Open Trial of Modular Cognitive-Behavioral Therapy in the Treatment of Anxiety Among Late Adolescents with Autism Spectrum Disorder

Abstract

Given the high rates of comorbid anxiety and autism spectrum disorder (ASD) in the adolescent and young adult population, effective treatment protocols to address anxiety symptoms are of importance to help promote greater independence across settings. While research supports the use of cognitive-behavioral therapy (CBT) across younger age groups with ASD, the literature is limited on interventions benefitting adolescents and young adults with comorbid anxiety disorders and ASD. Therefore, this open trial utilized a modified CBT manual for seven participants between the ages of 16 and 20 years, consisting of a 16-week modularized CBT treatment, including psychoeducation, cognitive therapy, and exposure therapy. Measures of anxiety and depression were completed at baseline and post-treatment. Findings demonstrated significant reductions on clinician-rated measures of anxiety. While findings are encouraging, additional studies examining the efficacy of CBT for this population with ASD and clinical anxiety are necessary to further identify beneficial treatment components.

This is a preview of subscription content, log in to check access.

References

  1. 1.

    CDC (2016) Autism spectrum disorder (ASD): data and statistics. https://www.cdc.gov/ncbddd/autism/data.html. Accessed Dec 2017

  2. 2.

    Kogan MD et al (2009) Prevalence of parent-reported diagnosis of autism spectrum disorder among children in the US, 2007. Pediatrics 124(5):1395–1403

    PubMed  Article  Google Scholar 

  3. 3.

    Christenson D et al (2016) Prevalence and characteristics of autism spectrum disorder among children aged 8 years—autism and developmental disabilities monitoring network, 11 sites, United States, 2012. MMWR Surveill Summ 65:1–23

    Article  Google Scholar 

  4. 4.

    APA (2013) Diagnostic and statistical manual of mental health disorders, 5th edn. American Psychiatric Publishing, Arlington

    Google Scholar 

  5. 5.

    Simonoff E et al (2012) Severe mood problems in adolescents with autism spectrum disorder. J Child Psychol Psychiatry 53(11):1157–1166

    PubMed  Article  Google Scholar 

  6. 6.

    de Bruin EI et al (2007) High rates of psychiatric co-morbidity in PDD-NOS. J Autism Dev Disord 37(5):877–886

    PubMed  Article  Google Scholar 

  7. 7.

    Sukhodolsky DG et al (2008) Parent-rated anxiety symptoms in children with pervasive developmental disorders: frequency and association with core autism symptoms and cognitive functioning. J Abnorm Child Psychol 36(1):117–128

    PubMed  Article  Google Scholar 

  8. 8.

    Kerns CM et al (2016) The treatment of anxiety in autism spectrum disorder (TAASD) study: rationale, design and methods. J Child Fam Stud 25(6):1889–1902

    PubMed  PubMed Central  Article  Google Scholar 

  9. 9.

    van Steensel FJA, Bögels SM, Perrin S (2011) Anxiety disorders in children and adolescents with autistic spectrum disorders: a meta-analysis. Clin Child Fam Psychol Rev 14(3):302–317

    PubMed  PubMed Central  Article  Google Scholar 

  10. 10.

    White SW et al (2009) Anxiety in children and adolescents with autism spectrum disorders. Clin Psychol Rev 29(3):216–229

    PubMed  PubMed Central  Article  Google Scholar 

  11. 11.

    White SW, Ollendick TH, Bray BC (2011) College students on the autism spectrum: prevalence and associated problems. Autism 15(6):683–701

    PubMed  Article  Google Scholar 

  12. 12.

    Bellini S (2004) Social skill deficits and anxiety in high-functioning adolescents with autism spectrum disorders. Focus Autism Other Dev Disabil 19(2):78–86

    Article  Google Scholar 

  13. 13.

    Kuusikko S et al (2008) Social anxiety in high-functioning children and adolescents with autism and Asperger syndrome. J Autism Dev Disord 38(9):1697–1709

    PubMed  Article  Google Scholar 

  14. 14.

    Storch EA et al (2015) A randomized controlled trial of cognitive-behavioral therapy versus treatment as usual for adolescents with autism spectrum disorders and comorbid anxiety. Depress Anxiety 32(3):174–181

    PubMed  Article  Google Scholar 

  15. 15.

    Davis TE et al (2011) Anxiety symptoms across the lifespan in people diagnosed with Autistic Disorder. Res Autism Spectr Disord 5(1):112–118

    Article  Google Scholar 

  16. 16.

    Baxter A (1997) The power of friendship. J Dev Disabil 5(2):112–117

    Google Scholar 

  17. 17.

    Lugnegård T, Hallerbäck MU, Gillberg C (2011) Psychiatric comorbidity in young adults with a clinical diagnosis of asperger syndrome. Res Dev Disabil 32(5):1910–1917

    PubMed  Article  Google Scholar 

  18. 18.

    Moseley DS et al (2011) Psychiatric comorbidity in adolescents and young adults with autism. J Mental Health Res Intellect Disabil 4(4):229–243

    Article  Google Scholar 

  19. 19.

    Simonoff E et al (2008) Psychiatric disorders in children with autism spectrum disorders: prevalence, comorbidity, and associated factors in a population-derived sample. J Am Acad Child Adolesc Psychiatry 47(8):921–929

    PubMed  Article  Google Scholar 

  20. 20.

    Bellini S (2006) The development of social anxiety in adolescents with autism spectrum disorders. Focus Autism Other Dev Disabil 21(3):138–145

    Article  Google Scholar 

  21. 21.

    Glennon TJ (2001) The stress of the university experience for students with Asperger syndrome. Work 17(3):183–190

    PubMed  Google Scholar 

  22. 22.

    Kanne SM, Christ SE, Reiersen AM (2009) Psychiatric symptoms and psychosocial difficulties in young adults with autistic traits. J Autism Dev Disord 39(6):827–833

    PubMed  Article  Google Scholar 

  23. 23.

    VanBergeijk E, Klin A, Volkmar F (2008) Supporting more able students on the autism spectrum: college and beyond. J Autism Dev Disord 38(7):1359–1370

    PubMed  Article  Google Scholar 

  24. 24.

    Burrows M, Ford J, Bottroff V (2001) The post school outcomes of young adults with autism spectrum disorder. Australas J Spec Educ 25(1–2):34–48

    Article  Google Scholar 

  25. 25.

    Hendricks DR, Wehman P (2009) Transition from school to adulthood for youth with autism spectrum disorders: review and recommendations. Focus Autism Other Dev Disabil 24(2):77–88

    Article  Google Scholar 

  26. 26.

    Cartwright-Hatton S et al (2011) A new parenting-based group intervention for young anxious children: results of a randomized controlled trial. J Am Acad Child Adolesc Psychiatry 50(3):242–251

    PubMed  Article  Google Scholar 

  27. 27.

    Ung D et al (2015) A systematic review and meta-analysis of cognitive-behavioral therapy for anxiety in youth with high-functioning autism spectrum disorders. Child Psychiatry Hum Dev 46(4):533–547

    PubMed  Article  Google Scholar 

  28. 28.

    Hofmann SG, Smits JAJ (2008) Cognitive-behavioral therapy for adult anxiety disorders: a meta-analysis of randomized placebo-controlled trials. J Clin Psychiatry 69(4):621–632

    PubMed  PubMed Central  Article  Google Scholar 

  29. 29.

    Norton PJ, Price EC (2007) A meta-analytic review of adult cognitive-behavioral treatment outcome across the anxiety disorders. J Nerv Mental Dis 195(6):521–531

    Article  Google Scholar 

  30. 30.

    Butler AC et al (2006) The empirical status of cognitive-behavioral therapy: a review of meta-analyses. Clin Psychol Rev 26(1):17–31

    PubMed  Article  Google Scholar 

  31. 31.

    Hare DJ (1997) The use of cognitive-behavioral therapy with people with Asperger syndrome: a case study. Autism 1(2):215–225

    Article  Google Scholar 

  32. 32.

    Gaus VL (2007) Cognitive-behavioral therapy for adult Asperger syndrome. Guides to individualized evidence-based treatment. Guilford Press, New York

    Google Scholar 

  33. 33.

    Gaus VL (2011) Adult Asperger syndrome and the utility of cognitive-behavioral therapy. J Contemp Psychother 41(1):47–56

    Article  Google Scholar 

  34. 34.

    McGillivray JA, Evert HT (2014) Group cognitive behavioural therapy program shows potential in reducing symptoms of depression and stress among young people with ASD. J Autism Dev Disord 44(8):2041–2051

    PubMed  Article  Google Scholar 

  35. 35.

    Murray K et al (2015) Outcomes of cognitive behaviour therapy for obsessive–compulsive disorder in young people with and without autism spectrum disorders: a case controlled study. Psychiatry Res 228(1):8–13

    PubMed  Article  Google Scholar 

  36. 36.

    Ehrenreich-May J et al (2014) An open trial of cognitive-behavioral therapy for anxiety disorders in adolescents with autism spectrum disorders. Focus Autism Other Dev Disabil 29(3):145–155

    Article  Google Scholar 

  37. 37.

    Wood JJ et al (2009) Cognitive behavioral therapy for anxiety in children with autism spectrum disorders: a randomized, controlled trial. J Child Psychol Psychiatry 50(3):224–234

    PubMed  PubMed Central  Article  Google Scholar 

  38. 38.

    Wood JJ et al (2015) Cognitive behavioral therapy for early adolescents with autism spectrum disorders and clinical anxiety: a randomized, controlled trial. Behav Ther 46(1):7–19

    PubMed  Article  Google Scholar 

  39. 39.

    Hamilton M (1959) The assessment of anxiety states by rating. Br J Med Psychol 1959:50–55

    Article  Google Scholar 

  40. 40.

    Wechsler D (2011) Wechsler abbreviated scale of intelligence-second edition (WASI-II). NCS Pearson, San Antonio

    Google Scholar 

  41. 41.

    Lord C et al (2012) Autism diagnostic observation schedule, 2nd edn. W.P. Services, Torrance

    Google Scholar 

  42. 42.

    Brown TA, Barlow DH (2014) Anxiety and related disorders interview schedule for DSM-5 (ADIS-5), adult version. Oxford University Press, New York

    Google Scholar 

  43. 43.

    Bech P (2009) Fifty years with the Hamilton scales for anxiety and depression: a tribute to max Hamilton. Psychother Psychosom 78(4):202–211

    PubMed  Article  Google Scholar 

  44. 44.

    Kim T-S et al (2006) Comparison of venlafaxine extended release versus paroxetine for treatment of patients with generalized anxiety disorder. Psychiatry Clin Neurosci 60(3):347–351

    PubMed  Article  Google Scholar 

  45. 45.

    Nimatoudis I et al (2004) Remission rates with venlafaxine extended release in Greek outpatients with generalized anxiety disorder: a double-blind, randomized, placebo controlled study. Int Clin Psychopharmacol 19(6):331–336

    PubMed  Article  Google Scholar 

  46. 46.

    Perugi G et al (2002) Open-label evaluation of venlafaxine sustained release in outpatients with generalized anxiety disorder with comorbid major depression or dysthymia: effectiveness, tolerability and predictors of response. Neuropsychobiology 46(3):145–149

    PubMed  Article  Google Scholar 

  47. 47.

    Rynn MA, Brawman-Mintzer O (2004) Generalized anxiety disorder: acute and chronic treatment. CNS Spectr 9(10):716–723

    PubMed  Article  Google Scholar 

  48. 48.

    Hamilton M (1960) A rating scale for depression. J Neurol Neurosurg Psychiatry 23:56–61

    PubMed  PubMed Central  Article  Google Scholar 

  49. 49.

    NIMH (1985) CGI (clinical global impression) scale. Psychopharmacol Bull 21:839–844

    Google Scholar 

  50. 50.

    Guy W (1976) Clinical global impression scale. ECDEU Assistant Manual for Psychopharmacology

  51. 51.

    Beck AT et al (1988) An inventory for measuring clinical anxiety: psychometric properties. J Consult Clin Psychol 56(6):893–897

    PubMed  Article  Google Scholar 

  52. 52.

    De Ayala RJ, Vonderharr-Carlson DJ, Kim D (2005) Assessing the reliability of the beck anxiety inventory scores. Educ Psychol Measur 65(5):742–756

    Article  Google Scholar 

  53. 53.

    Cohen J (1988) Statistical power anaylsis for the behavioral sciences, 2nd edn. Lawrence Erlbaum Associates, Hillsdale

    Google Scholar 

  54. 54.

    Fujii C et al (2013) Intensive cognitive behavioral therapy for anxiety disorders in school-aged children with autism: a preliminary comparison with treatment-as-usual. School Mental Health 5(1):25–37

    Article  Google Scholar 

Download references

Acknowledgements

We acknowledge the contributions of Jennifer M. Katzenstein, PhD, Dennis A. Hart, MD, Janelle Garcia, PhD, Bobbie Vaughn, Lauren Zellmer, and Olivia Hernandez. This study was supported by the Johns Hopkins All Childrens Hospital Research Foundation.

Author information

Affiliations

Authors

Corresponding author

Correspondence to Eric A. Storch.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Wise, J.M., Cepeda, S.L., Ordaz, D.L. et al. Open Trial of Modular Cognitive-Behavioral Therapy in the Treatment of Anxiety Among Late Adolescents with Autism Spectrum Disorder. Child Psychiatry Hum Dev 50, 27–34 (2019). https://doi.org/10.1007/s10578-018-0817-5

Download citation

Keywords

  • Young adult
  • Anxiety
  • Autism spectrum disorder
  • Cognitive-behavioral therapy
  • Treatment
  • Adolescent