Journal of Autism and Developmental Disorders

Two-Step Family Cognitive Behavior Therapy May Benefit Some Autism Spectrum Disorder (ASD) Children with Anxiety

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.

Aggressive Behavior by Youth with Autism Spectrum Disorder (ASD) Is Influenced by the Environment

To what extent is the aggressive behavior of youth with Autism Spectrum Disorder (ASD) moderated (or aggravated) by attributes of their environment? Brown and colleagues tried to answer this question based on caregiver reports for 511 ASD youth. Overall, their data indicated that demographic and environmental factors accounted for up to 40% of the variance in children’s aggressive behavior. The main factors influencing reported aggressive behavior were:

Family income
The child’s age and social communication skills
Parental distress arising from having to deal with a difficult child

Besides these factors, the researchers also found a slight effect of family warmth as measured by the Family Environment Scale and Caregiver-Child Dyad Satisfaction, but this factor barely accounted for an additional one percent of the observed total variance.

High Functioning Individuals with Autistic Spectrum Disorder (ASD) Are Less Able to Process Their Emotions

Hill and colleagues compared 27 high functioning adults with Autism Spectrum Disorder (ASD) to 35 neurotypical controls and 49 biological relatives. They found that ASD individuals were less able to process their emotions and, perhaps for that reason, more depressed than both the controls and the relatives. Their findings join others in showing that, even for high functioning individuals, ASD is associated with poorer emotion regulation and higher negative affect.

Higher Functioning in Autism Spectrum Disorder (ASD) is Associated with Improved Emotion Regulation

While individuals with Autism Spectrum Disorder (ASD) generally may be less able to regulate their emotions and handle frustration than neurotypical individuals, we might reasonably expect higher functioning individuals with ASD to be better able to control their emotions than those who are lower functioning. In this article, Konstantareas and Stewart report data supporting this expectation, but they also found that higher functioning individuals experienced higher negative affectivity including more negative emotions such as anger or sadness and potentially lower self-esteem.