| | - James Voyvodic
- Duke-UNC Brain Imaging and Analysis Center, Duke University Medical Center, Durham, NC, 27710, USA
| | - Aaron S Heller
- Sackler Institute for Developmental Psychobiology, Weill Medical College of Cornell University, New York, NY, 10065, USA
| | | | - Moria Smoski
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Box 3026, Durham, NC, 27710, USA
| | - Richard J Davidson
- Waisman Laboratory for Brain Imaging and Behavior, Center for Investigating Healthy Minds, University of Wisconsin-Madison, Madison, WI, USA
| | - Gabriel S Dichter
- Carolina Institute for Developmental Disabilities, University of North Carolina at Chapel Hill School of Medicine, CB# 3366, 101 Manning Drive, Chapel Hill, NC, 27599-7160, USA. .,Duke-UNC Brain Imaging and Analysis Center, Duke University Medical Center, Durham, NC, 27710, USA. .,Department of Psychiatry, University of North Carolina at Chapel Hill School of Medicine, CB# 7160, Chapel Hill, NC, 27599-7160, USA. .,Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Box 3026, Durham, NC, 27710, USA. .,Department of Psychology, University of North Carolina at Chapel Hill, Davie Hall, Chapel Hill, NC, 27599-3270, USA.
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115
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Langdon PE, Murphy GH, Shepstone L, Wilson ECF, Fowler D, Heavens D, Malovic A, Russell A, Rose A, Mullineaux L. The People with Asperger syndrome and anxiety disorders (PAsSA) trial: a pilot multicentre, single-blind randomised trial of group cognitive-behavioural therapy. BJPsych Open 2016; 2:179-186. [PMID: 27703772 PMCID: PMC4995577 DOI: 10.1192/bjpo.bp.115.002527] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2015] [Revised: 01/28/2016] [Accepted: 03/23/2016] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND There is a growing interest in using cognitive-behavioural therapy (CBT) with people who have Asperger syndrome and comorbid mental health problems. AIMS To examine whether modified group CBT for clinically significant anxiety in an Asperger syndrome population is feasible and likely to be efficacious. METHOD Using a randomised assessor-blind trial, 52 individuals with Asperger syndrome were randomised into a treatment arm or a waiting-list control arm. After 24 weeks, those in the waiting-list control arm received treatment, while those initially randomised to treatment were followed up for 24 weeks. RESULTS The conversion rate for this trial was high (1.6:1), while attrition was 13%. After 24 weeks, there was no significant difference between those randomised to the treatment arm compared with those randomised to the waiting-list control arm on the primary outcome measure, the Hamilton Rating Scale for Anxiety. CONCLUSIONS Trials of psychological therapies with this population are feasible. Larger definitive trials are now needed. DECLARATION OF INTEREST None. COPYRIGHT AND USAGE © The Royal College of Psychiatrists 2016. This is an open access article distributed under the terms of the Creative Commons Attribution (CC BY) licence.
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Affiliation(s)
- Peter E Langdon
- , DClinPsy, PhD, Tizard Centre, University of Kent, Canterbury, UK; Broadland Clinic, Hertfordshire Partnership University NHS Foundation Trust in Norfolk, Norwich, UK
| | - Glynis H Murphy
- , PhD, Tizard Centre, University of Kent, Canterbury, UK, and Oxleas NHS Foundation Trust, Dartford, UK
| | - Lee Shepstone
- , PhD, Department of Population Health and Primary Care, Norwich Medical School, University of East Anglia, Norwich, UK
| | - Edward C F Wilson
- , PhD, School of Clinical Medicine, University of Cambridge, Cambridge, UK
| | - David Fowler
- , MSc, School of Psychology, University of Sussex, Brighton, UK
| | - David Heavens
- , ClinPsyD, Department of Clinical Psychology, Norwich Medical School, University of East Anglia, Norwich, and Norfolk and Suffolk NHS Foundation Trust, Norwich, UK
| | - Aida Malovic
- , MSc, Tizard Centre, University of Kent, Canterbury, UK
| | | | - Alice Rose
- , BSc (Hons), Department of Clinical Psychology, Norwich Medical School, University of East Anglia, Norwich, UK, and Norfolk and Suffolk NHS Foundation Trust, Norwich, UK
| | - Louise Mullineaux
- , BSc (Hons), Department of Clinical Psychology, Norwich Medical School, University of East Anglia, Norwich, UK, and Hertfordshire Partnership University NHS Foundation Trust in Norfolk, Norwich, UK
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116
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Rosen TE, Connell JE, Kerns CM. A Review of Behavioral Interventions for Anxiety-Related Behaviors in Lower-Functioning Individuals with Autism. BEHAVIORAL INTERVENTIONS 2016. [DOI: 10.1002/bin.1442] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Affiliation(s)
- Tamara E. Rosen
- A.J. Drexel Autism Institute; Drexel University; Philadelphia PA USA
- Stony Brook University; Stony Brook NY USA
| | - James E. Connell
- A.J. Drexel Autism Institute; Drexel University; Philadelphia PA USA
| | - Connor M. Kerns
- A.J. Drexel Autism Institute; Drexel University; Philadelphia PA USA
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117
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Joint trajectories of internalizing and externalizing problems in preschool children with autism spectrum disorder. Dev Psychopathol 2016; 29:203-214. [DOI: 10.1017/s0954579416000043] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
AbstractThe co-occurring development of internalizing and externalizing problems were examined in an inception cohort of 392 children diagnosed with autism spectrum disorder at age 3 who were assessed on four occasions. Results indicated that internalizing and externalizing problems were stable over time and highly comorbid. Joint trajectory analysis suggested that 13% of the sample followed a dual high-risk trajectory. High risk was not found to be associated with intellectual ability or autism spectrum disorder symptom severity but was linked to lower income and gender: more girls than boys were found in the high/stable internalizing problems trajectory. The results suggest that 1 in 4 preschoolers followed a trajectory of internalizing or externalizing problems (or a combination of the two) that could be characterized as clinically elevated.
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118
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Sukhodolsky DG, Wyk BCV, Eilbott JA, McCauley SA, Ibrahim K, Crowley MJ, Pelphrey KA. Neural Mechanisms of Cognitive-Behavioral Therapy for Aggression in Children and Adolescents: Design of a Randomized Controlled Trial Within the National Institute for Mental Health Research Domain Criteria Construct of Frustrative Non-Reward. J Child Adolesc Psychopharmacol 2016; 26:38-48. [PMID: 26784537 PMCID: PMC4779273 DOI: 10.1089/cap.2015.0164] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
OBJECTIVE We present the rationale and design of a randomized controlled trial of cognitive-behavioral therapy (CBT) for aggression in children and adolescents, which is conducted in response to the National Institute of Mental Health (NIMH) Research Domain Criteria (RDoC) approach initiative. Specifically, the study is focused on the brain-behavior associations within the RDoC construct of frustrative non-reward. On the behavioral level, this construct is defined by reactions elicited in response to withdrawal or prevention of reward, most notably reactive aggression. This study is designed to test the functional magnetic resonance (fMRI) and electrophysiological (EEG) correlates of aggression and its reduction after CBT. METHODS Eighty children and adolescents with high levels of aggression across multiple traditional diagnostic categories, ages 8-16, will be randomly assigned to receive 12 sessions of CBT or 12 sessions of supportive psychotherapy. Clinical outcomes will be measured by the ratings of aggressive behavior collected at baseline, midpoint, and endpoint evaluations, and by the Improvement Score of the Clinical Global Impressions Scale assigned by an independent evaluator (blinded rater). Subjects will also perform a frustration-induction Go-NoGo task and a task of emotional face perception during fMRI scanning and EEG recording at baseline and endpoint. RESULTS Consistent with the NIMH strategic research priorities, if functional neuroimaging and EEG variables can identify subjects who respond to CBT for aggression, this can provide a neuroscience-based classification scheme that will improve treatment outcomes for children and adolescents with aggressive behavior. CONCLUSIONS Demonstrating that a change in the key nodes of the emotion regulation circuitry is associated with a reduction of reactive aggression will provide evidence to support the validity of the frustrative non-reward construct.
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Affiliation(s)
| | - Brent C. Vander Wyk
- Child Study Center, Yale University School of Medicine, New Haven, Connecticut
| | - Jeffrey A. Eilbott
- Child Study Center, Yale University School of Medicine, New Haven, Connecticut
| | - Spencer A. McCauley
- Child Study Center, Yale University School of Medicine, New Haven, Connecticut
| | - Karim Ibrahim
- Child Study Center, Yale University School of Medicine, New Haven, Connecticut
| | - Michael J. Crowley
- Child Study Center, Yale University School of Medicine, New Haven, Connecticut
| | - Kevin A. Pelphrey
- Child Study Center, Yale University School of Medicine, New Haven, Connecticut
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119
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Abstract
Anxiety disorders are one of the most common psychiatric comorbidities among children and adolescents with autism spectrum disorders (ASD). There has been a recent proliferation of research examining the prevalence, phenomenology, assessment and treatment of anxiety disorders among youth with ASD. While there is currently very limited support for the use of pharmacological agents to treat anxiety among youth with ASD and comorbid anxiety, there has been overwhelming support across numerous modestly sized controlled studies for the efficacy of cognitive behavioral therapy. This review discusses advances in the treatment literature for anxiety in youth with ASD, and discusses the current evidence base for whether standard treatment needs to be adapted for this population.
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Affiliation(s)
- Carly Johnco
- Department of Pediatrics, University of South Florida
| | - Eric A. Storch
- Department of Pediatrics, University of South Florida
- Department of Psychology, University of South Florida
- Department of Psychiatry & Behavioral Neurosciences, University of South Florida
- Department of Health Policy and Management, University of South Florida
- Rogers Behavioral Health – Tampa Bay
- All Children’s Hospital – Johns Hopkins Medicine
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120
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Spain D, Sin J, Paliokosta E, Furuta M, Chalder T, Murphy DG, Happé FG. Family therapy for autism spectrum disorders. THE COCHRANE DATABASE OF SYSTEMATIC REVIEWS 2015. [DOI: 10.1002/14651858.cd011894] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
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121
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Johnco CJ, De Nadai AS, Lewin AB, Ehrenreich-May J, Wood JJ, Storch EA. Defining treatment response and symptom remission for anxiety disorders in pediatric autism spectrum disorders using the Pediatric Anxiety Rating Scale. J Autism Dev Disord 2015; 45:3232-42. [PMID: 26031924 PMCID: PMC4574290 DOI: 10.1007/s10803-015-2483-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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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Affiliation(s)
- Carly J Johnco
- Department of Pediatrics, University of South Florida, St. Petersburg, FL, USA.
- Rothman Center for Pediatric Neuropsychiatry, Child Development and Rehabilitation Center, 880 6th Street South Suite 460, Box 7523, St. Petersburg, FL, 33701, USA.
| | | | - Adam B Lewin
- Department of Pediatrics, University of South Florida, St. Petersburg, FL, USA
- Department of Psychology, University of South Florida, Tampa, FL, USA
- Department of Psychiatry and Behavioral Neurosciences, University of South Florida, Tampa, FL, USA
| | | | - Jeffrey J Wood
- Division of Child Psychiatry, University of California, Los Angeles, CA, USA
- Division of Psychological Studies in Education, University of California, Los Angeles, CA, USA
| | - Eric A Storch
- Department of Pediatrics, University of South Florida, St. Petersburg, FL, USA
- Department of Psychology, University of South Florida, Tampa, FL, USA
- Department of Psychiatry and Behavioral Neurosciences, University of South Florida, Tampa, FL, USA
- Department of Health Policy and Management, University of South Florida, Tampa, FL, USA
- Rogers Behavioral Health - Tampa Bay, Tampa, FL, USA
- All Children's Hospital - Johns Hopkins Medicine, St. Petersburg, FL, USA
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122
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Ung D, Selles R, Small BJ, Storch EA. A Systematic Review and Meta-Analysis of Cognitive-Behavioral Therapy for Anxiety in Youth with High-Functioning Autism Spectrum Disorders. Child Psychiatry Hum Dev 2015; 46:533-47. [PMID: 25246292 DOI: 10.1007/s10578-014-0494-y] [Citation(s) in RCA: 121] [Impact Index Per Article: 13.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Cognitive-behavioral therapy (CBT) has been developed and modified to treat anxiety symptoms in youth with high-functioning autism spectrum disorders (ASD) but has yielded varying findings. The present report is a systematic review and meta-analysis examining the efficacy of CBT for anxiety among youth with ASD. A systematic search identified 14 studies involving 511 youth with high-functioning ASD. A random effects meta-analysis yielded a statistically significant pooled treatment effect size (g) estimate for CBT (g = -0.71, p < .001) with significant heterogeneity [Q (13) = 102.27, p < .001]. Removal of a study outlier yielded a statistically significant pooled treatment effect size, (g = -0.47, p < .001). Anxiety informant and treatment modality were not statistically significant moderators of treatment response. Findings suggest that CBT demonstrates robust efficacy in reducing anxiety symptoms in youth with high-functioning ASD.
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Affiliation(s)
- Danielle Ung
- Department of Psychology, University of South Florida, 4202 E. Fowler Ave., PCD 4118G, Tampa, FL, 33620-7200, USA,
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123
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Kreslins A, Robertson AE, Melville C. The effectiveness of psychosocial interventions for anxiety in children and adolescents with autism spectrum disorder: a systematic review and meta-analysis. Child Adolesc Psychiatry Ment Health 2015; 9:22. [PMID: 26120361 PMCID: PMC4482189 DOI: 10.1186/s13034-015-0054-7] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2014] [Accepted: 06/08/2015] [Indexed: 12/28/2022] Open
Abstract
Anxiety is a common problem in children and adolescents with autism spectrum disorder (ASD). This meta-analysis aimed to systematically evaluate the evidence for the use of psychosocial interventions to manage anxiety in this population. Cognitive behavioural therapy (CBT) was the primary intervention modality studied. A comprehensive systematic search and study selection process was conducted. Separate statistical analyses were carried out for clinician-, parent-, and self-reported outcome measures. Sensitivity analyses were conducted by removing any outlying studies and any studies that did not use a CBT intervention. A subgroup analysis was performed to compare individual and group delivery of treatment. Ten randomised control trials involving a total of 470 participants were included. The overall SMD was d = 1.05 (95 % CI 0.45, 1.65; z = 3.45, p = 0.0006) for clinician- reported outcome measures; d = 1.00 (95%CI 0.21, 1.80; z = 2.47, p = 0.01) for parent-reported outcome measures; and d = 0.65 (95%CI -0.10, 1.07; z = 1.63, p = 0.10) for self-reported outcome measures. Clinician- and parent-reported outcome measures showed that psychosocial interventions were superior to waitlist and treatment-as-usual control conditions at post-treatment. However, the results of self-reported outcome measures failed to reach significance. The sensitivity analyses did not significantly change these results and the subgroup analysis indicated that individual treatment was more effective than group treatment. The main limitations of this review were the small number of included studies as well as the clinical and methodological variability between studies.
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Affiliation(s)
- Ance Kreslins
- Institute of Health and Wellbeing, University of Glasgow, 1st Floor Admin Building Gartnavel Royal Hospital, 1055 Great Western Road, Glasgow, G12 0XH, Scotland
| | - Ashley E. Robertson
- Institute of Health and Wellbeing, University of Glasgow, 1st Floor Admin Building Gartnavel Royal Hospital, 1055 Great Western Road, Glasgow, G12 0XH, Scotland
| | - Craig Melville
- Institute of Health and Wellbeing, University of Glasgow, 1st Floor Admin Building Gartnavel Royal Hospital, 1055 Great Western Road, Glasgow, G12 0XH, Scotland
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124
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Frye RE. Metabolic and mitochondrial disorders associated with epilepsy in children with autism spectrum disorder. Epilepsy Behav 2015; 47:147-57. [PMID: 25440829 DOI: 10.1016/j.yebeh.2014.08.134] [Citation(s) in RCA: 67] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2014] [Revised: 08/25/2014] [Accepted: 08/27/2014] [Indexed: 01/07/2023]
Abstract
Autism spectrum disorder (ASD) affects a significant number of individuals in the United States, with the prevalence continuing to grow. A significant proportion of individuals with ASD have comorbid medical conditions such as epilepsy. In fact, treatment-resistant epilepsy appears to have a higher prevalence in children with ASD than in children without ASD, suggesting that current antiepileptic treatments may be suboptimal in controlling seizures in many individuals with ASD. Many individuals with ASD also appear to have underlying metabolic conditions. Metabolic conditions such as mitochondrial disease and dysfunction and abnormalities in cerebral folate metabolism may affect a substantial number of children with ASD, while other metabolic conditions that have been associated with ASD such as disorders of creatine, cholesterol, pyridoxine, biotin, carnitine, γ-aminobutyric acid, purine, pyrimidine, and amino acid metabolism and urea cycle disorders have also been associated with ASD without the prevalence clearly known. Interestingly, all of these metabolic conditions have been associated with epilepsy in children with ASD. The identification and treatment of these disorders could improve the underlying metabolic derangements and potentially improve behavior and seizure frequency and/or severity in these individuals. This paper provides an overview of these metabolic disorders in the context of ASD and discusses their characteristics, diagnostic testing, and treatment with concentration on mitochondrial disorders. To this end, this paper aims to help optimize the diagnosis and treatment of children with ASD and epilepsy. This article is part of a Special Issue entitled "Autism and Epilepsy".
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Affiliation(s)
- Richard E Frye
- Autism Research Program, Arkansas Children's Hospital Research Institute, Little Rock, AR, USA; Department of Pediatrics, University of Arkansas for Medical Sciences, Little Rock, AR, USA.
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125
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Frye RE, Rose S, Slattery J, MacFabe DF. Gastrointestinal dysfunction in autism spectrum disorder: the role of the mitochondria and the enteric microbiome. MICROBIAL ECOLOGY IN HEALTH AND DISEASE 2015; 26:27458. [PMID: 25956238 PMCID: PMC4425813 DOI: 10.3402/mehd.v26.27458] [Citation(s) in RCA: 58] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/01/2015] [Revised: 04/09/2015] [Accepted: 04/10/2015] [Indexed: 12/26/2022]
Abstract
Autism spectrum disorder (ASD) affects a significant number of individuals worldwide with the prevalence continuing to grow. It is becoming clear that a large subgroup of individuals with ASD demonstrate abnormalities in mitochondrial function as well as gastrointestinal (GI) symptoms. Interestingly, GI disturbances are common in individuals with mitochondrial disorders and have been reported to be highly prevalent in individuals with co-occurring ASD and mitochondrial disease. The majority of individuals with ASD and mitochondrial disorders do not manifest a primary genetic mutation, raising the possibility that their mitochondrial disorder is acquired or, at least, results from a combination of genetic susceptibility interacting with a wide range of environmental triggers. Mitochondria are very sensitive to both endogenous and exogenous environmental stressors such as toxicants, iatrogenic medications, immune activation, and metabolic disturbances. Many of these same environmental stressors have been associated with ASD, suggesting that the mitochondria could be the biological link between environmental stressors and neurometabolic abnormalities associated with ASD. This paper reviews the possible links between GI abnormalities, mitochondria, and ASD. First, we review the link between GI symptoms and abnormalities in mitochondrial function. Second, we review the evidence supporting the notion that environmental stressors linked to ASD can also adversely affect both mitochondria and GI function. Third, we review the evidence that enteric bacteria that are overrepresented in children with ASD, particularly Clostridia spp., produce short-chain fatty acid metabolites that are potentially toxic to the mitochondria. We provide an example of this gut–brain connection by highlighting the propionic acid rodent model of ASD and the clinical evidence that supports this animal model. Lastly, we discuss the potential therapeutic approaches that could be helpful for GI symptoms in ASD and mitochondrial disorders. To this end, this review aims to help better understand the underlying pathophysiology associated with ASD that may be related to concurrent mitochondrial and GI dysfunction.
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Affiliation(s)
- Richard E Frye
- Autism Research Program, Arkansas Children's Hospital Research Institute, Little Rock, AR, USA.,Department of Pediatrics, University of Arkansas for Medical Sciences, Little Rock, AR, USA;
| | - Shannon Rose
- Autism Research Program, Arkansas Children's Hospital Research Institute, Little Rock, AR, USA.,Department of Pediatrics, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - John Slattery
- Autism Research Program, Arkansas Children's Hospital Research Institute, Little Rock, AR, USA.,Department of Pediatrics, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Derrick F MacFabe
- Kilee Patchell-Evans Autism Research Group, Division of Developmental Disabilities, Departments of Psychology and Psychiatry, University of Western Ontario, London, ON, Canada
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126
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Magiati I, Ong C, Lim XY, Tan JWL, Ong AYL, Patrycia F, Fung DSS, Sung M, Poon KK, Howlin P. Anxiety symptoms in young people with autism spectrum disorder attending special schools: Associations with gender, adaptive functioning and autism symptomatology. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2015; 20:306-20. [PMID: 25916865 DOI: 10.1177/1362361315577519] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Anxiety-related problems are among the most frequently reported mental health difficulties in autism spectrum disorder. As most research has focused on clinical samples or high-functioning children with autism spectrum disorder, less is known about the factors associated with anxiety in community samples across the ability range. This cross-sectional study examined the association of gender, age, adaptive functioning and autism symptom severity with different caregiver-reported anxiety symptoms. Participants were caregivers of 241 children (6-18 years old) with autism spectrum disorder attending special schools in Singapore. Measures included the Spence Children's Anxiety Scale and assessments of overall emotional, behavioural and adaptive functioning. Caregivers reported more anxiety symptoms in total, but fewer social anxiety symptoms, than Spence Children's Anxiety Scale Australian/Dutch norms. There were no gender differences. Variance in total anxiety scores was best explained by severity of repetitive speech/stereotyped behaviour symptoms, followed by adaptive functioning. Severity of repetitive speech/behaviour symptoms was a significant predictor of separation anxiety, generalized anxiety, panic/agoraphobia and obsessive-compulsive subscale symptoms, but not of social phobia and physical injury fears. Adaptive functioning and chronological age predicted social phobia and generalized anxiety symptoms only. Severity of social/communication autism symptoms did not explain any anxiety symptoms, when the other variables were controlled for. Findings are discussed in relation to the existing literature. Limitations and possible implications for prevention, assessment and intervention are also discussed.
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Affiliation(s)
| | | | - Xin Yi Lim
- National University of Singapore, Singapore
| | | | | | | | | | - Min Sung
- Institute of Mental Health, Singapore
| | - Kenneth K Poon
- National Institute of Education, Nanyang Technological University, Singapore
| | - Patricia Howlin
- Institute of Psychiatry, UK Faculty of Health Sciences, University of Sydney, Australia
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127
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Loades ME. Evidence-Based Practice in the Face of Complexity and Comorbidity: A Case Study of an Adolescent With Asperger's Syndrome, Anxiety, Depression, and Chronic Pain. JOURNAL OF CHILD AND ADOLESCENT PSYCHIATRIC NURSING 2015; 28:73-83. [PMID: 25865961 DOI: 10.1111/jcap.12108] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
PROBLEM Working with clients who present with multiple conditions and comorbidities, including mental health difficulties, neurodevelopmental disorders, and physical health conditions, requires the therapist to go beyond the existing evidence base to make decisions about which specific cognitive behavior therapy (CBT) models and resultant treatment approaches to draw on in therapy. Routine outcome monitoring across a number of parameters, including goal progress, symptom improvement, and changes in functioning, are core to maintaining accountability through monitoring the ongoing impact of idiosyncratic interventions. METHOD The case of a young person (age 17 years) who presented with mixed anxiety and depression in the context of autism spectrum disorder (ASD) and chronic pain are presented. In addition to evidence-based adaptations to CBT for clients with ASDs, the therapist selected a cognitive model of low self-esteem as a means of collaboratively conceptualizing the client's difficulties. FINDINGS AND CONCLUSION Routine outcome measurement demonstrated the effectiveness of the intervention.
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Affiliation(s)
- Maria E Loades
- Clinical Psychology Doctorate Programme, University of Bath, Bath, UK
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128
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Abstract
PURPOSE OF REVIEW Anxiety is one of the most common co-occurring psychiatric conditions in youth with autism spectrum disorders (ASDs). This article reviews recent evidence as well as earlier relevant studies regarding the characteristics, assessment, and treatment of anxiety in youth with ASD. RECENT FINDINGS It is well established that the prevalence of anxiety in youth with an ASD is significantly greater than the prevalence of anxiety in the general population. Recent studies have highlighted the importance of informant, method, and instrument when measuring anxiety in this population. Despite the high prevalence, findings to date have been unable to identify any consistent risk factors for anxiety. New psychological treatments, including modified cognitive behavioral therapy for youth with high functioning ASD and co-occurring anxiety, are emerging. Pharmacological data, however, are scant. Existing studies show that youth with ASD are at increased risk for behavioral activation when taking SSRIs. SUMMARY Clinicians working with youth with ASD are encouraged to routinely screen for anxiety. Until further data are available, clinical judgment is needed when prescribing treatments, particularly selective serotonin reuptake inhibitors, which require close monitoring of side-effects. Research on risk factors, pathophysiology, and treatment of this condition is needed.
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129
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Neural systems for cognitive reappraisal in children and adolescents with autism spectrum disorder. Dev Cogn Neurosci 2014; 10:117-28. [PMID: 25198094 PMCID: PMC4253669 DOI: 10.1016/j.dcn.2014.08.007] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2013] [Revised: 08/06/2014] [Accepted: 08/08/2014] [Indexed: 11/21/2022] Open
Abstract
We explore brain mechanisms of cognitive reappraisal in youth with autism. Youth with autism are capable of modulating their emotional response to disgust. They exhibit atypical brain activity in amygdala and insula compared to controls. We report altered functional connectivity between amygdala and prefrontal cortex. These findings have implications for treatment of emotion dysregulation in autism.
Despite substantial clinical and anecdotal evidence for emotion dysregulation in individuals with autism spectrum disorder (ASD), little is known about the neural substrates underlying this phenomenon. We sought to explore neural mechanisms for cognitive reappraisal in children and adolescents with ASD using functional magnetic resonance imaging (fMRI). We studied 16 youth with ASD and 15 age- and IQ-matched typically developing (TD) comparison youth. Participants were instructed in the use of cognitive reappraisal strategies to increase and decrease their emotional responses to disgusting images. Participants in both groups displayed distinct patterns of brain activity for increasing versus decreasing their emotions. TD participants showed downregulation of bilateral insula and left amygdala on decrease trials, whereas ASD participants showed no modulation of insula and upregulation of left amygdala. Furthermore, TD youth exhibited increased functional connectivity between amygdala and ventrolateral prefrontal cortex compared to ASD participants when downregulating disgust, as well as decreased functional connectivity between amygdala and orbitofrontal cortex. These findings have important implications for our understanding of emotion dysregulation and its treatment in ASD. In particular, the relative lack of prefrontal-amygdala connectivity provides a potential target for treatment-related outcome measurements.
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130
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A Systematic Review of Treatments for Anxiety in Youth with Autism Spectrum Disorders. J Autism Dev Disord 2014; 44:3215-29. [DOI: 10.1007/s10803-014-2184-9] [Citation(s) in RCA: 70] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
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131
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Ousley O, Cermak T. Autism Spectrum Disorder: Defining Dimensions and Subgroups. CURRENT DEVELOPMENTAL DISORDERS REPORTS 2014; 1:20-28. [PMID: 25072016 PMCID: PMC4111262 DOI: 10.1007/s40474-013-0003-1] [Citation(s) in RCA: 81] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Autism spectrum disorder (ASD) is a behaviorally defined neurodevelopmental disorder associated with the presence of social-communication deficits and restricted and repetitive behaviors. In the latest conceptualization of ASD, these two behavioral dimensions represent the core defining features of ASD, whereas associated dimensions, such as intellectual and language ability, provide a means for describing the ASD heterogeneity. In addition, the characterization of ASD subgroups, defined by the presence of known medical, genetic, or other psychiatric disorders, furthers our understanding of ASD heterogeneity. This paper reviews the history of autism, describes its core defining features, and provides an overview of the clinically and etiologically relevant subgroups that add to the complexity of this condition.
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Affiliation(s)
- Opal Ousley
- Emory Autism Center, Department of Psychiatry and Behavioral
Sciences, Emory University School of Medicine, 1551 Shoup Court, Atlanta, GA
30322, USA
| | - Tracy Cermak
- Marcus Autism Center, Children’s Healthcare of Atlanta,
1920 Briarcliff Road, Atlanta, GA 30329, USA
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