Skip to main content
Log in

Effectiveness of Cognitive Behavioral Therapy for Individuals with Autism Spectrum Disorders and Comorbid Obsessive-Compulsive Disorder: A Review of the Research

  • REVIEW ARTICLE
  • Published:
Journal of Developmental and Physical Disabilities Aims and scope Submit manuscript

Abstract

Autism spectrum disorders (ASD) and obsessive-compulsive disorder (OCD) are highly comorbid, precipitating an urgent need to identify evidence-based practices that might be used to address this comorbidity exclusively. The aim of this study was to conduct a review of intervention research and clinical reports to examine the use of cognitive behavioral therapy (CBT) with individuals who have comorbid ASD and OCD. Based on the pre-determined review inclusion criteria, 11 studies were included in the review: three randomized control trials (RCT), one case controlled study, two single subject experimental designs, and five case studies. These studies offer promising data on the use of CBT interventions for individuals with ASD and comorbid OCD as well as for individuals with OCD and comorbid ASD when standard CBT protocol is enhanced with modifications such as parental involvement, increased use of visuals, personalized treatment metaphors, self-monitoring, positive reinforcement, and use of clear language and instructions. Limitations and implications for future research and practice are discussed.

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

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1

Similar content being viewed by others

References

  • Achenbach, T. M., & Rescorla, L. (2001). Manual for the ASEBA school-age forms & profiles: An integrated system of multi-informant assessment. Burlington: ASEBA.

    Google Scholar 

  • American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders (4 th ed., text rev.). Washington, DC: American Psychiatric Association.

    Google Scholar 

  • American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington: American Psychiatric Publishing.

    Book  Google Scholar 

  • Autism and Developmental Disabilities Monitoring Network Surveillance (2010). Principal Investigators. Prevalence of autism spectrum disorder among children aged 8 years—Autism and developmental disabilities monitoring network, 11 sites, United States, 2010. MMWR. 2014; 63(2), 1–21.

  • Bird, G., & Cook, R. (2013). Mixed emotions: The contribution of alexithymia to the emotional symptoms of autism. Translational Psychiatry, 3(7), e285. doi:10.1038/tp.2013.61.

    Article  PubMed  PubMed Central  Google Scholar 

  • Bodfish, J. W., Symons, F., & Lewis, M. (1999). The repetitive behavior scale: Test manual. Morganton: Western Carolina Center Research Reports.

    Google Scholar 

  • Boyd, B. A., Woodard, C. R., & Bodfish, J. W. (2013). Feasibility of exposure response prevention to treat repetitive behaviors of children with autism and an intellectual disability: A brief report. Autism, 17, 196–204. doi:10.1177/1362361311414066.

    Article  PubMed  Google Scholar 

  • Dahlgren, S., Sandberg, A. D., & Hjelmquist, E. (2003). The non-specificity of theory of mind deficits: Evidence from children with communicative disabilities. European Journal of Cognitive Psychology, 15, 129–155. doi:10.1080/09541440303601.

    Article  Google Scholar 

  • Dawson, G., Rogers, S., Munson, J., Smith, M., Winter, J., Greenson, J., et al. (2010). Randomized, controlled trial of an intervention for toddlers with autism: The early start Denver model. Pediatrics, 125(1), e17–e23. doi:10.1542/peds.2009-0958.

    Article  PubMed  Google Scholar 

  • Elliott, S. J., & Fitzsimons, L. (2014). Modified CBT for treatment of OCD in a 7-year-old boy with ASD—A case report. Journal of Child and Adolescent Psychiatric Nursing, 27, 156–159. doi:10.1111/jcap.12081.

    Article  PubMed  Google Scholar 

  • Farrell, L. J., James, S. C., Maddox, B. B., Griffiths, D., & White, S. (2016). Treatment of comorbid obsessive-compulsive disorder in youth with ASD: The case of Max. Clinical Handbook of Obsessive-Compulsive and Related Disorders (pp. 337-355). Switzerland: Springer International Publishing. doi:10.1007/978-3-319-17139-5_23.

  • Feldman, M. A., Condillac, R. A., Tough, S., Hunt, S., & Griffiths, D. (2002). Effectiveness of community positive behavioral intervention for persons with developmental disabilities and severe behavior disorders. Behavior Therapy, 33, 377–398. doi:10.1016/S0005-7894(02)80034-X.

    Article  Google Scholar 

  • Foa, E. B., Liebowitz, M. R., Kozak, M. J., Davies, S., Campeas, R., Franklin, M. E., et al. (2005). Randomized, placebo-controlled trial of exposure and ritual prevention, clomipramine, and their combination in the treatment of obsessive-compulsive disorder. American Journal of Psychiatry, 162, 151–161. doi:10.1176/appi.ajp.162.1.151.

    Article  PubMed  Google Scholar 

  • Freeston, M. H., & Ladouceur, R. (1999). Exposure and response prevention for obsessive thoughts. Cognitive and Behavioral Practice, 6, 362–383. doi:10.1016/S1077-7229(99)80056-X.

    Article  Google Scholar 

  • Gadow, K. D., Devincent, C. J., Pomeroy, J., & Azizian, A. (2005). Comparison of DSM-IV symptoms in elementary school-age children with PDD versus clinic and community samples. Autism, 9, 392–415. doi:10.1177/1362361305056079.

    Article  PubMed  Google Scholar 

  • Gillott, A., Furniss, F., & Walter, A. (2001). Anxiety in high-functioning children with autism. Autism, 5, 277–286. doi:10.1177/1362361301005003005.

    Article  PubMed  Google Scholar 

  • Hanley, G. P., Iwata, B. A., & McCord, B. E. (2003). Functional analysis of problem behavior: A review. Journal of Applied Behavior Analysis, 36, 147–185. doi:10.1901/jaba.2003.36-147.

    Article  PubMed  PubMed Central  Google Scholar 

  • Happé, F., & Frith, U. (2006). The weak coherence account: Detail-focused cognitive style in autism spectrum disorders. Journal of Autism and Developmental Disorders, 36, 5–25. doi:10.1007/s10803-005-0039-0.

    Article  PubMed  Google Scholar 

  • Joshi, G., Petty, C., Wozniak, J., Henin, A., Fried, R., Galdo, M., et al. (2010). The heavy burden of psychiatric comorbidity in youth with autism spectrum disorders: A large comparative study of a psychiatrically referred population. Journal of Autism and Developmental Disorders, 40, 1361–1370. doi:10.1007/s10803-010-0996-9.

    Article  PubMed  Google Scholar 

  • Joshi, G., Wozniak, J., Petty, C., Martelon, M. K., Fried, R., Bolfek, A., et al. (2013). Psychiatric comorbidity and functioning in a clinically referred population of adults with autism spectrum disorders: A comparative study. Journal of Autism and Developmental Disorders, 43, 1314–1325. doi:10.1007/s10803-012-1679-5.

    Article  PubMed  Google Scholar 

  • Kasari, C. (2002). Assessing change in early intervention programs for children with autism. Journal of Autism and Developmental Disorders, 32, 447–461. doi:10.1023/A:1020546006971.

    Article  PubMed  Google Scholar 

  • Kuhn, D. E., Hardesty, S. L., & Sweeney, N. M. (2009). Assessment and treatment of excessive straightening and destructive behavior in an adolescent diagnosed with autism. Journal of Applied Behavior Analysis, 42, 355–360. doi:10.1901/jaba.2009.42-355.

    Article  PubMed  PubMed Central  Google Scholar 

  • 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, 53–63. doi:10.3109/17518420903236288.

    Article  PubMed  Google Scholar 

  • Lehmkuhl, H. D., Storch, E. A., Bodfish, J. W., & Geffken, G. R. (2008). Brief report: Exposure and response prevention for obsessive compulsive disorder in a 12-year-old with autism. Journal of Autism and Developmental Disorders, 38, 977–981. doi:10.1007/s10803-007-0457-2.

    Article  PubMed  PubMed Central  Google Scholar 

  • 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.

    Article  PubMed  Google Scholar 

  • Lord, C., Rutter, M., DiLavore, P., & Risi, S. (1999). Autism diagnostic observation schedule (ADOS) manual. Los Angeles: Western Psychological Services.

    Google Scholar 

  • March, J. S., & Mulle, K. (1998). OCD in children and adolescents: A cognitive-behavioral treatment manual. New York: Guilford Press.

    Google Scholar 

  • March, J. S., Franklin, M., Nelson, A., & Foa, E. (2001). Cognitive-behavioral psychotherapy for pediatric obsessive-compulsive disorder. Journal of Clinical Child Psychology, 30, 8–18.

    Article  PubMed  Google Scholar 

  • Matson, J. L., & Nebel-Schwalm, M. S. (2007). Comorbid psychopathology with autism spectrum disorder in children: An overview. Research in Developmental Disabilities, 28, 341–352. doi:10.1016/j.ridd.2005.12.004.

    Article  PubMed  Google Scholar 

  • McGuire, J. F., Piacentini, J., Lewin, A. B., Brennan, E. A., Murphy, T. K., & Storch, E. A. (2015). A meta-analysis of cognitive behavior therapy and medication for child obsessive-compulsive disorder: Moderators of treatment efficacy, response, and remission. Depression and Anxiety, 32, 580–593. doi:10.1002/da.22389.

    Article  PubMed  PubMed Central  Google Scholar 

  • Meier, S. M., Petersen, L., Schendel, D. E., Mattheisen, M., Mortensen, P. B., & Mors, O. (2015). Obsessive-compulsive disorder and autism Spectrum disorders: Longitudinal and offspring risk. PloS One, 10, 1–12. doi:10.1371/journal.pone.0141703.

    Google Scholar 

  • Murray, K., Jassi, A., Mataix-Cols, D., Barrow, F., & Krebs, G. (2015). Outcomes of cognitive behavior therapy for obsessive–compulsive disorder in young people with and without autism spectrum disorders: A case controlled study. Psychiatry Research, 228, 8–13. doi:10.1016/j.psychres.2015.03.012.

    Article  PubMed  Google Scholar 

  • Nadeau, J. M., Arnold, E. B., Storch, E. A., & Lewin, A. B. (2013). Family cognitive-behavioral treatment for a child with autism and comorbid obsessive compulsive disorder. Clinical Case Studies, 13, 22–36. doi:10.1177/1534650113504488.

    Article  Google Scholar 

  • Neil, N., & Sturmey, P. (2014). Assessment and treatment of obsessions and compulsions in individuals with autism spectrum disorders: A systematic review. Review Journal of Autism and Developmental Disorders, 1, 62–79. doi:10.1007/s40489-013-0006-1.

    Article  Google Scholar 

  • Neil, N., Vause, T., Yates, H., & Feldman, M. (2017). Effects of group functional behavior-based cognitive behavioral therapy for obsessive-compulsive behavior in a youth with autism spectrum disorder. Journal of Child and Family Behavior Therapy, (in press).

  • Piacentini, J., & Langley, A. K. (2004). Cognitive-behavioral therapy for children who have obsessive-compulsive disorder. Journal of Clinical Psychology, 60, 1181–1194. doi:10.1002/jclp.20082.

    Article  PubMed  Google Scholar 

  • Ponniah, K., Magiati, I., & Hollon, S. D. (2013). An update on the efficacy of psychological treatments for obsessive–compulsive disorder in adults. Journal of Obsessive-compulsive and Related Disorders, 2, 207–218. doi:10.1016/j.jocrd.2013.02.005.

    Article  PubMed  PubMed Central  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. doi:10.1177/1362361303007002003.

    Article  PubMed  Google Scholar 

  • Reaven, J. A., Blakeley-Smith, A., Nichols, S., Dasari, M., Flanigan, E., & Hepburn, S. (2009). Cognitive-behavioral group treatment for anxiety symptoms in children with high-functioning autism spectrum disorders a pilot study. Focus on Autism and Other Developmental Disabilities, 24, 27–37. doi:10.1177/1088357608327666.

    Article  Google Scholar 

  • 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.

    Article  PubMed  PubMed Central  Google Scholar 

  • Rodriguez, N. M., Thompson, R. H., Schlichenmeyer, K., & Stocco, C. S. (2012). Functional analysis and treatment of arranging and ordering by individuals with an autism spectrum disorder. Journal of Applied Behavior Analysis, 45, 1–22. doi:10.1901/jaba.2012.45-1.

    Article  PubMed  PubMed Central  Google Scholar 

  • Russell, A. J., Jassi, A., Fullana, M. A., Mack, H., Johnston, K., Heyman, I., & Mataix-Cols, D. (2013). Cognitive behavior therapy for comorbid obsessive-compulsive disorder in high-functioning autism Spectrum disorders: A randomized controlled trial. Depression and Anxiety, 30, 697–708. doi:10.1002/da.22053.

    Article  PubMed  Google Scholar 

  • Scahill, L., Riddle, M. A., McSwiggin-Hardin, M., Ort, S. I., King, R. A., Goodman, W. K., et al. (1997). Children's Yale-Brown obsessive compulsive scale: Reliability and validity. Journal of the American Academy of Child & Adolescent Psychiatry, 36, 844–852. doi:10.1097/00004583-199706000-00023.

    Article  Google Scholar 

  • Scattone, D., & Mong, M. (2013). Cognitive behavior therapy in the treatment of anxiety for adolescents and adults with autism spectrum disorders. Psychology in the Schools, 50, 923–935. doi:10.1002/pits.21717.

    Article  Google Scholar 

  • Shaffer, D., Gould, M. S., Brasic, J., Ambrosini, P., Fisher, P., Bird, H., & Aluwahlia, S. (1983). A children's global assessment scale (CGAS). Archives of General Psychiatry, 40, 1228–1231. doi:10.1001/archpsyc.1983.01790100074010.

    Article  PubMed  Google Scholar 

  • Silverman, W. K., & Albano, A. M. (1996). Anxiety disorders interview schedule for DSM-IV: Child interview schedule. San Antonio: Graywind Publications.

    Google Scholar 

  • Simpson, H. B., Foa, E. B., Liebowitz, M. R., Ledley, D. R., Huppert, J. D., Cahill, S., et al. (2008). A randomized, controlled trial of cognitive-behavioral therapy for augmenting pharmacotherapy in obsessive-compulsive disorder. American Journal of Psychiatry, 165, 621–630. doi:10.1176/appi.ajp.2007.07091440.

    Article  PubMed  PubMed Central  Google Scholar 

  • Sofronoff, K., Attwood, T., & Hinton, S. (2005). A randomized controlled trial of a CBT intervention for anxiety in children with Asperger syndrome. Journal of Child Psychology and Psychiatry, 46, 1152–1160. doi:10.1111/j.1469-7610.2005.00411.x.

    Article  PubMed  Google Scholar 

  • Storch, E. A., Geffken, G. R., Merlo, L. J., Mann, G., Duke, D., Munson, M., et al. (2007). Family-based cognitive behavioral therapy for pediatric obsessive-compulsive disorder: Comparison of intensive and weekly approaches. Journal of the American Academy of Child & Adolescent Psychiatry, 46, 469–478. doi:10.1097/chi.0b013e31803062e7.

    Article  Google Scholar 

  • Storch, E. A., Arnold, E. B., Lewin, A. B., Nadeau, J. M., Jones, A. M., De Nadai, A. S., et al. (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 & Adolescent Psychiatry, 52, 132–142. doi:10.1016/j.jaac.2012.11.007.

    Article  Google Scholar 

  • Storch, E. A., Lewin, A. B., Collier, A. B., Arnold, E., De Nadai, A. S., Dane, B. F., et al. (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.

    Article  PubMed  Google Scholar 

  • Tsakanikos, E., Costello, H., Holt, G., Bouras, N., Sturmey, P., & Newton, T. (2006). Psychopathology in adults with autism and intellectual disability. Journal of Autism and Developmental Disorders, 36, 1123–1129. doi:10.1007/s10803-006-0149-3.

    Article  PubMed  Google Scholar 

  • Vause, T., Hoekstra, S., & Feldman, M. (2014). Evaluation of individual function-based cognitive-behavioural therapy for obsessive compulsive behaviour in children with autism spectrum disorder. Journal on Developmental Disabilities, 20(3), 30–41.

    Google Scholar 

  • Vause, T., Neil, N., Jaksic, H., Jackiewicz, G., & Feldman, M. (2015). Preliminary randomized trial of function-based cognitive-behavioral therapy to treat obsessive compulsive behavior in children with autism spectrum disorder. Focus on Autism and Other Developmental Disabilities 1-11. doi:10.1177/1088357615588517.

  • White, S. W., Ollendick, T., Scahill, L., Oswald, D., & Albano, A. M. (2009a). Preliminary efficacy of a cognitive-behavioral treatment program for anxious youth with autism spectrum disorders. Journal of Autism and Developmental Disorders, 39, 1652–1662. doi:10.1007/s10803-009-0801-9.

    Article  PubMed  Google Scholar 

  • White, S. W., Oswald, D., Ollendick, T., & Scahill, L. (2009b). Anxiety in children and adolescents with autism spectrum disorders. Clinical Psychology Review, 29, 216–229. doi:10.1016/j.cpr.2009.01.003.

    Article  PubMed  PubMed Central  Google Scholar 

  • White, S. W., Albano, A. M., Johnson, C. R., Kasari, C., Ollendick, T., Klin, A., et al. (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.

    Article  PubMed  PubMed Central  Google Scholar 

  • Wolters, L. H., de Haan, E., Hogendoorn, S. M., Boer, F., & Prins, P. J. (2016). Severe pediatric obsessive compulsive disorder and co-morbid autistic symptoms: Effectiveness of cognitive behavioral therapy. Journal of Obsessive-Compulsive and Related Disorders, 10, 69–77. doi:10.1016/j.jocrd.2016.06.002.

    Article  Google Scholar 

  • 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.

    Article  PubMed  PubMed Central  Google Scholar 

  • Wood, J. J., Ehrenreich-May, J., Alessandri, M., Fujii, C., Renno, P., Laugeson, E., et al. (2015). Cognitive behavioral therapy for early adolescents with autism spectrum disorders and clinical anxiety: A randomized, controlled trial. Behavior Therapy, 46, 7–19. doi:10.1016/j.beth.2014.01.002.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Leman Kaniturk Kose.

Ethics declarations

Funding

Preparation of this article was supported, in part, by funding from the National Institutes of Health. Treatment of Anxiety in Autism. 1R01HD080096-01A1.

Ethical Approval

This article does not contain any studies with human participants or animals performed by any of the authors.

Informed Consent

No informed consent was required for this article.

Conflict of Interest

All authors declare that they have no conflict of interest.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Kose, L.K., Fox, L. & Storch, E.A. Effectiveness of Cognitive Behavioral Therapy for Individuals with Autism Spectrum Disorders and Comorbid Obsessive-Compulsive Disorder: A Review of the Research. J Dev Phys Disabil 30, 69–87 (2018). https://doi.org/10.1007/s10882-017-9559-8

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10882-017-9559-8

Keywords

Navigation