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Group Based Cognitive Behavioural Therapy for Anxiety in Children with Autism Spectrum Disorder: A Randomised Controlled Trial in a General Child Psychiatric Hospital Setting

Abstract

Cognitive Behavioural Therapy (CBT) programs adapted to children with Autism Spectrum Disorder (ASD) effectively reduce anxiety when run in university clinics. Forty-nine children aged 8–14 years participated in a waitlist controlled study in a general child psychiatric hospital setting. Post-treatment 30% of the children were free of their primary anxiety diagnoses and 5% were free of all anxiety diagnoses. No statistically significant difference between the two trial conditions were found on primary outcomes. However, statistically significant differences were found on secondary outcomes indicating clinically meaningful treatment responses. Together with high program satisfaction this study shows the CBT program to be feasible and potentially efficacious in treating anxiety in children with ASD in a general child psychiatric hospital setting.

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References

  1. Arendt, K. B., Hougaard, E., & Thastum, M. (2014). Psychometric properties of the child and parent versions of Spence Children's Anxiety Scale in a Danish community and clinical sample. Journal of Anxiety Disorders,28(8), 947–956.

    Article  PubMed  PubMed Central  Google Scholar 

  2. Arendt, K. B., Hougaard, E., & Thastum, M. (2016). Efficacy of a Danish version of the Cool Kids program: A randomized wait-list controlled trial. Acta Psychiatrica Scandinavica,133(2), 109–121.

    Article  PubMed  PubMed Central  Google Scholar 

  3. Association, A. P. (2013). Diagnostic and statistical manual of mental disorders (DSM-5). Arkington, VA: American Psychiatric Publishing.

    Book  Google Scholar 

  4. Attride-Sterling, J. (2002). Development of methods to capture users’ views of CAMHS in clinical governance reviews. Cambridge, UK: Commission for Health Improvement.

    Google Scholar 

  5. Attwood, T. (2004). Cognitive behaviour therapy for children and adults with Asperger's syndrome. Behaviour Change.,21(3), 147–161.

    Article  Google Scholar 

  6. Bellini, S. (2006). The development of social anxiety in adolescents with autism spectrum disorders. Focus on Autism and Other Developmental Disabilities,21(3), 138–145.

    Article  Google Scholar 

  7. Brereton, A. V., Tonge, B. J., & Einfeld, S. L. (2006). Psychopathology in children and adolescents with autism compared to young people with intellectual disability. Journal of Autism and Developmental Disorders.,36(7), 863–870.

    Article  PubMed  PubMed Central  Google Scholar 

  8. Brown, A., Ford, T., Deighton, J., & Wolpert, M. (2014). Satisfaction in child and adolescent mental health services: Translating users feedback into measurement. Administration and Policy in Mental Health,41(4), 434–446.

    Article  PubMed  PubMed Central  Google Scholar 

  9. Chalfant, A., Lyneham, H. J., Rapee, R. M., & Carroll, L. (2003). The cool kids anxiety program: Autism Spectrum Disorder adaptation. Sydney: Macquarie University.

    Google Scholar 

  10. Chalfant, A., Rapee, R. M., & 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.

    Article  PubMed  PubMed Central  Google Scholar 

  11. Coleman, M. (2000). The biology of the autistic syndromes. Cambridge: University Press.

    Google Scholar 

  12. de Marchena, A. B., Eigsti, I.-M., & Yerys, B. E. (2015). Brief report: Generalization weaknesses in verbally fluent children and adolescents with autism spectrum disorder. Journal of Autism and Developmental Disorders.,45(10), 3370–3376.

    Article  PubMed  PubMed Central  Google Scholar 

  13. Djurhuus, I. D., & Bikic, A. (2019). Is the Cool Kids programme working in outpatient psychiatric clinics? A Danish naturalistic effectiveness study. Nordic Journal of Psychiatry,15, 1–8.

    Google Scholar 

  14. Eaves, L. C., & Ho, H. H. (2008). Young adult outcome of autism spectrum disorders. Journal of Autism and Developmental Disorders,38(4), 739–747.

    Article  PubMed  PubMed Central  Google Scholar 

  15. Ghaziuddin, M. (2005). Mental health aspects of autism and Asperger syndrome. London, UK: Jessica Kingsley Publishers.

    Google Scholar 

  16. Gillberg, C., & Coleman, M. (1992). The biology of the autistic syndromes. London, UK: Mac Keith Press.

    Google Scholar 

  17. Higa-McMillan, C. K., Francis, S. E., Rith-Najarian, L., & Chorpita, B. F. (2016). Evidence base update: 50 years of research on treatment for child and adolescent anxiety. Journal of Clinical Child and Adolescent Psychology.,45(2), 91–113.

    Article  PubMed  PubMed Central  Google Scholar 

  18. James, A. C., James, G., Cowdrey, F. A., Soler, A., & Choke, A. (2015). Cognitive Behavioural Therapy for anxiety disorders in children and adolescents. Cochrane Database of Systematic Reviews,2015(2), 1465–1858.

    Google Scholar 

  19. Jónsson, H., Thastum, M., Arendt, K., & Juul-Sørensen, M. (2015). Group cognitive behavioural treatment of youth anxiety in community based clinical practice: Clinical significance and benchmarking against efficacy. Journal of Anxiety Disorders,35, 9–18.

    Article  PubMed  PubMed Central  Google Scholar 

  20. Kazantzis, N., Whittington, C., & Dattilio, F. (2010). Meta analysis of homework effects in cognitive and behavioral therapy: A replication and extension. Clinical Psychology: Science and Practice,17, 144–156.

    Google Scholar 

  21. Kazdin, A. E. (2004). Evidence-based treatments: Challenges and priorities for practice and research. Child and Adolescent Psychiatric Clinics of North America,13(4), 923–940.

    Article  PubMed  PubMed Central  Google Scholar 

  22. Kilburn, T. R., Sørensen, M. J., Thastum, M., Rapee, R. M., et al. (2018). Rationale and design for cognitive behavioral therapy for anxiety disorders in children with autism spectrum disorder: A study protocol of a randomized controlled trial. Trials,19, 210.

    Article  PubMed  PubMed Central  Google Scholar 

  23. Kilburn, T. R., Sørensen, M. J., Thastum, M., Rapee, R. M., et al. (2019). Group-based Cognitive Behavioural Therapy for anxiety disorder in children with Autism Spectrum Disorder: A feasibility study. Nordic Journal of Psychiatry.,73(4–5), 273–280.

    Article  PubMed  PubMed Central  Google Scholar 

  24. 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.

    Article  PubMed  PubMed Central  Google Scholar 

  25. Leyfer, O. T., Folstein, S. E., Bacalman, S., Davis, N. O., 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.

    Article  PubMed  PubMed Central  Google Scholar 

  26. Lord, C., Rutter, M., Goode, S., Heemsbergen, J., et al. (1989). Austism diagnostic observation schedule: A standardized observation of communicative and social behavior. Journal of Autism and Developmental Disorders,19(2), 185–212.

    Article  PubMed  PubMed Central  Google Scholar 

  27. Luxford, S., Hadwin, J. A., & Kovshoff, H. (2017). Evaluating the effectiveness of a school-based cognitive behavioural therapy intervention for anxiety in adolescents diagnosed with autism spectrum disorder. Journal of Autism and Developmental Disorders, 47(12), 3896–3908.

    Article  PubMed  PubMed Central  Google Scholar 

  28. Lyneham, H. J., Abbott, M. J., Wignall, A., & Rapee, R. M. (2003). The cool kids child and adolescent anxiety program children's workbook. Sydney, AU: Macquarie University.

    Google Scholar 

  29. Lyneham, H. J., Chalfant, A., Kilburn, T. R., & Rapee, R. M. (2018). The cool kids anxiety program: Autism Spectrum Disorder adaptation. Children's workbook. Sydney, AU: Macquarie University. Unpublished.

    Google Scholar 

  30. Lyneham, H. J., Sburlati, E. S., Abbott, M. J., Rapee, R. M., et al. (2013). Psychometric properties of the Child Anxiety Life Interference Scale (CALIS). Journal of Anxiety Disorders,27(7), 711–719.

    Article  PubMed  PubMed Central  Google Scholar 

  31. McConachie, H., McLaughlin, E., Grahame, V., Taylor, H., et al. (2014). Group therapy for anxiety in children with autism spectrum disorder. Autism, 18(6), 723–732.

    Article  PubMed  PubMed Central  Google Scholar 

  32. Pellecchia, M., Connell, J. E., Kerns, C. M., Xie, M., et al. (2016). Child characteristics associated with outcome for children with autism in a school-based behavioral intervention. Autism,20(3), 321–329.

    Article  PubMed  PubMed Central  Google Scholar 

  33. Perihan, C., Burke, M., Bowman-Perrott, L., Bicer, A., et al. (2019). Effects of cognitive behavioral therapy for reducing anxiety in children with high functioning ASD: A systematic review and meta-analysis. Journal of Autism and Developmental Disorders. https://doi.org/10.1007/s10803-019-03949-7.

    Article  PubMed  PubMed Central  Google Scholar 

  34. Qian, N., & Lipkin, R. M. (2011). A learning-style theory for understanding autistic behaviors. Frontiers in Human Neuroscience.,5, 77.

    Article  PubMed  PubMed Central  Google Scholar 

  35. Ramböll. (2019). SurveyXact:Version 13.0. Aarhus N: Ramböll Management Conculting.

  36. Rapee, R. M. (2003). The influence of comorbidity on treatment outcome for children and adolescents with anxiety disorders. Behaviour Research and Therapy,41(1), 105–112.

    Article  PubMed  PubMed Central  Google Scholar 

  37. Rapee, R. M., Schniering, C. A., Lyneham, H. J. W. V. H. J., & Wignall, A. (2006). Cool kids (chilled) adolescent anxiety and depression program. Sydney AU: Macquarie University.

    Google Scholar 

  38. Reynolds, C. R., & Kamphaus, R. W. (2003). Reynolds intellectual assessment scales (RIAS). Lutz FL: Psychological Assessment Resrouces.

    Google Scholar 

  39. Reynolds, S., Wilson, C., Austin, J., & Hooper, L. (2012). Effects of psychotherapy for anxiety in children and adolescents: A meta-analytic review. Clinical Psychology Review,32(4), 251–262.

    Article  PubMed  PubMed Central  Google Scholar 

  40. Rothman, K. J. (1990). No adjustments are needed for multiple comparisons. Epidemiology,1(1), 43–46.

    Article  PubMed  PubMed Central  Google Scholar 

  41. Schniering, C. A., & Rapee, R. M. (2002). Development and validation of a measure of children’s automatic thoughts: The children’s automatic thoughts scale. Behaviour Research and Therapy,40(9), 1091–1109.

    Article  PubMed  PubMed Central  Google Scholar 

  42. Silverman, W. K., & Albano, A. M. (1996). The anxiety disorders interview schedule for DSM-IV—child and parent versions. San Antonio, TX: Psychological Corporation.

    Google Scholar 

  43. Silverman, W. K., Saavedra, L. M., & Pina, A. A. (2001). Test-retest reliability of anxiety symptoms and diagnoses with the anxiety disorders interview schedule for DSM-IV: Child and parent versions. Journal of the American Academy of Child and Adolescent Psychiatry.,40(8), 937–944.

    Article  PubMed  PubMed Central  Google Scholar 

  44. Simonoff, E., Pickles, A., Charman, T., Chandler, S., et al. (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.

    Article  PubMed  PubMed Central  Google Scholar 

  45. Spence, S. H. (1998). A measure of anxiety symptoms among children. Behaviour Research and Therapy,36(5), 545–566.

    Article  PubMed  PubMed Central  Google Scholar 

  46. StataCorp. (2019). Stata Statistical Software: Release 16. College Station, TX: StataCorp LLC.

  47. Steinhausen, H. C., & Metzke, C. W. (2004). Differentiating the behavioural profile in autism and mental retardation and testing of a screener. European Child & Adolescent Psychiatry,13(4), 214–220.

    Article  Google Scholar 

  48. Sukhodolsky, D. G., Bloch, M. H., Panza, K. E., & Reichow, B. (2013). Cognitive-behavioral therapy for anxiety in children with high-functioning autism: A meta-analysis. Pediatrics,132(5), 1341–1350.

    Article  Google Scholar 

  49. van Steensel, F. J., & Bogels, S. M. (2015). CBT for anxiety disorders in children with and without autism spectrum disorders. Journal of Consulting and Clinical Psychology, 83(3), 512–523.

    Article  PubMed  PubMed Central  Google Scholar 

  50. Wasserstein, R. L., & Lazar, N. A. (2016). The ASA statement on p-values: Context, process, and purpose. The American Statistician,70(2), 129–133.

    Article  Google Scholar 

  51. Wechsler, D. (2004). The Wechsler intelligence scale for children (4th ed.). London: Pearson Assessment.

    Google Scholar 

  52. WHO (World Health Organization). (2010). International Statistical Classification of Diseases and Related Health Problems (10th Revision). Retrieved from https://apps.who.int/classifications/icd10/browse/2010/en.

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Acknowledgments

We wish to thank the TRYG Foundation (Grant 112476) for funding this study and all the families for participating.

Funding

This work was supported by the TRYG Foundation under Grant 112476.

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Correspondence to Tina R. Kilburn.

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Conflict of interest

The authors report no conflicts of interest. Ron M Rapee and Tina R. Kilburn are co-authors of the treatment program—no royalties and Non-remunerative. The authors alone are responsible for the content and writing of the paper.

Ethical Approval

The study involved human participants and is registered and approved by: Clinicaltrials.gov, ID.nr: NCT02908321. The Regional Ethical Committee: ID.nr:1-10-72-46-15. Danish Data Protection Agency ID.nr:1-16-02-263-15.

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All parents gave informed consent to participate in the study and to the use of their data.

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Kilburn, T.R., Sørensen, M.J., Thastum, M. et al. Group Based Cognitive Behavioural Therapy for Anxiety in Children with Autism Spectrum Disorder: A Randomised Controlled Trial in a General Child Psychiatric Hospital Setting. J Autism Dev Disord (2020). https://doi.org/10.1007/s10803-020-04471-x

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Keywords

  • Autism spectrum disorder
  • Anxiety disorder
  • CBT
  • Children