Cognitive behavior therapies are generally effective for treating anxiety, but modifications may be needed when anxiety is accompanied by Autism Spectrum Disorder (ASD). Storch and associates evaluated the effectiveness of a two-step approach to family-based cognitive behavior therapy for anxiety with ASD children up to 14 years of age. The first step was parent-led with therapist assistance. The second step was therapist-led for children who had not shown improvement in step 1 (non-responders). These non-responders generally had higher levels of pre-treatment anxiety than those who had improved.
All children were evaluated again 12 weeks following step 1. At this point, the authors reported no difference between those that had improved in step 1 and those that had continued into step 2. A major weakness of this study however was a high attrition rate: of the 76 children who started in step 1, only 45 completed their entire treatment program. The authors noted that this attrition rate is higher than that observed with more standard forms of Cognitive Behavior Therapy, and noted that some of the attrition may have been due to the COVID-19 pandemic.
Abstract
This trial examined stepped-care cognitive-behavioral treatment (CBT) among 96 autistic youth with co-occurring anxiety. Step 1 included an open trial of parent-led, therapist-guided bibliotherapy. Step 2 was family-based CBT for those who did not respond to Step 1 or maintenance for those who did. Eighteen participants (28%) who completed Step 1 responded. Responders reported significantly lower pre-treatment anxiety, internalizing symptoms, and functional impairment than non-responders. After Steps 1 and 2, 80% of completers (55% intent-to-treat) were responders. Anxiety, impairment, and ASD-related impairments significantly improved. Youth in maintenance experienced faster improvement through post-treatment, though there were no group differences at 3-month-follow-up. A stepped approach may help some individuals in Step 1, particularly those who are less anxious.
Citation
Storch, E. A., Schneider, S. C., Olsen, S. M., Ramirez, A. C., Berry, L. N., Goin-Kochel, R. P., McNeel, M., Candelari, A. E., Guzick, A. G., Cepeda, S. L., Weinzimmer, S., Voigt, R. G., Quast, T., Goodman, W. K., & Salloum, A. (2024). Stepped-care cognitive behavioral therapy in children on the autism spectrum with co-occurring anxiety. Journal of Autism and Developmental Disorders, 54(1), 93–108.
Dr Martin Fracker 