Adolescents with autism spectrum disorders (ASD) face the same developmental challenges as their peers, but their lives are complicated by the core deficits of ASD, as well as increased risk for anxiety (Farrugia & Hudson, 2006). To date, there are no published psychosocial studies that target anxiety reduction in adolescents with ASD (White et. al, 2009). There is a critical need for anxiety specific interventions for this age group as they are on the cusp of living independently, attending institutions of higher learning, and/or entering the working world (Broadstock et al., 2007), and clinical anxiety symptoms can interfere with independent functioning in these areas. The purpose of the current study was to extend a manualized family-focused CBT group treatment designed for children with ASD and anxiety (Reaven et al., 2009) to adolescents, incorporating the use of technology (i.e., a Personal Digital Assistant; PDA). Given the complexity of adolescents with ASD, the addition of technology may potentially be an innovative way to enhance the portability of CBT techniques to everyday life.
Objectives:
Methods: Twelve adolescents participated in the 14 week intervention and: (a) met criteria for an ASD, as confirmed by the ADOS (Lord, et. Al, 2002); (b) had a Verbal IQ of 80 or above; and (c) exhibited clinically significant symptoms of anxiety, as measured by Anxiety Disorders Inventory Schedule for Children, Parent Report (ADIS-P; Silverman & Albano, 1996). Each adolescent received a PDA and was coached in its use throughout the intervention.
Results:
Results from the ADIS-P indicated that pre-treatment, 11 of the 12 participants met diagnostic criteria for 2-6 psychiatric diagnoses (mode=4); post-treatment, 11 of the 12 participants met criteria for 1-4 psychiatric diagnoses (mode=3). Post-treatment ratings on the Clinical Global Impressions Scale for the participants’ primary anxiety diagnoses indicated that 2 of the 12 participants were “very much improved”, 3 were “much improved,” 4 were “minimally improved,” and 3 were “no change.” All adolescents engaged in self-monitoring of anxiety symptoms and graded exposure documentation via their PDAs.
Conclusions:
Results of the pilot study indicated that 75% of the adolescents who participated in the group CBT intervention displayed reductions in anxiety symptoms. These results represent a preliminary, but important step in the development of efficacious CBT interventions for high school students with ASD. In addition, while all adolescents used their PDAs for self-monitoring and to record their exposure practice, variability was noted in their use. Benefits and challenges related to the use of the PDA will be discussed and the relationship between PDA compliance and anxiety symptom reduction will be explored. Study limitations include the lack of a comparison group and the small sample size.