Standard Cognitive Behavior Therapy (CBT) focuses on teaching patients to recognize self-defeating ways of thinking and replace them with more constructive thoughts. Hollocks and colleagues knew that CBT treatments for Autism Spectrum Disorder (ASD) patients with anxiety were most effective when tailored to the specific needs of ASD patients. They hypothesized that patient decision-making ability and sensitivity to reward contingencies might underlie the superiority of specially tailored CBT treatments. Accordingly, they assessed the decision-making ability and reward sensitivity of 148 children with ASD who were randomly assigned to standard CBT or tailored CBT treatments. Their results suggested that ASD patient decision-making ability and reward sensitivity accounted for the superiority of tailored CBT.
Abstract
Objective
Cognitive–behavioral therapy (CBT) is an effective treatment for anxiety in youth with autism spectrum disorder (ASD). However, research has yet to examine what cognitive characteristics may influence treatment response. The current study investigated decision-making ability and social cognition as potential (a) predictors of differential treatment response to two versions of CBT and (b) moderators of the effect of treatment condition.
Method
The study included 148 children (mean age = 9.8 years) with interfering anxiety and a diagnosis of ASD who were enrolled in a randomized clinical trial comparing two versions of CBT for anxiety (standard and adapted for ASD). Participants completed pretreatment measures of decision-making ability (adapted Iowa Gambling Task) and social cognition (Strange Stories) and analyses tested whether task performance predicted treatment response across and between (moderation) treatment conditions.
Results
Our findings indicate that decision-making ability moderated treatment outcomes in youth with ASD and anxiety, with a better decision-making performance being associated with higher post-treatment anxiety scores for those who received standard, not adapted, CBT.
Conclusions
Children with ASD and anxiety who are more sensitive to reward contingencies and reinforcement may benefit more from adapted CBT approaches that work more explicitly with reward.
Citation
Hollocks, M. J., Wood, J. J., Storch, E. A., Cho, A.-C., Kerns, C. M., & Kendall, P. C. (2023). Reward sensitivity predicts the response to cognitive behavioral therapy for children with autism and anxiety. Journal of Clinical Child and Adolescent Psychology, 52(6), 811–818.
Dr Martin Fracker 