A Family Focused Group Cognitive Behavior Therapy for Adolescents with High-Functioning Autism Spectrum Disorders and Anxiety: A Pilot Study

Background: Anxiety disorders are among the most common mental health conditions in childhood.  Children and adolescents with high-functioning autism spectrum disorders (ASD) are at high risk for developing clinically significant anxiety symptoms (Brereton et al. 2006; White et al. 2009).  Cognitive behavior therapy (CBT) has been identified as the treatment of choice in addressing anxiety symptoms in the general population, and an emerging body of literature indicates that modified CBT for youth with ASD can be effective in reducing anxiety symptoms (Reaven et al. 2009; Wood et al., 2009).  However, very few treatment studies published to date have specifically targeted adolescents with ASD.  Thus, the feasibility, acceptability and potential efficacy of modified, family-focused, group CBT approaches with teens needs to be empirically examined.

 Objectives: (1) To expand the Facing Your Fears (FYF) program (Reaven et al., in press), a group CBT program for school-aged children with ASD and anxiety  to adolescents with ASD (ages 13-18) and co-occurring anxiety disorders,  and (2) to assess the feasibility and acceptability of the intervention for this age group, and (3) to conduct a pilot treatment study,  using an A-B design to examine the potential impact of the FYF intervention on the severity of anxiety symptoms. 

Methods: Twenty-four teens, ages 13-18 (and their parents) participated in the study and met strict diagnostic criteria for Autism or Asperger Syndrome and were reported by their parents and/or by self-report to be presenting with clinically significant anxiety symptoms.    After completing the pre-treatment assessment battery, which included the Screening for Childhood Anxiety and Related Disorders (SCARED, Birmaher et al. 1999), the Anxiety Disorders Interview Schedule – Parent  versions (ADIS-P; Silverman & Albano, 1996), and the Developmental Behavior Checklist (DBC;  Einfeld & Tonge, 1994), teens and their parents participated in the 14 week group treatment.  The adolescent version of FYF is different from the child version in that it includes a social skills module, emphasizes teen group cohesion, and uses technology (i.e. PDA/iPod Touch) to record anxiety symptoms and document exposure practice

Results: Teen participants presented with multiple psychiatric diagnoses in addition to ASD (range = 2-11).  Participation in the group sessions exceeded 90% and attrition was very low.   Parent and youth acceptability data will be also be presented.  Preliminary findings on pre-post treatment analyses revealed significant reductions in anxiety symptoms as reported by the parents (t=2.875, p = .009) and youth (t=3.896, p=.001) on the SCARED.  Based on the Clinical Global Impressions Scale – Improvement (CGIS-I) derived from the ADIS-P, mean ratings of improvement were 2.80 (much improved).   In addition, paired t-tests revealed significant reductions after treatment in Total Problem Behavior Scores from the DBC (t=4.818, p=.0001). 
Conclusions: Implementation of the FYF treatment package with psychiatrically complex teens with ASD was found to be feasible and potentially therapeutic.  Pilot results suggest possible decreases in anxiety severity and problem behaviors; however, the A-B design limits the interpretability of the findings.   Our next step is to conduct a randomized controlled trial of the intervention.