Can CBT Improve Core Deficits Among Adolescents and Young Adults with Anxiety Disorders and ASD?

Background:

Anxiety-related concerns are common among high-functioning youth with an autism spectrum disorder (ASD); some studies suggest a comorbidity rate as high as 42 to 84 %. Given the potential distress experienced by adolescents with these comorbid conditions, it may be beneficial to examine treatments targeting anxiety symptoms and their utility in treating individuals with ASD. Research has established the preliminary efficacy of cognitive-behavioral treatments (CBT) for concurrent anxiety and ASD in younger children; but adolescents and young adults, who have a higher rate of anxiety disorders, have been under represented or ignored in this research thus far. Additionally, it is unclear to what degree CBT treatments may improve core deficits associated with ASD.

Objectives:  

The present multiple-baseline design study explored the feasibility of a modified version of an evidence-based, cognitive behavioral treatment (BIACA; Wood & Drahota, 2006), adapted for adolescents and young adults with anxiety disorders and ASD.  It was expected that there would be some reductions in autism related symptoms as measured by the SRS (Constantino & Gruber, 2005) and current symptoms on the SCQ (Rutter et al., 2003), though not as substantial as anxiety-related improvements. The SRS is quantitative and measures autistic traits in 4-18 year-olds. Questions focus on behaviors occurring over the past six months. The SCQ is a parent measure focusing on autism-like behaviors at the age of 4-5 and currently.

Methods:

The 16-session treatment protocol utilized in this investigation includes source material from BIACA, the Unified Protocol for the Treatment of Emotional Disorders in Youth (UP-Y; Ehrenreich et al., 2008) and the Program for the Education and Enrichment of Relational Skills (PEERS; Laugeson & Frankel, 2006) manuals. After an initial diagnostic interview, and before beginning treatment, six adolescents and young adults (aged 14-21) were assigned to one of three baselines (i.e., 4-, 8-, or 12-week). The SRS and SCQ were completed at pre-baseline, post-baseline, post-treatment, and one month follow-up, along with a battery of anxiety related questionnaires.

Results:  

Prior presentations have detailed positive changes in anxiety symptoms and social responsiveness following treatment for these participants (Rowley et al., 2010; Simpson et al., 2010). For the present study, SCQ total scores were observed to decrease from pre-baseline levels to post-treatment for five of the six participants using visual inspection techniques. SRS total scores decreased from intake to post-treatment for three of the six participants and maintained for one. At the time of presentation, reliable change index (RCI) scores for SRS and SCQ scores will also be discussed.

Conclusions:  

Initial findings suggest CBT treatments for anxiety in adolescents and young adults with ASD may also improve core deficits associated with this comorbidity among some participants. Limitations of these results, including potential response biases among parents of participants and difficulty discriminating between improvements in anxiety versus ASD will also be detailed.