Acceptability of Cognitive-Behavioral Therapy for Teens with Autism Spectrum Disorders

Background: Cognitive-behavioral therapy (CBT) is the primary, non-medical treatment of choice for mood and anxiety disorders of childhood. As identification rates of autism spectrum disorders (ASD) have risen, so has interest in adapting CBT to treat this population (Attwood, 1994). Although the efficacy of CBT modified for youth with ASD is promising, to the authors' knowledge, no previous research has examined teenagers' satisfaction with the treatment (Reaven & Hepburn, 2003). Objectives: The primary purpose of the present study was to evaluate teenagers' satisfaction with a manual-based CBT program. Additionally, we explored self-report measures of change. Methods: Four adolescents (12-14 years; 2 boys) with confirmed ASD and anxiety disorder diagnoses received the treatment, which addressed anxiety and social skills deficits. Teenagers had high intellectual capacity (IQ: 105-135). Following each individual therapy session and at treatment completion, the teenagers and their parents completed blinded measures of satisfaction with the treatment. Youth completed self-report measures of anxiety, loneliness, and depression. Results: The data indicate that the youth found the sessions helpful (range: 5.82-8.83, on 1-10 scale) and overall program satisfaction was quite high (range: 7-10). Individual, followed by group, therapy were the components rated as most helpful. Parents also rated the sessions as helpful (6.18-9.91) with program satisfaction equally high (8-10). Individual therapy, followed by between-session assignments, were rated as the most useful components by parents. On self-report measures of change, there was considerable variability. Despite confirmed anxiety disorders at the beginning of treatment and independent clinician-rated change following treatment, teens reported little difficulty with anxiety and minimal change following treatment on the MASC (March, 1999) self report measure of anxiety. Only two teens reported clinically significant change (RCI = 5.67, 2.72). Two teens showed elevated scores on the depression measure at baseline. Change in depression, and social and emotional loneliness was variable and generally nonsignificant. Conclusions: Overall, both youth and parents found treatment helpful and acceptable, although they differed in what components they found most helpful. Results of this pilot study have potentially important implications for outcome measurement in treatment studies of ASD. Despite clinically confirmed anxiety disorders and parent-reported change with anxiety, the youth reported minimal problems with anxiety and inconsistent change. Furthermore, there was variability in both the report and change of depression and loneliness. In summary, the teenagers found the CBT program to be helpful, but there are implications for reliance on self-report measures of change. High-functioning youth with ASD may have difficulty recognizing or reliably reporting their symptoms of anxiety, depression, or loneliness. It is recommended that self-report measures for screening, diagnosis, and change be supplemented with clinician, teacher and parent ratings. References Attwood, T. (2004). Cognitive behaviour therapy for children and adults with asperger's syndrome. Behaviour Change, 21, 147-161. March, J.S. (1999). Multidimensional Anxiety Scale for Children manual. North Tonawanda, NY: Multi-Health Systems. Reaven, J. & Hepburn, S. (2003). Cognitive-behavioral treatment of obsessive-compulsive disorder in a child with Asperger syndrome: A case report. Autism, 7, 145-164.