Examining the Impact of Cognitive Behavioral Group Therapy on Quality of Life In Adolescents with High Functioning Autism Spectrum Disorders

Background: Adolescents with autism spectrum disorders (ASD) are at increased risk for anxiety (Farrugia & Hudson, 2006; White et al., 2010). High levels of anxiety often result in avoidance and withdrawal, potentially exacerbating the core deficits of ASD and impacting quality of life. The purpose of the present study was to determine if a family-focused cognitive behavioral group treatment (Facing Your Fears (FYF), Adolescent Version, Reaven et al., 2009) designed to reduce symptoms of anxiety would also result in changes in adolescent quality of life. Quality of life is a critical variable to explore given that it may be a more socially valid and functional way of understanding outcome than anxiety reduction alone.  It is hypothesized that improvements in quality of life will correspond with reductions in anxiety.   

Objectives: To determine if there are significant changes  in adolescent quality of life following the 14 week FYF  intervention

Methods: Twenty four adolescents ages 13-18 participated in the FYF program and: (a) met criteria for an ASD, as confirmed by the ADOS (Lord, et. Al, 2002); (b) had a Verbal IQ of 70 or above; and (c) exhibited clinically significant symptoms of anxiety, as measured by Anxiety Disorders Inventory Schedule for Children, Parent Version (ADIS-P; Silverman & Albano, 1996). Parents and adolescents were also administered the Quality of Student Life Questionnaire (QSLQ; Keith & Schalock, 2003). Parent ratings were based on their perception of their teen’s quality of life.     The QSLQ contains four subscales (Satisfaction, Well Being, Social Belonging, and Empowerment/Control).  Both the ADIS-P and the QSLQ were administered pre/post intervention. 

Results: Overall, results from the ADIS-P indicated that the majority of adolescents were “much improved” post treatment (see Reaven et al.,IMFAR abstract submission, 2011).  Furthermore, parents’ ratings yielded significant improvements on Satisfaction (t= -2.702; p = .013), Well Being (t = -2.528, p = .02), and Social Belonging:  (t = -2.977; p = .007).  However, there were no significant differences in adolescent ratings on the QSLQ subscales post-treatment.  The relationship between quality of life and symptom improvement is important to consider and will also be presented (analyses ongoing). 

Conclusions: Parent report indicates significant reductions in anxiety and significant improvement in quality of life post treatment.  On the other hand, adolescents’ report does not indicate change in quality of life. It is not surprising that there is disagreement between parents and adolescents, given the difficulty individuals with ASD have in introspection and emotion identification (Baron-Cohen et al., 1985).  While it is unclear what underlies the change in quality of life scores reported by parents (i.e., anxiety symptom reduction, group membership, etc.), it is believed that as anxiety lessens, opportunities increase for adolescent engagement in the world, thus improving quality of life. However, further study is needed to explore potential mechanisms for change in addition to socially valid outcomes of intervention.  Study limitations include the lack of a comparison group and small sample size.