1
|
Aymerich C, Pacho M, Catalan A, Yousaf N, Pérez-Rodríguez V, Hollocks MJ, Parellada M, Krebs G, Clark B, Salazar de Pablo G. Prevalence and Correlates of the Concurrence of Autism Spectrum Disorder and Obsessive Compulsive Disorder in Children and Adolescents: A Systematic Review and Meta-Analysis. Brain Sci 2024; 14:379. [PMID: 38672028 PMCID: PMC11048346 DOI: 10.3390/brainsci14040379] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2024] [Revised: 04/10/2024] [Accepted: 04/11/2024] [Indexed: 04/28/2024] Open
Abstract
BACKGROUND Autism spectrum disorder (ASD) and obsessive compulsive disorder (OCD) are two common and impairing neurodevelopmental conditions with partial symptomatic overlap. The aim of this study is to systematically and meta-analytically examine the following: (i) the prevalence of an OCD diagnosis among young people with ASD, (ii) the prevalence of an ASD diagnosis among young people with OCD, and (iii) the clinical and therapeutic implications of such comorbidity. METHOD A multistep literature search was performed from database inception until 17 November 2023. This PRISMA/MOOSE-compliant systematic review, registered in PROSPERO (CRD42023480543), identified studies reporting on the prevalence, sociodemographic, psychopathologic, prognostic, and therapeutic correlates of OCD and ASD concurrence in children and adolescents. A quantitative meta-analysis with random effects was conducted to analyse the pooled prevalence of OCD among samples with a mean age of < 18 years old with ASD and the prevalence of ASD among individuals under 18 with OCD. Sensitivity analyses were performed to investigate the effect of diagnostic criteria and different continents. Meta-regression analyses were conducted to examine the effect of gender, age, IQ, and OCD severity scores. A narrative review of the clinical and therapeutical implications of the comorbidity was provided. RESULTS 42 studies were selected for the systematic review (SR), and 31 of them were also included in one of the meta-analyses. The pooled prevalence of OCD among ASD youth samples (n = 8916, mean age = 10.6 ± 1.6; 16.4% female) was 11.6% (95% confidence intervals [CI] = 6.9%; 18.8%), and the pooled prevalence of ASD among OCD children and adolescent samples (n = 6209, mean age = 14.1 ± 1.4; 45.7% female) was 9.5% (95% CI = 6.0%; 14.7%). Meta-regressions found a statistically higher prevalence of ASD among samples with a lower prevalence of females (β = -4.7; 95%CI = -8.6; -0.8). Children with both OCD and ASD present higher rates of functional impairment, psychopathology, and other comorbidities, compared to youth with either of the disorders alone. CONCLUSIONS OCD and ASD are highly concurrent conditions in youth, with symptomatic, prognostic, severity, and therapeutic implications. Future research should focus on conducting longitudinal cohort studies prospectively to determine development trajectories, along with randomized controlled trials to assess the efficacy of specific therapeutic interventions.
Collapse
Affiliation(s)
- Claudia Aymerich
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London WC2R 2LS, UK
- Biobizkaia Health Research Institute, Basque Country University, Basurto University Hospital, OSI Bilbao-Basurto, Centro de Investigación en Red de Salud Mental (CIBERSAM), Instituto de Salud Carlos III, 48903 Barakaldo, Spain
| | - Malein Pacho
- Biobizkaia Health Research Institute, Basque Country University, Basurto University Hospital, OSI Bilbao-Basurto, Centro de Investigación en Red de Salud Mental (CIBERSAM), Instituto de Salud Carlos III, 48903 Barakaldo, Spain
| | - Ana Catalan
- Biobizkaia Health Research Institute, Basque Country University, Basurto University Hospital, OSI Bilbao-Basurto, Centro de Investigación en Red de Salud Mental (CIBERSAM), Instituto de Salud Carlos III, 48903 Barakaldo, Spain
- Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London WC2R 2LS, UK
| | - Noorulain Yousaf
- Child and Adolescent Mental Health Services, South London and Maudsley NHS Foundation Trust, London SE5 8AZ, UK
| | - Violeta Pérez-Rodríguez
- Child and Adolescent Mental Health Services, South London and Maudsley NHS Foundation Trust, London SE5 8AZ, UK
| | - Matthew J. Hollocks
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London WC2R 2LS, UK
- Service for Complex Autism & Associated Neurodevelopmental Disorders, South London and Maudsley NHS Foundation Trust, London SE5 8AZ, UK
| | - Mara Parellada
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry and Mental Health, Hospital General Universitario Gregorio Marañón School of Medicine, Universidad Complutense, Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Centro de Investigación en Red en Salud Mental (CIBERSAM), 28007 Madrid, Spain
| | - Georgina Krebs
- Research Department of Clinical, Educational and Health Psychology, University College London, London WC1E 6BT, UK
- National & Specialist OCD, BDD and Related Disorder Clinic, South London & Maudsley NHS Foundation Trust, London SE5 8AZ, UK
| | - Bruce Clark
- National & Specialist OCD, BDD and Related Disorder Clinic, South London & Maudsley NHS Foundation Trust, London SE5 8AZ, UK
| | - Gonzalo Salazar de Pablo
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London WC2R 2LS, UK
- Child and Adolescent Mental Health Services, South London and Maudsley NHS Foundation Trust, London SE5 8AZ, UK
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry and Mental Health, Hospital General Universitario Gregorio Marañón School of Medicine, Universidad Complutense, Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Centro de Investigación en Red en Salud Mental (CIBERSAM), 28007 Madrid, Spain
| |
Collapse
|
2
|
Rozenblat S, Shimshoni Y, Lebowitz ER, Perez M, Koller J. A Pilot Trial of SPACE (Supportive Parenting for Anxious Childhood Emotions) in Autism. Child Psychiatry Hum Dev 2023:10.1007/s10578-023-01555-4. [PMID: 37353645 DOI: 10.1007/s10578-023-01555-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/10/2023] [Indexed: 06/25/2023]
Abstract
Family accommodation describes changes parents make to their behavior, intended to alleviate their child's distress, which stems from a psychopathology. In anxiety, studies show that accommodation alleviates distress in the short term but is associated with increased symptom severity, greater functional impairment, poorer treatment outcomes, increased caregiver burden and disruption to family functioning longitudinally. Research shows high prevalence of family accommodation of anxiety in autism. While the most common treatments for anxiety in autism are cognitive-behavior therapy and pharmacology, research is limited and other approaches must be considered. Supportive Parenting for Anxious Childhood Emotions (SPACE) is a parent-based, manualized treatment for anxiety targeting family accommodation, which has been found to be acceptable and efficacious in treating childhood anxiety. This pilot trial examined the feasibility, acceptability, treatment-satisfaction, and preliminary efficacy of SPACE for anxiety in autism. Parents of 15 autistic children (ages 6-10 years) with at least average cognitive abilities exhibiting high levels of anxiety participated in 13 weekly sessions of SPACE. Feasibility and acceptability were assessed through enrollment, attrition rates, and adverse events. Of 26 eligible families, 22 (84.62%) elected to participate, 15 of whom (68.18%) completed treatment. Parents rated the treatment as highly satisfactory. Anxiety symptom severity and family accommodation were significantly reduced following treatment, with 86.66% of participants showing reliable change post-treatment, and this reduction was preserved at 2-month follow-up. This study provides preliminary evidence that SPACE is feasible, acceptable, satisfactory, and produces improvement in anxiety in the autistic population.Trial registration number: NCT04747262 Date of registration: February 10, 2021.
Collapse
Affiliation(s)
- Shir Rozenblat
- Seymour Fox School of Education, The Hebrew University of Jerusalem, Jerusalem, Israel.
| | | | | | - Michal Perez
- Seymour Fox School of Education, The Hebrew University of Jerusalem, Jerusalem, Israel
| | - Judah Koller
- Seymour Fox School of Education, The Hebrew University of Jerusalem, Jerusalem, Israel.
| |
Collapse
|
3
|
Albaum CS, Vashi N, Bohr Y, Weiss JA. A Systematic Review of Therapeutic Process Factors in Mental Health Treatment for Autistic Youth. Clin Child Fam Psychol Rev 2023; 26:212-241. [PMID: 35999330 PMCID: PMC9879813 DOI: 10.1007/s10567-022-00409-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/08/2022] [Indexed: 01/31/2023]
Abstract
Understanding the role of therapeutic process factors in treatment change may prove useful for discerning why some autistic youth benefit from psychosocial interventions that target emotional and psychological aspects of mental health, while others do not. The aim of the current study was to synthesize what is currently known about therapeutic process factors in mental health treatment of emotional and psychological challenges for autistic youth, regarding how process factors have been measured in past research, and the relation between process factors and treatment outcome. A systematic review of the literature was conducted to narratively synthesize all articles published up until June 2021. Methodological quality of included studies was appraised. Twenty-five studies met inclusion criteria. Process factors assessed across studies included relational factors; treatment expectations, readiness, and satisfaction; and treatment engagement from youth and their parents. Process-outcome associations were reported for a limited number of constructs. There is a limited, albeit growing, body of high-quality research evaluating the role of process factors in the treatment of mental health issues for autistic youth. Future research should continue to examine process factors in relation to treatment outcome, and validate measures to accurately capture process-related constructs in mental health treatment for this population. Greater understanding of therapy processes can lead to developing evidence-informed strategies that clinicians can implement to promote positive expectations, relationships, and engagement.
Collapse
Affiliation(s)
- Carly S Albaum
- Department of Psychology, York University, 4700 Keele Street, Toronto, ON, M3J 1P3, Canada.
| | - Nisha Vashi
- Department of Psychology, York University, 4700 Keele Street, Toronto, ON, M3J 1P3, Canada
| | - Yvonne Bohr
- Department of Psychology, York University, 4700 Keele Street, Toronto, ON, M3J 1P3, Canada
| | - Jonathan A Weiss
- Department of Psychology, York University, 4700 Keele Street, Toronto, ON, M3J 1P3, Canada
| |
Collapse
|
4
|
Casper R, Shloim N, Hebron J. Use of non‐directive therapy for adolescents with autism spectrum disorder: A systematic review. COUNSELLING & PSYCHOTHERAPY RESEARCH 2021. [DOI: 10.1002/capr.12504] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
|
5
|
Jassi AD, Vidal-Ribas P, Krebs G, Mataix-Cols D, Monzani B. Examining clinical correlates, treatment outcomes and mediators in young people with comorbid obsessive-compulsive disorder and autism spectrum disorder. Eur Child Adolesc Psychiatry 2021:10.1007/s00787-021-01921-4. [PMID: 34914003 DOI: 10.1007/s00787-021-01921-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Accepted: 11/21/2021] [Indexed: 12/25/2022]
Abstract
Despite the high comorbidity, surprisingly little is known about the clinical features, treatment prognosis, and treatment mediators for youth with Obsessive-Compulsive Disorder (OCD) and Autism Spectrum Disorder (ASD). This study, the largest to date, compared 172 young people with OCD and ASD (OCD + ASD) to 447 without ASD (OCD) on clinical characteristics, finding those with OCD + ASD were more likely to endorse poorer insight into their OCD, have greater global functional impairment, greater levels of concurrent psychopathology, higher levels of family accommodation and to be on medication. Treatment outcomes following a course of Cognitive Behaviour Therapy with or without medication were explored for a subgroup; 100 young people with OCD + ASD and 223 with OCD. Whilst both groups benefitted from treatment, the OCD + ASD group had significantly poorer treatment outcomes. Greater global functional impairment and being on medication mediated the between-group difference in outcomes. Further research and treatment refinements are needed to improve outcomes for youth with OCD + ASD.
Collapse
Affiliation(s)
- A D Jassi
- National and Specialist OCD, BDD and Related Disorders Clinic for Young People, South London and Maudsley NHS Foundation Trust, London, SE5 8AZ, UK.
| | - P Vidal-Ribas
- Social and Behavioral Science Branch, National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD, USA
| | - G Krebs
- National and Specialist OCD, BDD and Related Disorders Clinic for Young People, South London and Maudsley NHS Foundation Trust, London, SE5 8AZ, UK.,Social, Genetic and Developmental Psychiatry Centre, King's College London, Institute of Psychiatry, Psychology and Neuroscience, London, SE5 8AF, UK
| | - D Mataix-Cols
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - B Monzani
- National and Specialist OCD, BDD and Related Disorders Clinic for Young People, South London and Maudsley NHS Foundation Trust, London, SE5 8AZ, UK
| |
Collapse
|
6
|
Loomes R, Bryant-Waugh R. Widening the reach of family-based interventions for Anorexia Nervosa: autism-adaptations for children and adolescents. J Eat Disord 2021; 9:157. [PMID: 34863292 PMCID: PMC8645124 DOI: 10.1186/s40337-021-00511-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2021] [Accepted: 11/17/2021] [Indexed: 11/10/2022] Open
Abstract
Family-based interventions are widely recommended as a first line treatment for children and young people with Anorexia Nervosa. There is clear evidence that model-adherent delivery of specific eating disorder focused family interventions has the potential to help adolescents with Anorexia Nervosa, who have typically engaged in extreme dietary restriction and lost a significant amount of weight over a relatively short period of time. Nevertheless, there remains a significant number of young people with restrictive eating disorders for whom family-based interventions for Anorexia Nervosa prove less effective, suggesting adaptations may be indicated for some. In this paper we provide a rationale and structure for considering a number of possible adaptations to the delivery of family-based therapy for anorexia nervosa specifically intended to enhance its relevance and potential effectiveness for children and adolescents on the autism spectrum; a subgroup known to represent a significant minority in eating disorder populations who have been identified as having relatively poor outcomes. Past research has shown that certain family-based treatments are effective for many children and adolescents who develop Anorexia Nervosa. At the same time this type of treatment approach in its current form does not work for everyone. Recent research has highlighted the overlap between anorexia and autism and the need for the development of adaptations to existing treatments to better meet the requirements of people on the autism spectrum who develop anorexia. With this in mind we propose a number of autism-related adaptations that could be made to family-based treatments for anorexia. We hope that these might be formally tested in the future to see if these adaptations improve outcomes for this group of individuals.
Collapse
Affiliation(s)
- Rachel Loomes
- Maudsley Centre for Child and Adolescent Eating Disorders, Michael Rutter Centre, Maudsley Hospital, De Crespigny Park, London, UK.
| | - Rachel Bryant-Waugh
- Maudsley Centre for Child and Adolescent Eating Disorders, Michael Rutter Centre, Maudsley Hospital, De Crespigny Park, London, UK.,Department of Child and Adolescent Psychiatry, Institute of Psychiatry, Psychology and Neuroscience, Kings College London, London, UK
| |
Collapse
|
7
|
Jones G, Jassi A. Modified Cognitive Behavior Therapy for Severe, Treatment Resistant Obsessive-Compulsive Disorder in an Adolescent With Autism Spectrum Disorder: The Importance of Parental Involvement. J Cogn Psychother 2020; 34:319-335. [PMID: 33372126 DOI: 10.1891/jcpsy-d-20-00019] [Citation(s) in RCA: 1] [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
The prevalence of obsessive-compulsive disorder (OCD) is higher among young people with autism spectrum disorders (ASD). Case studies and randomized controlled trials show that modified cognitive behavioral therapy (CBT) can be effective for young people with OCD and co-morbid ASD. This case study describes modified CBT for an adolescent with severe, treatment-resistant OCD and co-morbid ASD, and highlights the importance of family accommodation and parental mental health in pediatric OCD. Modifications to the standard evidence-based CBT for OCD protocol included extended psychoeducation, visual session material, mini exposure and response prevention hierarchies and parallel parent sessions to address familial accommodation and parental mental health. Progress was measured at seven times points throughout treatment using clinician administered, youth and parent self-report measures. Outcome data indicated significant improvements in OCD symptoms, general functioning, and maternal mental health as well as significant reductions in family accommodation. Gains were maintained over a 12-month follow-up period. This case study illustrates that modified CBT can be effective in youth with OCD and ASD and discusses the importance of familial accommodation and parental mental health.
Collapse
Affiliation(s)
- Gazal Jones
- National Specialist Clinic for Young People With OCD, BDD and Related Disorders, South London, and Maudsley NHS Foundation Trust, London, UK
| | - Amita Jassi
- National Specialist Clinic for Young People With OCD, BDD and Related Disorders, South London, and Maudsley NHS Foundation Trust, London, UK
| |
Collapse
|