Evaluation of Multidisciplinary, Multi-Tiered Approach to Anxiety Treatment in Youth with Autism Spectrum Disorder
Anxiety is a commonly seen comorbidity in children and adolescents with autism spectrum disorder (ASD). It is estimated that 40% of individuals with ASD meet criteria for an anxiety disorder with some studies reporting up to 80% comorbidity, which is higher than other clinical populations (van Steesel, 2011; Selles & Storch, 2012). Cognitive behavioral therapy has previously been adapted for ASD and mild to moderate anxiety symptoms with promising results (e.g. exposure and response-prevention; Ooi et al, 2008; Wood et al, 2008; Sukhodolsky et al, 2013; Shaker-Naeeni et al., 2014), yet little is known about treatment delivery and efficacy with clients who present with severe anxiety symptoms in the context of autism. Seattle Children’s Hospital Autism Center (SCAC) developed an Anxiety Program consisting of multidisciplinary care and coordination for children and adolescents with ASD and co-occurring anxiety disorders. The Anxiety Program provides a multi-tiered model of service, incorporating time-limited individual CBT, medication management, and group therapy. This multi-tier service model significantly improved access to care for patients seeking treatment. Additionally, a clinical outcome monitoring system has been implemented to evaluate client progress and program efficacy.
Describe and evaluate the efficacy of a multidisciplinary team approach and multi-tiered model of service for youth with acute anxiety symptoms in the context of autism.
A total number of 51 clients were seen by the program receiving an average of 18 individual therapy sessions (SD=8.77). A total number of 46 patients (Mage=12.1, SDage=2.64) were included in this preliminary analysis. Thirty-nine percentof patients (N=18) received medication management, and 32% of patients (N=15) participated in at least one round of group therapy. Pre-treatment Clinical Global Impression Severity Scale (CGIS; Guy, 1976) and Multidimensional Anxiety Scale for Children – 2nd Edition Parent Report (MASC2-P; March, 2013) were collected to determine the severity of symptoms. The Clinical Global Impression Improvement Scale (CGI-I; Guy, 1976) were measured for post-treatment clinical improvement. Pre- and post-scores of Children’s Yale-Brown Obsessive Compulsive Scale (CY-BOCS; Scahill et al., 1997) were analyzed.
The clinical sample reflects highly acute anxiety symptoms and significant impact on functioning at the start of treatment as indicated by the CGI-S score (M=5.19) in the Markedly to Severely Ill range. An average MASC2-P Total Anxiety T score of 72.1 (N=16; SD=12.06) was in the Very Elevated range. The average post-treatment CGI-I is 2.59, indicating good improvement of symptoms (minimal to moderate improvement), with 36% clients receiving a rating of 1 or 2 (much improved or very much improved). Paired-sample t test indicated a significant lower post-treatment CYBOCS score than the pre-treatment score (t(4)=4.98, p=.008).
A focused multidisciplinary team approach to treating severe anxiety symptoms among youth with ASD, and a multi-tiered service delivery model appears to reduce symptoms of anxiety as well as improve overall functioning. Additionally, the approach of SCAC’s Anxiety Program improves access to care, careful treatment monitoring, and provider satisfaction.