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Moderators of Response to Personalized and Standard Care Cognitive-Behavioral Therapy for Youth with Autism Spectrum Disorder and Comorbid Anxiety

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Abstract

Anxiety/obsessive-compulsive disorders are common among youth with autism spectrum disorder (ASD). Two versions of cognitive behavior therapy (CBT) are effective, with some advantage for a personalized, adapted version. This study evaluated predictors and moderators of standard CBT and adapted CBT. Youth (N = 167) ages 7–13 were randomized to standard or adapted CBT, or treatment-as-usual. Age, IQ, ASD severity, and emotional-behavioral symptom severity were examined. More severe internalizing and emotional-behavioral problems predicted poorer treatment outcomes especially in standard versus personalized CBT. Elevated repetitive behaviors and restricted interests predicted poorer treatment outcomes across treatments, though youth with “moderate” repetitive behaviors and restricted interested experienced poorer outcomes only in standard but not personalized CBT. Externalizing symptoms directly predicted treatment outcomes. Older age predicted improved outcomes in adapted but not standard CBT. Findings highlight the need for further treatment refinements and the value in adapting treatment for youth with more complex presentations. Trial Registration Clinicialtrials.gov: NCT02028247; https://clinicaltrials.gov/ct2/show/NCT02028247.

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Notes

  1. To ensure that this age*condition interaction was not a by-product of increased symptom severity that is sometimes associated with older age, correlations were conducted between CBCL-Internalizing, Externalizing, and Total Problems and age, failing to find significant relationships (rs < .03). Analyses also controlled for baseline anxiety severity.

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Acknowledgments

We acknowledge the contributions of Adam Lewin, Jane Mutch, Tanya Murphy, Nicole McBride, Monica Wu, Sandra Cepeda, and Carly Johnco. Research for this work was supported in part by grants to the first, second and final authors (1R01HD080096; R01HD080098). The views expressed are those of the authors alone, and do not necessarily reflect views of the NIH, or Baylor College of Medicine.

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Authors and Affiliations

  1. Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, 1977 Butler Blvd, Suite 4-400, Houston, TX, 77030, USA

    Eric A. Storch, Andrew G. Guzick & Sophie C. Schneider

  2. Department of Education, University of California, Los Angeles, CA, USA

    Jeffrey J. Wood

  3. School of Aging Studies, University of South Florida, Tampa, FL, USA

    Brent J. Small

  4. Department of Psychology, University of British Columbia, Vancouver, BC, Canada

    Connor M. Kerns

  5. Jacob Center for Evidence-Based Therapy, Boca Raton, FL, USA

    D. Luis Ordaz

  6. Department of Psychology, Temple University, Philadelphia, PA, USA

    Philip C. Kendall

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  1. Eric A. Storch
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  2. Jeffrey J. Wood
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  7. Sophie C. Schneider
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  8. Philip C. Kendall
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Contributions

EAS was involved in conceptualizing this study, data acquisition, drafting the manuscript, and interpretation of findings. JJW was involved in conceptualizing this study, data acquisition, drafting and revising the manuscript, and interpretation of findings. AG was involved in conceptualizing this study, data analysis, drafting the manuscript, and interpretation of findings. BJS was involved in conceptualizing this study, data analysis, revising the manuscript, and interpretation of findings. CMK was involved in conceptualizing this study, data acquisition, revising the manuscript, and interpretation of findings. DLO was involved in conceptualizing this study, data acquisition, drafting the manuscript, and interpretation of findings. SCS was involved in conceptualizing this study, drafting the manuscript, and interpretation of findings. PCK was involved in conceptualizing this study, data acquisition, drafting the manuscript, and interpretation of findings.

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Correspondence to Eric A. Storch.

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Storch, E.A., Wood, J.J., Guzick, A.G. et al. Moderators of Response to Personalized and Standard Care Cognitive-Behavioral Therapy for Youth with Autism Spectrum Disorder and Comorbid Anxiety. J Autism Dev Disord 52, 950–958 (2022). https://doi.org/10.1007/s10803-021-05000-0

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