Who Responds to Cognitive-Behavioral Group Treatment? Associations Between Anxiety Symptom Reduction and Autism Symptom Domains

Background: There is evidence that cognitive-behavioral therapy (CBT) is effective for reducing anxiety symptoms in some children with autism spectrum disorder (ASD) (Reaven et al., 2012; Storch et al., 2013). Delivery for these treatments differs by study; some are delivered individually, some in a group format. Approximately 50-93% benefit from CBT (regardless of modality), as defined by marked reductions in parent-reported anxiety symptoms (Storch et al., 2013. Little is known about who the best candidates for CBT are, especially when the treatment is delivered in a group context. Understanding the characteristics of treatment responders is helpful in determining who could benefit from group intervention.

Objectives: The goal of this study is to examine the associations between anxiety symptom reductions observed through participation in a multi-family group CBT intervention (Facing Your Fears; Reaven et al., 2011) and quantitative autistic traits as defined by domain scores on the Social Responsiveness Scale (SRS).  We hypothesize that there will be a negative correlation between the change in parent-reported child anxiety and severity of social awareness, social motivation, and social cognition; such that children with less social impairment will show greater reduction of anxiety symptoms after group treatment.   

Methods: This is a secondary analysis of data collected as part of a larger study examining the effects of a multi-family CBT intervention targeting anxiety in youth with ASD.  Inclusion criteria for these analyses were: data completeness, timeliness of data collection (i.e., within 3 months of starting treatment and within 4 months of completing), and attendance (i.e., 3 or fewer absences).  Fifty-seven youth, ages 8-18 (M = 12.49, SD = 2.74), with confirmed ASD and their parents met eligibility criteria for this study. Parents completed the Social Responsiveness Scale (SRS) and the Screen for Child Anxiety Related Emotional Disorders (SCARED; Birmaher et al., 1999) before treatment, and then completed the SCARED again at post-treatment.

Results: A lack of normality in the distribution of the sample was observed, thus Spearman’s rho was used to examine correlations. Preliminary results indicate a significant positive correlation between impairment in social motivation and anxiety symptom reduction (r_s = .36, p = .007); suggesting that strengths in social motivation are not required for group CBT to be effective. Results also indicate a trend towards significance for positive correlations between anxiety symptom reduction and impairments in social cognition (r_s = .23), as well as autistic mannerisms (r_s = .29), and the overall total autistic social impairment (r_s = .27). No significant correlations were found between anxiety symptom reduction and impairments in social awareness or social communication.

Conclusions: The results of this study suggest that social impairment does not preclude readiness for a structured, group treatment for youth with ASD. Contrary to our hypotheses,  even if a parent reports that his/her child is not socially motivated, group treatment may be beneficial. Further implications, limitations, and future directions will be discussed.