Journal of Autism and Developmental Disorders

, Volume 47, Issue 12, pp 3872–3882 | Cite as

Long-Term Effects of CBT on Social Impairment in Adolescents with ASD

  • Brenna B. Maddox
  • Yasuo Miyazaki
  • Susan W. White
S.I. : Anxiety in Autism Spectrum Disorders

Abstract

Anxiety interventions involving social skills training and CBT for youth with ASD have shown promise, but few studies have examined the effects on social functioning or the maintenance of treatment gains. This study evaluated change in social skills during a randomized controlled trial of CBT and during the 1-year follow-up for 25 adolescents with ASD and anxiety. We examined the effect of pretreatment social anxiety and loneliness on treatment response. Social impairment improved during treatment and continued to improve through the 3-month follow-up. Although adolescents with higher social anxiety had greater pretreatment social impairment, they showed steeper improvement in social skills during treatment. Loneliness was not a significant predictor of change during treatment. CBT targeting social skills and anxiety can lead to long-term improvements in social functioning.

Keywords

Autism spectrum disorder Anxiety Adolescents CBT Social skills 

Notes

Acknowledgments

This project was funded by the NIMH (K01MH079945; PI: S. White). Portions of these findings were presented at the 2015 Society for Research in Child Development Biennial Meeting.

Author Contributions

BM conceived of the study, participated in its design, performed the statistical analyses, interpreted the data, and drafted the manuscript; YM consulted on the study design, performed the statistical analyses, and consulted on interpretation of results; SW participated in the design of the study, oversaw the collection of the data, assisted with interpretation of the data, and revised the manuscript critically. All authors read and approved the final manuscript.

Compliance with Ethical Standards

Conflict of interest

The authors have no conflicts of interest.

References

  1. American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC: Author.CrossRefGoogle Scholar
  2. Bauminger, N., & Kasari, C. (2000). Loneliness and friendship in high-functioning children with autism. Child Development, 71, 447–456. doi: 10.1111/1467-8624.00156.CrossRefPubMedGoogle Scholar
  3. Bauminger, N., Shulman, C., & Agam, G. (2003). Peer interaction and loneliness in high-functioning children with autism. Journal of Autism and Developmental Disorders, 33, 489–507. doi: 10.1023/A:1025827427901.CrossRefPubMedGoogle Scholar
  4. Chang, Y.-C., Quan, J., & Wood, J. J. (2012). Effects of anxiety disorder severity on social functioning in children with autism spectrum disorders. Journal of Developmental and Physical Disabilities, 24, 235–345. doi: 10.1007/s10882-012-9268-2.CrossRefGoogle Scholar
  5. Cohen, J. (1988). Statistical power analysis for the behavioral sciences (2nd ed.). Hillsdale, NJ: Erlbaum.Google Scholar
  6. Constantino, J. N., & Gruber, C. P. (2005). Social Responsiveness Scale (SRS). Los Angeles, CA: Western Psychological Services.Google Scholar
  7. Gearing, R. E., Schwalbe, C. S., Lee, R., & Hoagwood, K. E. (2013). The effectiveness of booster sessions in CBT treatment for child and adolescent mood and anxiety disorders. Depression and Anxiety, 30, 800–808. doi: 10.1002/da.22118.CrossRefPubMedGoogle Scholar
  8. Howell, D. C. (2013). Statistical methods for psychology (8th ed.). Belmont, CA: Wadsworth.Google Scholar
  9. Kanne, S. M., Gerber, A. J., Quirmbach, L. M., Sparrow, S. S., Cicchetti, D. V., & Saulnier, C. A. (2011). The role of adaptive behavior in autism spectrum disorders: Implications for functional outcome. Journal of Autism and Developmental Disorders, 41, 1007–1018. doi: 10.1007/s10803-010-1126-4.CrossRefPubMedGoogle Scholar
  10. Kuusikko, S., Pollock-Wurman, R., Jussila, K., Carter, A. S., Mattila, M.-L., Ebeling, H., & Moilanen, I. (2008). Social anxiety in high-functioning children and adolescents with autism and Asperger syndrome. Journal of Autism and Developmental Disorders, 38, 1697–1709. doi: 10.1007/s10803-008-0555-9.CrossRefPubMedGoogle Scholar
  11. Ladd, G. W., & Ettekal, I. (2013). Peer-related loneliness across early to late adolescence: Normative trends, intra-individual trajectories, and links with depressive symptoms. Journal of Adolescence, 36, 1269–1282. doi: 10.1016/j.adolescence.2013.05.004.CrossRefPubMedGoogle Scholar
  12. Lasgaard, M., Nielsen, A., Eriksen, M. E., & Goossens, L. (2010). Loneliness and social support in adolescent boys with autism spectrum disorders. Journal of Autism and Developmental Disorders, 40, 218–226. doi: 10.1007/s10803-009-0851-z.CrossRefPubMedGoogle Scholar
  13. Laugeson, E. A., & Frankel, F. (2010). Social skills for teenagers with developmental and autism spectrum disorders: The PEERS treatment manual. New York, NY: Routledge.Google Scholar
  14. Laugeson, E. A., Frankel, F., Mogil, C., & Dillon, A. R. (2009). Parent-assisted social skills training to improve friendships in teens with autism spectrum disorders. Journal of Autism and Developmental Disorders, 39, 596–606. doi: 10.1007/s10803-008-0664-5.CrossRefPubMedGoogle Scholar
  15. Little, R. J. A., & Rubin, D. B. (1987). Statistical analysis with missing data. New York, NY: Wiley.Google Scholar
  16. Little, R. J. A., & Schenker, N. (1995). Missing data. In G. Arminger, C. C. Clogg, & M. E. Sobel (Eds.), Handbook of statistical modeling for the social sciences (pp. 39–75). New York, NY: Plenum Press.CrossRefGoogle Scholar
  17. Lord, C., Rutter, M., DiLavore, P. C., & Risi, S. (2002). Autism diagnostic observation schedule. Los Angeles, CA: Western Psychological Services.Google Scholar
  18. 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, 659–685. doi: 10.1007/BF02172145.CrossRefPubMedGoogle Scholar
  19. Mandelberg, J., Laugeson, E. A., Cunningham, T. D., Ellingsen, R., Bates, S., & Frankel, F. (2014). Long-term treatment outcomes for parent-assisted social skills training for adolescents with autism spectrum disorders: The UCLA PEERS program. Journal of Mental Health Research in Intellectual Disabilities, 7, 45–73. doi: 10.1080/5864.2012.730600.CrossRefGoogle Scholar
  20. Myles, B. S., Barnhill, G. P., Hagiwara, T., Griswold, D. E., & Simpson, R. L. (2001). A synthesis of studies on the intellectual, academic, social/emotional and sensory characteristics of children and youth with Asperger syndrome. Education and Training in Mental Retardation and Developmental Disabilities, 36, 304–311.Google Scholar
  21. Raudenbush, S. W., & Bryk, A. S. (2002). Hierarchical linear models: Applications and data analysis methods (2nd ed.). Thousand Oaks, CA: Sage.Google Scholar
  22. Raudenbush, S. W., Bryk, A. S., Cheong, Y. F., Congdon, R. T., & du Toit, M. (2011). HLM for Windows (Version 7.01) [Computer software]. Skokie, IL: Scientific Software International, Inc.Google Scholar
  23. Reaven, J., Blakeley-Smith, A., Culhane-Shelburne, K., & Hepburn, S. (2012). Group cognitive behavior therapy for children with high-functioning autism spectrum disorders and anxiety: A randomized trial. Journal of Child Psychology and Psychiatry, 53, 410–419. doi: 10.1111/j.1469-7610.2011.02486.x.CrossRefPubMedPubMedCentralGoogle Scholar
  24. Renno, P., & Wood, J. J. (2013). Discriminant and convergent validity of the anxiety construct in children with autism spectrum disorders. Journal of Autism and Developmental Disorders, 43, 2135–2146. doi: 10.1007/s10803-013-1767-1.CrossRefPubMedPubMedCentralGoogle Scholar
  25. Schafer, J. L. (1997). Analysis of incomplete multivariate data. London: Chapman & Hall.CrossRefGoogle Scholar
  26. Seligman, L. D., & Ollendick, T. H. (2011). Cognitive-behavioral therapy for anxiety disorders in youth. Child and Adolescent Psychiatric Clinics of North America, 20, 217–238. doi: 10.1016/j.chc.2011.01.003.CrossRefPubMedPubMedCentralGoogle Scholar
  27. Selles, R. R., Arnold, E. B., Phares, V., Lewin, A. B., Murphy, T. K., & Storch, E. A. (2015). Cognitive-behavioral therapy for anxiety in youth with an autism spectrum disorder: A follow-up study. Autism, 19, 613–621. doi: 10.1177/1362361314537912.CrossRefPubMedGoogle Scholar
  28. Silverman, W. K., & Albano, A. M. (1996). The anxiety disorders interview schedule for DSM-IV: Child and parent versions. San Antonio, TX: Graywind.Google Scholar
  29. Storch, E. A., Arnold, E. B., Lewin, A. B., Nadeau, J. M., Jones, A. M., De Nadai, A. S., & Murphy, T. K. (2013). The effect of cognitive-behavioral therapy versus treatment as usual for anxiety in children with autism spectrum disorders: A randomized, controlled trial. Journal of the American Academy of Child and Adolescent Psychiatry, 52, 132–142. doi: 10.1016/j.jaac.2012.11.007.CrossRefPubMedGoogle Scholar
  30. Storch, E. A., Lewin, A. B., Collier, A. B., Arnold, E., De Nadai, A. S., Dane, B. F., & Murphy, T. K. (2015). A randomized controlled trial of cognitive-behavioral therapy versus treatment as usual for adolescents with autism spectrum disorders and comorbid anxiety. Depression and Anxiety, 32, 174–181. doi: 10.1002/da.22332.CrossRefPubMedGoogle Scholar
  31. Sukhodolsky, D. G., Scahill, L., Gadow, K. D., Arnold, L. E., Aman, M. G., McDougle, C. J., & Vitiello, B. (2008). Parent-rated anxiety symptoms in children with pervasive developmental disorders: Frequency and association with core autism symptoms and cognitive functioning. Journal of Abnormal Child Psychology, 36, 117–128. doi: 10.1007/s10802-007-9165-9.CrossRefPubMedGoogle Scholar
  32. Ung, D., Arnold, E. B., De Nadai, A. S., Lewin, A. B., Phares, V., Murphy, T. K., & Storch, E. A. (2014). Inter-rater reliability of the anxiety disorders interview schedule for DSM-IV in high-functioning youth with autism spectrum disorder. Journal of Developmental and Physical Disabilities, 26, 53–65. doi: 10.1007/s10882-013-9343-3.CrossRefPubMedGoogle Scholar
  33. van Steensel, F. J. A., Bögels, S. M., & Perrin, S. (2011). Anxiety disorders in children and adolescents with autistic spectrum disorders: A meta-analysis. Clinical Child and Family Psychology Review, 14, 302–317. doi: 10.1007/s10567-011-0097-0.CrossRefPubMedPubMedCentralGoogle Scholar
  34. Wechsler, D. (1999). Manual for the Wechsler abbreviated scale of intelligence. San Antonio, TX: Psychological Corporation.Google Scholar
  35. White, S. W., Albano, A. M., Johnson, C. R., Kasari, C., Ollendick, T., Klin, A., & Scahill, L. (2010). Development of a cognitive-behavioral intervention program to treat anxiety and social deficits in teens with high-functioning autism. Clinical Child and Family Psychology Review, 13, 77–90. doi: 10.1007/s10567-009-0062-3.CrossRefPubMedPubMedCentralGoogle Scholar
  36. White, S. W., Ollendick, T., Albano, A. M., Oswald, D., Johnson, C., Southam-Gerow, M. A., & Scahill, L. (2013). Randomized controlled trial: Multimodal anxiety and social skill intervention for adolescents with autism spectrum disorder. Journal of Autism and Developmental Disorders, 43, 382–394. doi: 10.1007/s10803-012-1577-x.CrossRefPubMedPubMedCentralGoogle Scholar
  37. White, S. W., & Roberson-Nay, R. (2009). Anxiety, social deficits, and loneliness in youth with autism spectrum disorders. Journal of Autism and Developmental Disorders, 39, 1006–1013. doi: 10.1007/s10803-009-0713-8.CrossRefPubMedGoogle Scholar
  38. White, S. W., Schry, A. R., & Kreiser, N. L. (2014). Social worries and difficulties: Autism and/or social anxiety disorder? In T. E. Davis III, S. W. White, & T. H. Ollendick (Eds.), Handbook of autism and anxiety. New York, NY: Springer.Google Scholar
  39. White, S. W., Schry, A. R., Miyazaki, Y., Ollendick, T. H., & Scahill, L. (2015). Effects of verbal ability and severity of autism on anxiety in adolescents with ASD: One-year follow-up after cognitive behavioral therapy. Journal of Clinical Child and Adolescent Psychology, 44, 839–845. doi: 10.1080/15374416.2014.893515.CrossRefPubMedGoogle Scholar
  40. Williamson, S., Craig, J., & Slinger, R. (2008). Exploring the relationship between measures of self-esteem and psychological adjustment among adolescents with Asperger syndrome. Autism, 12, 391–402. doi: 10.1177/1362361308091652.CrossRefPubMedGoogle Scholar
  41. Wood, J. J., Drahota, A., Sze, K., Har, K., Chiu, A., & Langer, D. A. (2009). Cognitive behavioral therapy for anxiety in children with autism spectrum disorders: A randomized, controlled trial. Journal of Child Psychology and Psychiatry, 50, 224–234. doi: 10.1111/j.1469-7610.2008.01948.x.CrossRefPubMedPubMedCentralGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2016

Authors and Affiliations

  • Brenna B. Maddox
    • 1
    • 2
  • Yasuo Miyazaki
    • 3
  • Susan W. White
    • 2
  1. 1.Center for Autism ResearchChildren’s Hospital of PhiladelphiaPhiladelphiaUSA
  2. 2.Department of PsychologyVirginia TechBlacksburgUSA
  3. 3.School of EducationVirginia TechBlacksburgUSA

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