Treating Anxiety Disorders in Adolescents with High Functioning Autism: The Case of John

Background: Adolescents with high functioning autism (HFA) are at heightened risk for anxiety disorders (Bellini, 2004), which can interfere with adaptive functioning in academic, family, and social settings. Literature suggests that excessive anxiety is associated with adolescents’ increased negative thoughts, behavioral problems, and adaptive functioning (Farrugia & Hudson, 2006). Given the pervasive nature of HFA, the additional negative impact of anxiety disorders may make worse the difficulties experienced by these adolescents. While emergent literature involving randomized, controlled trials provides empirical support for cognitive behavioral treatment of anxiety disorders in children with HFA (Chalfant et al., 2007; Wood et al., in press), adolescents with HFA have been largely ignored in the treatment literature despite their clinical need.

Objectives: Accordingly, this presentation provides a brief history of the Family Cognitive Behavioral Therapy (FCBT) manual, Building Confidence (Wood et al., 2007). Moreover, research-based modifications and enhancements to the treatment manual, including their scientific rationale, will be examined. The presentation will conclude with a case study involving John, a 13-year-old male with HFA and comorbid generalized anxiety disorder (GAD), for which the GAD caused significant distress and disruption in his and his family’s life and interfered with John's academic performance and daily living skills.

Methods: A comprehensive assessment battery was administered at pretreatment, posttreatment, and 1-year posttreatment by a diagnostician unaware whether John received treatment. The assessment battery included the Anxiety Disorders Interview Scale for DSM-IV: Parent and Child versions (Silverman & Albano, 1996), a semi-structured interview yielding reliable diagnoses of anxiety disorders. In addition, John’s mother completed several paper-and-pencil measures, including the parent version of the Multidimensional Anxiety Scale for Children (March, 1998), a 39-item measure of anxiety with robust reliability and validity (Wood et al., 2002), the Child Anxiety Interference Scale (Langley et al., 2004), a 34-item scale assessing children’s functional impairment in school, social, and home situations due to anxiety, and the Social Skills Rating System (Gresham & Elliott, 1990), consisting of 55 items assessing social skills and competing problem behaviors.

Results: After 16 weeks of the modified FCBT, involving both John and his mother, symptoms of GAD were ameliorated and the clinical severity of the GAD was reduced to a nonclinical level. Further, significant improvements in his adaptive functioning, such as daily living and social skills, academic performance, and family cohesion, were reported at posttreatment and gains were maintained over a 1-year period. Feasibility and fidelity to treatment strategies were found to be quite good.

Conclusions: Despite developmental shifts from childhood to adolescence, which may impact the feasibility and fidelity of family cognitive behavioral therapy, modified and enhanced FCBT may be an appropriate treatment for adolescents with HFA and comorbid anxiety disorders, leading to improved overall adaptive functioning.