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Cognitive Behavioral Treatment of Comorbid Anxiety Disorders and Social Difficulties in Children with High-Functioning Autism: A Case Report

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Abstract

A substantial proportion of children with high-functioning autism (HFA) or Asperger syndrome (AS) have one or more comorbid anxiety disorders. Because anxiety disorders exacerbate the social difficulties and other functional impairments caused by an autism spectrum disorder (ASD), there is a need for efficacious treatments to address the clinical needs of youth with this comorbid presentation. This article describes an evidence-based cognitive behavioral therapy (CBT) treatment manual enhanced to address the unique characteristics and clinical needs of children with ASD. A case study is presented in which CBT was utilized in the successful treatment of an 11-year-old girl with HFA. The intervention was effective in reducing anxiety and improving social and adaptive functioning. These findings suggest that an enhanced CBT approach may be a viable intervention for children with comorbid HFA and anxiety disorders that should be further evaluated.

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References

  • American Psychiatric Association (2000). Diagnostic and statistical manual of mental disorders (4th ed.). Text Revision (DSM-IV-TR). Washington, DC: American Psychiatric Association

  • Anderson, S., & Morris, J. (2006). Cognitive behavior therapy for people with Asperger syndrome. Behavioural and Cognitive Psychotherapy, 34, 293–303

    Article  Google Scholar 

  • Attwood, T. (2003a). Frameworks for behavioral interventions. Child and Adolescent Psychiatric Clinics of North America, 12, 65–86

    Article  PubMed  Google Scholar 

  • Attwood, T. (2003b). Understanding and managing circumscribed interests. In M. Prior (Eds.), Learning and behavior problems in Asperger syndrome (pp. 126–147). New York: Guilford

    Google Scholar 

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

    Article  Google Scholar 

  • Baker, M. J., Koegel, R. L., & Koegel, L. K. (1998). Increasing the social behavior of young children with autism using their obsessive behaviors. Journal of the Association for Persons with Severe Handicaps, 23, 300–308

    Article  Google Scholar 

  • Baron-Cohen, S., Leslie, A. M., & Frith, U. (1985). Does the autistic child have a “theory of mind? Cognition, 21, 37–46

    Article  PubMed  CAS  Google Scholar 

  • Baron-Cohen, S., Wheelwright, S., Lawson, J., Griffin, R., Ashwin, C., Billington, J., et al. (2005). Empathizing and systemizing in autism spectrum conditions. In F.R. Volkmar, R. Paul, A. Klin, & D. Cohen (Eds.), Handbook of autism and pervasive developmental disorders (3rd ed.). Assessment, interventions, and policy (pp. 628–639). Hoboken, NJ: Wiley

    Google Scholar 

  • Barrett, P. M, Dadds, M. R., Rapee, R. M. (1996), Family treatment of childhood anxiety: A controlled trial. Journal of Consulting & Clinical Psychology, 64, 333–342

    Article  CAS  Google Scholar 

  • Bauminger, N. (2002). The facilitation of social-emotional understanding and social interaction in high-functioning children with autism: Intervention outcomes. Journal of Autism & Developmental Disorders, 32, 283–298

    Article  Google Scholar 

  • Bauminger, N., & Kasari, C. (2000). Loneliness and friendship in high-functioning children with autism. Child Development, 2, 447–456

    Article  Google Scholar 

  • Bellini, S. (2004). Social skill deficits and anxiety in high-functioning adolescents with autism spectrum disorders. Focus on Autism and Other Developmental Disabilities, 19, 78–86

    Article  Google Scholar 

  • Charlop-Christy, M. H., & Haymes, L. K. (1998). Using objects of obsession as token reinforcers for children with autism. Journal of Autism & Developmental Disorders, 28, 189–198

    Article  CAS  Google Scholar 

  • Cobham V. E., Dadds, M. R., Spence, S. H. (1998). The role of parental anxiety in the treatment of childhood anxiety. Journal of Consulting & Clinical Psychology, 66, 893–905

    Article  CAS  Google Scholar 

  • Green, J., Gilchrist, A., Burton, D., & Cox, A. (2000). Social and psychiatric functioning in adolescents with Asperger syndrome compared with Conduct disorder. Journal of Autism & Developmental Disorders, 30, 279–293

    Article  CAS  Google Scholar 

  • Greig, A., & MacKay, T. (2005). Asperger’s syndrome and cognitive behaviour therapy: New applications for educational psychologists. Educational and Child Psychology, 22, 4–15

    Google Scholar 

  • Kasari, C., Chamberlain, B., & Bauminger, N. (2001). Social emotions and social relationships: Can children with autism compensate? In J. A. Burack, T. Charman, N. Yirmiya, & P. R. Zerlazo (Eds.), The development of autism: Perspectives from theory and research (pp. 309–323). Mahwah, NJ: Lawrence Erlbaum

    Google Scholar 

  • Kendall, P. C., Flannery-Schroeder, E., Panichelli-Mindel, S. M., Southam-Gerow, M., Hein, A., & Warman, M. (1997). Therapy for youths with anxiety disorders: A second randomized clinical trial. Journal of Consulting & Clinical Psychology, 65, 366–380

    Article  CAS  Google Scholar 

  • Kim, J. A., Szatmari, P., Bryson, S. E., Streiner, D. L., & Wilson, F. J. (2000). The prevalence of anxiety and mood problems among children with autism and Asperger syndrome. Autism, 4, 117–132

    Article  Google Scholar 

  • Klin, A., Pauls, D., Schultz, R., & Volkmar, F. (2005). Three diagnostic approaches to Asperger syndrome: Implications for research. Journal of Autism & Developmental Disorders, 35, 221–234

    Article  Google Scholar 

  • Leyfer, O. T., Folstein, S. E., Bacalman, S., Davis, N. O., Dinh, E., Morgan, J., et al. (2006). Comborbid psychiatric disorders in children with autism: Interview development and rates of disorders. Journal of Autism & Developmental Disorders, 36, 849–861

    Article  Google Scholar 

  • Liss, M., Harel, B., Fein, D., Allen, D., Dunn, M., Feinstein, C., et al. (2001). Predictors and correlates of adaptive functioning in children with developmental disorders. Journal of Autism & Developmental Disorders, 31, 219–230

    Article  CAS  Google Scholar 

  • Lord, C., Rutter, M., & LeCouteur, 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 & Developmental Disorders, 19, 185–212

    Article  Google Scholar 

  • Lord, C., Rutter, M. L., DiLavore, P. C., & Risi, S. (1999). Autism Diagnostic Observation Schedule—WPS (WPS ed.). Los Angeles: Western Psychological Services

  • Marans, W. D., Rubin, E., & Laurent, A. (2005). Addressing social communication skills in individuals with high-functioning autism and Asperger syndrome: Critical priorities in educational programming. In F. R. Volkmar, R. Paul, A. Klin, & D. Cohen (Eds.), Handbook of autism and pervasive developmental disorders (3rd ed.): Assessment, interventions, and policy (pp. 977–1002). Hoboken, NJ: Wiley

    Google Scholar 

  • Muris, P., Steerneman, P., Merckelback, H., Holdrinet, I., & Meesters, C. (1998). Comorbid anxiety symptoms in children with Pervasive Developmental Disorders. Journal of Anxiety Disorders, 12, 387–393

    Article  PubMed  CAS  Google Scholar 

  • National Research Council (2001). Educating children with autism. Washington, DC: National Academy Press

  • Piacentini, J., Langley, A., Roblek, T., Chang, S., & Bergman, R. (2003). Multimodal CBT treatment for childhood OCD: A combined individual child and family treatment manual (3rd revision). Los Angeles: UCLA Department of Psychiatry

    Google Scholar 

  • Reaven, J., & Hepburn, S. (2003). Cognitive-behavioral treatment of obsessive-compulsive disorder in a child with Asperger syndrome: A case report. Autism, 7, 145–164

    Article  PubMed  Google Scholar 

  • Reaven, J., & Hepburn, S. (2006). The parent’s role in the treatment of anxiety symptoms in children with high-functioning autism spectrum disorders. Mental Health Aspects of Developmental Disabilities, 9, 73–80

    Google Scholar 

  • Sigman, M., & Ruskin, E. (1999). Continuity and change in the social competence of children with autism, Downs syndrome, and developmental delays. Monographs of the Society for Research in Child Development, 64, v114

    Article  Google Scholar 

  • 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 

  • Sofronoff, K., & Attwood, T. (2003). A cognitive behaviour therapy intervention for anxiety in children with Asperger’s syndrome. Good Autism Practice, 4, 228

    Google Scholar 

  • Sofronoff, K., Attwood, T., & Hinton, S. (2005). A randomized controlled trial of CBT intervention for anxiety in children with Asperger syndrome. Journal of Child Psychology and Psychiatry, 46, 1152–1160

    Article  PubMed  Google Scholar 

  • Volkmar, F. R., & Klin, A. (2000). Diagnostic issues in Asperger syndrome. In A. Klin, F. R. Volkmar, & S. S. Sparrow (Eds.), Asperger syndrome (pp. 25–71). New York: Guilford Press

    Google Scholar 

  • Volkmar, F. R., Sparrow, S. S., Goudreau, D., Cicchetti, D. V., Paul, R., Cohen, D. J., et al. (1987). Social deficits in autism: An operational approach using the Vineland Adaptive Behavior Scales. Journal of the American Academy of Child & Adolescent Psychiatry, 26, 156–161

    Article  CAS  Google Scholar 

  • Wood, J. J., Drahota, A., & Sze, K. M. (2007). Cognitive behavioral therapy for anxiety and social problems in children with autism: Intervention manual. Unpublished treatment manual developed at the University of California, Los Angeles

  • Wood, J. J., & McLeod, B. M. (in press). Child anxiety disorders: A treatment manual for practitioners. New York: Norton.

  • Wood, J. J., Piacentini, J. C., Southam-Gerow, M., Chu, B. C., & Sigman, M. (2006). Family cognitive behavioral therapy for child anxiety disorders. Journal of the American Academy of Child & Adolescent Psychiatry, 45, 314–321

    Article  Google Scholar 

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Acknowledgment

This article was supported by a grant from the National Institute of Mental Health (NIMH) awarded to Jeffrey J. Wood (MH075806), a grant from the Cure Autism Now Foundation awarded to Jeffrey J. Wood, and a Pilot Grant awarded to Jeffrey J. Wood by the UCLA Center for Autism Research and Treatment (CART); CART, established in 2003 as one of 8 autism centers of excellence, is funded by NIMH (U54-MH-068172; PI: Marian Sigman).

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Sze, K.M., Wood, J.J. Cognitive Behavioral Treatment of Comorbid Anxiety Disorders and Social Difficulties in Children with High-Functioning Autism: A Case Report. J Contemp Psychother 37, 133–143 (2007). https://doi.org/10.1007/s10879-007-9048-y

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