There is a marked discrepancy between access to specialised mental health services for people with Autism Spectrum Disorders (ASD) and reports of high rates of anxiety disorders in this group. Among anxiety disorders, obsessive compulsive disorder (OCD) in people with ASD represents a particular clinical and diagnostic challenge. Cognitive-behavioural techniques (CBT), used either alone or in combination with medication, are generally recognized as among the most successful methods for treating anxiety disorders and OCD in the general population.
Objectives:
The present study addresses ways to improve access to mental health services for individuals with ASD and OCD by enhancing the competence of professionals in secondary services. The study explores the outcome of individually focused CBT for children and young adults with OCD and ASD referred to ordinary clinical services. The aims were to educate and support therapists in conducting CBT with these individuals; to explore necessary adjustments to therapeutic techniques; to determine the optimal number of intervention sessions needed, and to identify standardized assessment instruments appropriate for evaluating treatment effectiveness.
Methods:
Five patients were given CBT modified to meet their ASD over a minimum of 12 sessions. The therapists were educated in ASD, CBT generally, and were given monthly group supervision on modifying CBT for people with ASD. A standardised assessment strategy was employed before the treatment including IQ assessment, the Social Communication Questionnaire (SCQ) and Vineland Adaptive Behaviour Scales. Pre- Post treatment measures were Children’s Yale– Brown Obsessive Compulsive Scale / Yale-Brown Obsessive-Compulsive Scale, The Aberrant Behaviour Checklist (ABC), and Goal Attainment Scaling (GAS).
Results:
Twelve to 20 sessions of CBT were associated with some improvement in all patients. Most patients needed more than the initially planned 12 sessions, and some adjustments in the therapeutic techniques were made for all patients. All the assessment instruments used to monitor behaviours during treatment showed decreased symptom severity and improved outcome post-treatment for all patients.
Conclusions:
With training and monthly education and supervision sessions, professionals in secondary services are able successfully to provide CBT modified to the needs of people with ASD. The study also shows that standardised assessment instruments can be used to evaluate treatment outcome in these individuals. CBT is a promising treatment option for people with ASD and OCD but they may need more sessions than other client groups. More research is indicated in this field, as is better professional training, better liaison between specialists, and development of more specialised interest and tertiary services.