Journal of Autism and Developmental Disorders

, Volume 42, Issue 6, pp 992–1000 | Cite as

Assessment of the Prerequisite Skills for Cognitive Behavioral Therapy in Children with and Without Autism Spectrum Disorders

  • Athena Lickel
  • William E. MacLeanJr.
  • Audrey Blakeley-Smith
  • Susan Hepburn
Original Paper

Abstract

The purpose of this study was to assess the cognitive skills of children with autism spectrum disorders (ASD) thought to be necessary for Cognitive Behavioral Therapy (CBT). Forty children with ASD and forty age-matched typically developing children between the ages of 7–12 years participated. Groups were comparable with regard to nonverbal IQ, but children with ASD had significantly lower verbal IQ. Children completed three CBT-related tasks requiring emotion recognition, discrimination among thoughts, feelings and behaviors, and cognitive mediation. With the exception of the emotion recognition task, children with ASD performed comparably to typically developing children and with a high rate of accuracy.

Keywords

Cognitive behavioral therapy Autism spectrum disorders Asperger’s syndrome Autism 

Notes

Acknowledgments

The authors wish to thank the agencies that assisted in obtaining participants for this study: the Interactive Autism Network (IAN) Research Database at the Kennedy Krieger Institute and Johns Hopkins Medicine, the Autism Society of America, and the Albany County School District #1. We also acknowledge the children and families who volunteered their time to participate in this study.

References

  1. Anderson, S., & Morris, J. (2006). Cognitive behaviour therapy for people with Asperger syndrome. Behavioural and Cognitive Psychotherapy, 34(3), 293–303.CrossRefGoogle Scholar
  2. Attwood, T. (2004). Cognitive behaviour therapy for children and adults with Asperger’s syndrome. Behaviour Change, 21(3), 147–161.CrossRefGoogle Scholar
  3. Baron-Cohen, S. (1991). Do people with autism understand what causes emotion? Child Development, 62(2), 385–395.PubMedCrossRefGoogle Scholar
  4. Berument, S., Rutter, M., Lord, C., Pickles, A., & Bailey, A. (1999). Autism screening questionnaire: Diagnostic validity. British Journal of Psychiatry, 175, 444–451.PubMedCrossRefGoogle Scholar
  5. Cardaciotto, L., & Herbert, J. (2004). Cognitive behavior therapy for social anxiety disorder in the context of Asperger’s syndrome: A single-subject report. Cognitive and Behavioral Practice, 11, 75–81.CrossRefGoogle Scholar
  6. Celani, G., Battachi, M. W., & Arcidiacono, L. (1999). The understanding of the emotional meaning of facial expressions in people with autism. Journal of Autism and Developmental Disorders, 29, 57–66.PubMedCrossRefGoogle Scholar
  7. Chalfant, A., Rapee, R., & Carroll, L. (2007). Treating anxiety disorders in children with high functioning autism spectrum disorders: A controlled trial. Journal of Autism and Developmental Disorders, 37(10), 1842–1857.PubMedCrossRefGoogle Scholar
  8. Charman, T. (2002). The prevalence of autism spectrum disorders: Recent evidence and future challenges. European Child and Adolescent Psychiatry, 11, 249–256.PubMedCrossRefGoogle Scholar
  9. Chung, M., & Thomson, D. (1995). Development of face recognition. British Journal of Psychology, 86, 55–87.PubMedCrossRefGoogle Scholar
  10. Dagnan, D., Chadwick, P., & Proudlove, J. (2000). Toward an assessment of suitability of people with mental retardation for cognitive therapy. Cognitive Therapy and Research, 24(6), 627–636.CrossRefGoogle Scholar
  11. Doherr, L., Reynolds, S., Wetherly, J., & Evans, E. (2005). Young children’s ability to engage in cognitive therapy tasks: Associations with age and educational experience. Behavioural and Cognitive Psychotherapy, 33(2), 201–215.CrossRefGoogle Scholar
  12. Ekman, P., & Friesen, W. L. (1976). Pictures of facial affect. Palo Alto, CA: Consulting Psychologist Press.Google Scholar
  13. Ellis, A. (1979). Negative linking of RET to positive thinking. PsycCRITIQUES, 24(12), 1058–1059.CrossRefGoogle Scholar
  14. Farber, B. (1985). The genesis, development, and implications of psychological-mindedness in psychotherapists. Psychotherapy: Theory, Research, Practice, Training, 22(2), 170–177.CrossRefGoogle Scholar
  15. Flavell, J., Flavell, E., & Green, F. (2001). Development of children’s understanding of connections between thinking and feeling. Psychological Science, 12(5), 430–432.PubMedCrossRefGoogle Scholar
  16. Fombonne, E. (2003). Epidemiological surveys of autism and other pervasive developmental disorders: An update. Journal of Autism and Developmental Disorders, 33, 365–382.PubMedCrossRefGoogle Scholar
  17. Gillott, A., Furniss, F., & Walter, A. (2004). Theory of mind ability in children with specific language impairment. Child Language Teaching & Therapy, 20(1), 1–11.CrossRefGoogle Scholar
  18. Golan, O., Ashwin, E., Granader, Y., McClintock, S., Day, K., Leggett, V., et al. (2010). Enhancing emotion recognition in children with autism spectrum conditions: An intervention using animated vehicles with real emotional faces. Journal of Autism and Developmental Disorders, 40(3), 269–279.PubMedCrossRefGoogle Scholar
  19. Golan, O., Baron-Cohen, S., & Golan, Y. (2008). The ‘Reading the Mind in Films’ Task (Child version): Complex emotion and mental state recognition in children with and without autism spectrum conditions. Journal of Autism and Developmental Disorders, 38(8), 1534–1541.PubMedCrossRefGoogle Scholar
  20. Grave, J., & Blissett, J. (2004). Is cognitive behavior therapy developmentally appropriate for young children? A critical review of the evidence. Clinical Psychology Review, 24(4), 399–420.PubMedCrossRefGoogle Scholar
  21. Greig, A., & MacKay, T. (2005). Asperger’s Syndrome and cognitive behaviour therapy: New applications for educational psychologists. Educational and Child Psychology, 22(4), 4–15.Google Scholar
  22. Haddock, K., & Jones, R. (2006). Practitioner consensus in the use of cognitive behaviour therapy for individuals with a learning disability. Journal of Intellectual Disabilities, 10(3), 221–230.PubMedCrossRefGoogle Scholar
  23. Hare, D. (1997). The use of cognitive-behavioral therapy with people with Asperger syndrome: A case study. Autism, 1(2), 215–225.CrossRefGoogle Scholar
  24. Herba, C., Landau, S., Russell, T., Ecker, C., & Phillips, M. (2006). The development of emotion-processing in children: Effects of age, emotion, and intensity. Journal of Child Psychology and Psychiatry, 47(11), 1098–1106.PubMedCrossRefGoogle Scholar
  25. Hobson, R. (1986a). The autistic child’s appraisal of expressions of emotion. Journal of Child Psychology and Psychiatry, 27(3), 321–342.PubMedCrossRefGoogle Scholar
  26. Hobson, R. (1986b). The autistic child’s appraisal of expressions of emotion: A further study. Journal of Child Psychology and Psychiatry, 27(5), 671–680.PubMedCrossRefGoogle Scholar
  27. Kaufman, A. S., & Kaufman, N. L. (2004). KBIT-2: Kaufman Brief Intelligence Test (2nd ed.). Minnesota: AGS Publishing.Google Scholar
  28. Kendall, P. (1993). Cognitive-behavioral therapies with youth: Guiding theory, current status, and emerging developments. Journal of Consulting and Clinical Psychology, 61(2), 235–247.PubMedCrossRefGoogle Scholar
  29. Kendall, P., & Choudhury, M. (2003). Children and adolescents in cognitive-behavioral therapy: Some past efforts and current advances, and the challenges in our future. Cognitive Therapy and Research, 27(1), 89–104.CrossRefGoogle Scholar
  30. Kendall, P. C., Robin, J., Hedtke, K., Suveg, C., Flannery-Schroeder, E., & Gosch, E. (2005). Considering CBT with anxious youth? Think exposure. Cognitive and Behavioral Practice, 12, 136–148.CrossRefGoogle Scholar
  31. Kendall, P., Stark, K., & Adam, T. (1990). Cognitive deficit or cognitive distortion of childhood depression. Journal of Abnormal Child Psychology, 18(3), 255–270.PubMedCrossRefGoogle Scholar
  32. Kerr, S., & Durkin, K. (2004). Understanding of thought bubbles as mental representations in children with autism: Implications for theory of mind. Journal of Autism and Developmental Disorders, 34(6), 637–648.PubMedCrossRefGoogle Scholar
  33. Kim, J., Szatmari, P., Bryson, S., Streiner, D., & Wilson, F. (2000). The prevalence of anxiety and mood problems among children with autism and Asperger syndrome. Autism, 4(2), 117–132.CrossRefGoogle Scholar
  34. Kingery, J., Roblek, T., Suveg, C., Grover, R., Sherrill, J., & Bergman, R. (2006). They’re not just ‘little adults’: Developmental considerations for implementing cognitive-behavioral therapy with anxious youth. Journal of Cognitive Psychotherapy, 20(3), 263–273.CrossRefGoogle Scholar
  35. Klinger, L., & Williams, A. (2009). Cognitive-behavioral interventions for students with autism spectrum disorders. Cognitive-behavioral interventions for emotional and behavioral disorders: School-based practice (pp. 328–362). New York, NY, USA: Guilford Press.Google Scholar
  36. Lang, R., Regester, A., Lauderdale, S., Ashbaugh, K., & Haring, A. (2010). Treatment of anxiety in autism spectrum disorders using cognitive behaviour therapy: A systematic review. Developmental Neurorehabilitation, 13(1), 53–63.PubMedCrossRefGoogle Scholar
  37. Lenti, C., Lenti-Boero, D., & Giacobbe, A. (1999). Decoding of emotional expressions in children and adolescents. Perceptual and Motor Skills, 89(3), 808–814.PubMedCrossRefGoogle Scholar
  38. Leyfer, O., Folstein, S., Bacalman, S., Davis, N., Dinh, E., Morgan, J., et al. (2006). Comorbid psychiatric disorders in children with autism: Interview development and rates of disorders. Journal of Autism and Developmental Disorders, 36(7), 849–861.PubMedCrossRefGoogle Scholar
  39. Lord, C. (1996). Treatment of a high-functioning adolescent with autism: A cognitive-behavioral approach. In M. Reinecke, F. M. Dattilio, & A. Freeman (Eds.), Cognitive therapy with children and adolescents: A casebook for clinical practice (pp. 394–404). New York, NY: Guilford Press.Google Scholar
  40. Lord, C., Risi, S., Lambrecht, L., Cook, E., Leventhal, B., DiLavore, P., et al. (2000). The Autism Diagnostic Observation Schedule—Generic: A standard measure of social and communication deficits associated with the spectrum of autism. Journal of Autism and Developmental Disorders, 30(3), 205–223.PubMedCrossRefGoogle Scholar
  41. Lord, C., Rutter, M., DiLavore, P., & Risi, S. (1999). Autism Diagnostic Observation Schedule-WPS Edition. Los Angeles, CA: Western Psychological Services.Google Scholar
  42. Lord, C., Rutter, M., & Le Couteur, A. (1994). Autism Diagnostic Interview—Revised: A revised version of a diagnostic interview for caregivers of individuals with possible pervasive developmental disorders. Journal of Autism and Developmental Disorders, 24(5), 659–685.PubMedCrossRefGoogle Scholar
  43. Oathamshaw, S., & Haddock, G. (2006). Do people with intellectual disabilities and psychosis have the cognitive skills required to undertake cognitive behavioural therapy? Journal of Applied Research in Intellectual Disabilities, 19(1), 35–46.CrossRefGoogle Scholar
  44. Ooi, Y. P., Lam, C. M., Sung, M., Tan, W. T., Goh, T. J., Fung, D. S., et al. (2008). Effects of cognitive-behavioural therapy on anxiety for children with high-functioning autistic spectrum disorders. Singapore Medical Journal, 49, 215–220.PubMedGoogle Scholar
  45. Pons, F., Harris, P., & de Rosnay, M. (2004). Emotion comprehension between 3 and 11 years: Developmental periods and hierarchical organization. European Journal of Developmental Psychology, 1(2), 127–152.CrossRefGoogle Scholar
  46. Puleo, C. M., & Kendall, P. C. (2010). Anxiety disorders in typically developing youth: Autism spectrum symptoms as a predictor of cognitive-behavioral treatment. Journal of Autism and Developmental Disorder. (Advance online publication). doi:10.1007/s10803-010-1047-2.
  47. Quakley, S., Coker, S., Palmer, K., & Reynolds, S. (2003). Can children distinguish between thoughts and behaviours? Behavioural and Cognitive Psychotherapy, 31(2), 159–167.CrossRefGoogle Scholar
  48. Quakley, S., Reynolds, S., & Coker, S. (2004). The effect of cues on young children’s abilities to discriminate among thoughts, feelings and behaviours. Behaviour Research and Therapy, 42(3), 343–356.PubMedCrossRefGoogle Scholar
  49. Reaven, J. (2009). Children with high-functioning autism spectrum disorders and co-occurring anxiety symptoms: Implications for assessment and treatment. Journal for Specialists in Pediatric Nursing, 143, 192–199.Google Scholar
  50. Reaven, J., Blakeley-Smith, A., Nichols, S., Dasari, M., Flanigan, E., & Hepburn, S. (2009). Cognitive-behavioral group treatment for anxiety symptoms in children with high-functioning autism spectrum disorders, a pilot study. Focus on Autism and Other Developmental Disabilities, 24, 27–37.CrossRefGoogle Scholar
  51. Reaven, J., & Hepburn, S. (2003). Cognitive-behavioral treatment of obsessive-compulsive disorder in a child with Asperger syndrome: A case report. Autism, 7(2), 145–164.PubMedCrossRefGoogle Scholar
  52. Reynolds, S., Girling, E., Coker, S., & Eastwood, L. (2006). The effect of mental health problems on children’s ability to discriminate amongst thoughts, feelings and behaviours. Cognitive Therapy and Research, 30(5), 599–607.CrossRefGoogle Scholar
  53. Safran, J., Segal, Z., Vallis, T., & Shaw, B. (1993). Assessing patient suitability for short-term cognitive therapy with an interpersonal focus. Cognitive Therapy and Research, 17(1), 23–38.CrossRefGoogle Scholar
  54. Sauter, F., Heyne, D., & Westenberg, P. (2009). Cognitive behavior therapy for anxious adolescents: Developmental influences on treatment design and delivery. Clinical Child and Family Psychology Review, 12(4), 310–335.PubMedCrossRefGoogle Scholar
  55. Seligman, L. D., & Ollendick, T. H. (2011). Cognitive-behavioral therapy for anxiety disorders in youth. Child and Adolescent Psychiatric Clinics of North America, 20(2), 217–238.PubMedCrossRefGoogle Scholar
  56. Simonoff, E., Pickles, A., Charman, T., Chandler, S., Loucas, T., & Baird, G. (2008). Psychiatric disorders in children with autism spectrum disorders: Prevalence, comorbidity, and associated factors in a population-derived sample. Journal of the American Academy of Child and Adolescent Psychiatry, 47(8), 921–929.PubMedCrossRefGoogle Scholar
  57. Sofronoff, K., Attwood, T., & Hinton, S. (2005). A randomised controlled trial of a CBT intervention for anxiety in children with Asperger syndrome. Journal of Child Psychology and Psychiatry, 46(11), 1152–1160.PubMedCrossRefGoogle Scholar
  58. Sofronoff, K., Attwood, T., Hinton, S., & Levin, I. (2007). A randomized controlled trial of a cognitive behavioural intervention for anger management in children diagnosed with Asperger syndrome. Journal of Autism and Developmental Disorders, 37(7), 1203–1214.PubMedCrossRefGoogle Scholar
  59. Stallard, P. (2002). Cognitive behaviour therapy with children and young people: A selective review of key issues. Behavioural and Cognitive Psychotherapy, 30(3), 297–309.CrossRefGoogle Scholar
  60. Steffenburg, S., Gillberg, C., & Steffenburg, U. (1996). Psychiatric disorders in children and adolescents with mental retardation and active epilepsy. Archives of Neurology, 53(9), 904–912.PubMedCrossRefGoogle Scholar
  61. Sturmey, P. (2005). Against psychotherapy with people who have mental retardation. Mental Retardation, 43(1), 55–57.PubMedCrossRefGoogle Scholar
  62. Sze, K., & Wood, J. (2007). Cognitive behavioral treatment of comorbid anxiety disorders and social difficulties in children with high-functioning autism: A case report. Journal of Contemporary Psychotherapy, 37(3), 133–143.CrossRefGoogle Scholar
  63. Thomas, L., De Bellis, M., Graham, R., & LaBar, K. (2007). Development of emotional facial recognition in late childhood and adolescence. Developmental Science, 10, 547–558.PubMedCrossRefGoogle Scholar
  64. Tonks, J., Williams, W., Frampton, I., Yates, P., & Slater, A. (2007). Assessing emotion recognition in 9–15-years olds: Preliminary analysis of abilities in reading emotion from faces, voices and eyes. Brain Injury, 21(6), 623–629.PubMedCrossRefGoogle Scholar
  65. Wechsler, D. (1999). Wechsler abbreviated scale of intelligence. San Antonio, TX: The Psychological Corporation.Google Scholar
  66. White, S., Oswald, D., Ollendick, T., & Scahill, L. (2009). Anxiety in children and adolescents with autism spectrum disorders. Clinical Psychology Review, 29(3), 216–229. doi:10.1016/j.cpr.2009.01.003.PubMedCrossRefGoogle Scholar
  67. Willner, P. (2005). The effectiveness of psychotherapeutic interventions for people with learning disabilities: A critical overview. Journal of Intellectual Disability Research, 49(1), 73–85.PubMedCrossRefGoogle Scholar
  68. Willner, P., & Hatton, C. (2006). CBT for people with intellectual disabilities. Journal of Applied Research in Intellectual Disabilities, 19(1), 1–3.CrossRefGoogle Scholar
  69. Wing, L., & Potter, D. (2009). The epidemiology of autism spectrum disorders: Is the prevalence rising? Assessment of autism spectrum disorders (pp. 18–54). New York, NY USA: Guilford Press.Google Scholar
  70. Wood, J., Drahota, A., Sze, K., Har, K., Chiu, A., & Langer, D. (2009). Cognitive behavioral therapy for anxiety in children with autism spectrum disorders: A randomized, controlled trial. Journal of Child Psychology and Psychiatry, 50(3), 224–234.PubMedCrossRefGoogle Scholar
  71. Yirmiya, N., Sigman, M., Kasari, C., & Mundy, P. (1992). Empathy and cognition in high-functioning children with autism. Child Development, 63(1), 150–160.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2011

Authors and Affiliations

  • Athena Lickel
    • 1
  • William E. MacLeanJr.
    • 1
  • Audrey Blakeley-Smith
    • 2
  • Susan Hepburn
    • 2
  1. 1.Department of PsychologyUniversity of WyomingLaramieUSA
  2. 2.University of Colorado, Anschutz Medical Campus, School of Medicine, JFK PartnersAuroraUSA

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