Using Group Function-Based Cognitive Behavioural Therapy for Children with High Functioning Autism and Obsessive-Compulsive Behaviours

Background: Researchers have conceptualized repetitive behaviours in individuals with Autism Spectrum Disorder (ASD) on a continuum ranging from lower-level, motoric, repetitive behaviours to higher-order, obsessive-compulsive like, repetitive behaviours (Hollander, Wang, Braun, & Marsh, 2009). Although obsessional, ritualistic, and stereotyped behaviours are a core feature of ASD, individuals with ASD frequently experience obsessions and compulsions that meet the DSM-IV-TR criteria (American Psychiatric Association, 2000) of Obsessive-Compulsive Disorder. Given the acknowledged difficulty in differentiating between OCD and Autism-related Obsessive-Compulsive phenomena, the present study will use the term Obsessive Compulsive Behaviour (OCB) to represent both phenomena.

Objectives: This study examines the effectiveness of a function-based Group Function-Based Cognitive Behavioural Therapy (GCBT) program in reducing OCBs in children with High Functioning Autism using a single-case research design.

Methods:  A multiple probe design and a multiple baseline design across behaviours will be used to investigate if function-based GCBT decreases OCB in seven children (7-12 years of age) with High Functioning Autism.  Children met criteria for Obsessive Compulsive Disorder using the Anxiety Disorders Interview Schedule – Parent Version (ADIS-P) and the Children’s Yale Brown Obsessive Compulsive Scale (CY-BOCS). All participants scored ≥ 70 on measures of intellectual abilities. The function-based GCBT protocol (Vause, Neil, & Feldman, 2010, in progress) will consist of awareness/cognitive training, behavioural skills training, and graded exposure plus response prevention. The Questions about Behavioural Function (Matson & Vollmer, 1995) will be used to identify hypothesized functions of OCB, which will be addressed throughout treatment.

Results: Targeted OCBs include, but not limited to: cleaning rituals, checking, inflexible routines, hoarding, and repeatedly seeking reassurance. Data collection is ongoing and includes both video and voice recorded probes accompanied by daily caregiver ratings of OCBs. Groups are expected to be completed in the beginning of April 2011.

 Conclusions: Similar to pilot studies the function-based GCBT program is expected to reduce the severity of targeted OCBs. Strengths and weaknesses of the methodology and implications for future research will be discussed